Yield and Compliance of Radiologist-Recommended Chest CT Tarik K. Alkasab, MD, PhD Matthew S. Cushing, MD Matthew D. Gilman, MD Jeannette Ryan Alkasab, SB Jo‑Anne O. Shepard, MD Mitchell A. Harris, PhD Hani H. Abujudeh, MD, MBA

Radiologist Recommendations Radiologists recommended follow-up imaging for 10% of cases Concern for role in increasing health care costs Challenge: Measure the value of these recommendations

Chest CT Recommendations Examined reports for chest radiographs (CXRs) for recommendations for follow-up chest CT All outpatient CXRs from a six-week period in early 2008 Definite recommendations for chest CT to evaluate an ambiguous radiographic finding Excluded patients with chest CT in the past 5 years For each recommendation, find the recommended CT Where recommended exam found, correlate CXR findings with CT findings No corresponding finding Incidental corresponding finding Significant corresponding finding

Example Case #1

Example Case #1

Example Case #2

Example Case #2

Results

Non-obtained Exams Why not? Not clinically indicated Obtained outside our system Patient lost to follow-up Recommendation missed

Recommendation Value Significant finding: treat appropriately Incidental finding: confident in no further workup No corresponding finding: potentially still valuable

Toward Rational Recommending Evidence-based standards Feedback to individual radiologists

Acknowledgements Steven Graham Thomas Schultz Michael Zalis, MD Keith Dreyer, DO, PhD Daniel Rosenthal, MD James Thrall, MD Supported by a Resident Research Grant from the RSNA Research and Education Foundation.