1. 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

2. 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

3. 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

4. Example Case #1

5. Example Case #1

6. Example Case #2

7. Example Case #2

8. Results

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

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

11. Toward Rational Recommending
Evidence-based standards
Feedback to individual radiologists

12. 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.