Study finds imaging appropriateness criteria should be modified, expanded

A review of appropriateness criteria of outpatient abdominal and pelvic CT and MRI exams published in Academic Radiology has found that of the exams matched with American College of Radiology appropriateness criteria, a high percentage were appropriate and more likely to lead to significant results than inappropriate studies.

At the same time, more than half of the exams had no relevant clinical condition, the authors found, suggesting there are areas in which appropriateness criteria can be expanded and modified.

In their study, the authors, led by Andrew Rosenkrantz, M.D., of the department of radiology at New York University Langone Medical Center, reviewed a total of 570 imaging studies (304 abdominopelvic CT exams and 266 MRI studies) performed over one month.

They found that 45 percent of all exams (52 percent of CTs and 38 percent of MRIs) matched an appropriateness criteria variant. Ninety-two percent of the exams matching the appropriateness criteria were appropriate, including 96 percent of CTs and 86 percent of MRIs. The most common indications not matching an appropriateness criteria were colon cancer follow-up and melanoma follow up for CT exams, and hepatocellular carcinoma screening and elevated PSA without prior biopsy for MRI.

In addition, appropriate exams were more likely than those studies that were inappropriate to have significant results (48 percent compared to 24 percent).  According to the authors, the alternative approaches that could have been used instead of the inappropriate exams were imaging exams like ultrasound, or even no imaging at all, approaches consistent with the ACR guidelines' aim of avoiding costs or unnecessary radiation exposure associated with excessive imaging.

Using an appropriate use criteria decision support tool can eliminate inappropriate imaging examinations to evaluate coronary artery disease, according to a research published in June 2013 in the Journal of the American College of Cardiology.

To learn more:
- see the study in Academic Radiology