William R. Hendee, Medical College of Wisconsin, makes some very valid points in a recent article about overuse of CT scans and the harmful effects unnecessary exams have on both patients and the healthcare industry. Specifically, he says that radiologists can “play a big role in educating ordering physicians about what scans are appropriate and when.”
A big part of the training and experience-based learning of radiologists is what imaging tests are appropriate for specific healthcare problems and what imaging tests are inappropriate. Inappropriate means the imaging test has little chance of adding significant value to the diagnosis and therapy of the patient, especially relative to its cost.
The American College of Radiology (ACR) has spent more than a decade developing imaging appropriateness guidelines for hundreds of clinical problems and indications. These ACR appropriateness guidelines are based on the best available scientific evidence and were written by panels of best sub-specialized experts. The guidelines each get revised every three to five years as new evidence becomes available. There is no better source available for appropriateness of diagnostic imaging.
The decision support computer programs mentioned in the article start with the ACR appropriateness guidelines and create a quick way for referring physicians to know if any imaging test they order is appropriate. At the point of computerized imaging exam order entry into an electronic system, the decision support examines the entered indications for an imaging exam and then either agrees with doing the exam, or cautions that the exam may be only marginally indicated – or states that by generally accepted criteria the requested exam is unindicated. There is education involved, as the evidence-based reasons an exam is unindicated are provided to the ordering physician, along with suggestions for a better approach to the patient’s problem (often involving some other type of imaging). These decision support programs are now running in several healthcare enterprises, and they hold good hope for decreasing inappropriate complex imaging exam utilization without blocking access to appropriate tests.