What's In The News
Radiologists’ Expertise Cuts Inappropriate Imaging
A radiology benefits management program in which radiologists used evidence-based guidelines to evaluate the appropriateness of requests when discussing cases with referring clinicians, reduced inappropriate imaging by 20%. View the report
Referring Clinicians Do Not Circumvent Clinical Decision Support
Providing evidence-based clinical decision support (CDS) to referring clinicians when they request diagnostic imaging reduces the number of low-utility examinations and limits the growth of imaging. Whilst there is a risk that clinicians may circumvent CDS by referring their patients to a provider that doesn’t use it, a study shows that very few examinations that were flagged as low value and cancelled, were subsequently performed elsewhere. View the report
Wasted: ABC Four Corners Investigation Of Medicare Waste
A report aired on 28 September 2015 explored the proposition that many "scans, tests and procedures ordered by medical practitioners are wasteful, unnecessary and potentially harmful." Hundreds of millions of dollars are wasted "sending people off for unnecessary tests and exposing them to unnecessary radiation." Unnecessary imaging of uncomplicated low back pain was discussed as an example. View the transcript
Diagnostic Imaging Pathways provides evidence-based recommendations for tests in a wide range of conditions including low back pain. View the recommendations Providing imaging examinations according to the recommendations will significantly reduce waste and unnecessary exposure to radiation.
DIP Smartphone App In The Spotlight
The DIP smartphone app is highlighted as a notable app in radiology by the internationally recognised radiology website AuntMinnie in its 'Mobile App Spotlight' feature. View the report
Reducing Inappropriate Imaging With Clinical Decision Support Software
It has been reported that providing decision support for clinicians when they are electronically requesting a medical imaging examination results in savings and yields a range of other benefits including: View the report
- Provides iterative education
- Reduces patient exposure to unnecessary radiation
- Documents the appropriateness of care
- Drives quality up and costs down
- Reduces rescheduling of scans
- Improves patient flow and clinical efficiencies
- Supports the clinician-patient relationship
- Promotes consultation between radiologists and requesting clinicians
As reported in April 2015 (see below) the suite of accredited and endorsed Diagnostic Imaging Pathways provides a suitable foundation for electronic clinical decision support for diagnostic imaging requests. Recommendations presented as flow charts are not only based on the best available evidence and broad clinical consensus, but alternative recommendations are also provided depending on the clinical picture. Access the menu and review the pathway diagrams
Decision Support For Imaging Requests Reduces Patient Exposure To Unwarranted Ionising Radiation
It is reported that implementation of an evidence-based decision support tool for inpatients with suspected pulmonary embolism (PE) resulted in a 12 per cent decrease in the use of CT Pulmonary Angiogram (CTPA) without a significant decrease in yield. View the report
If evidence-based guidance on the investigation of PE is followed, patients won’t be exposed to unwarranted ionising radiation. View the pathway
Decision Support For Radiologists?
While decision support tools have been promoted for referring clinicians as a means to reduce high rates of inappropriate diagnostic imaging, they have been found to be useful also for providers of imaging services. Radiologists who had access to a decision support tool while reporting on medical images tended to order more appropriate follow-up examinations. View the report
Inappropriate Imaging – Need For Decision Support
It is reported that inappropriate imaging is commonplace, and it adds no value to health services, only costs. Since it is a struggle to keep abreast of developments in diagnostic imaging, it is argued that appropriateness guidelines are needed and they will be best implemented by embedding them into electronic requesting applications. View the report
App For iPhonesUpdate: The DIP App is no longer available
The freely available app for iPhones that is based on DIP has been downloaded around 400 times since it was released early in May.
A short demonstration video of the app is available. View the video
Improving Appropriate Diagnostic Imaging
It is recognised that more appropriate use of diagnostic imaging may improve quality and reduce costs of health services. A systematic review and meta-analysis of interventions that used computerised clinical decision-support to improve appropriate diagnostic imaging is reported. It is concluded that “Computerised clinical decision support integrated with the electronic medical record can improve appropriate use of diagnostic radiology by a moderate amount and decrease use by a small amount”. There are suggestions for improving effectiveness. View the report
The suite of accredited and endorsed Diagnostic Imaging Pathways provides a suitable foundation for computerised clinical decision support for diagnostic imaging requests. Recommendations presented as flow charts are not only based on the best available evidence and broad clinical consensus, but alternative recommendations are also provided depending on the clinical picture. Access the menu and review pathway diagrams
There's A Problem With Appropriateness Criteria
It’s been reported that clinicians find it very frustrating when using a clinical decision support system (CDS) based on the American College of Radiology’s Appropriateness Criteria. When the CDS tells the requester that an examination is inappropriate, no help is given to finding one that is appropriate. View the commentary and access the report
An obvious major strength of Diagnostic Imaging Pathways and advantage over Appropriateness Criteria is that “alternative exams or care pathways” are suggested. The Ankle Injury pathway is a good example. A CDS based on this pathway won’t just advise that an MRI is not appropriate if a fracture has been detected, but will also advise that a CT of the ankle may be indicated if joint effusion is detected. Access the pathway
Choosing Wisely Australia
The Faculty of Clinical Radiology of the Royal Australian and New Zealand College of Radiologists (RANZCR) is a founding partner of Choosing Wisely Australia, which has the goal of stimulating conversations about unnecessary tests, treatments and procedures. RANZCR is committed to ensuring that all imaging is appropriate and clinically accountable, and recommends that six procedures should be questioned. Review the list
RANZCR endorses Diagnostic Imaging Pathways. The six recommendations are in accordance with the following six pathways which can be accessed from the links:
- Ankle Injury Access the pathway
- Deep Vein Thrombosis Access the pathway
- Pulmonary Embolism (Haematologically Stable) Access the pathway
- Low Back Pain Access the pathway
- Cervical Spine Injury Access the pathway
- Head Injury (Adult) Access the pathway
Early Diagnostic Imaging For Back Pain May Not Lead To Better Outcomes
Older patients who had diagnostic imaging within six weeks of an initial presentation for back pain, had pain and disability over the following year that was not different from a matched group who did not undergo early imaging. Furthermore, the lack of clinical benefit in the former group was associated with greater resource use and costs. The study supports the position that regardless of age, early imaging should not be performed routinely. View the report. It should be noted that current guidelines indicate that age at onset at >50-55 years is a ‘red-flag’ requiring early investigation.
The low back pain Diagnostic Imaging Pathway that is published at this website recommends early imaging only if there are neurological signs or symptoms or if there are ‘red flags’. In light of the above recent article, this pathway will be reviewed to determine whether a change is justified. Access the current pathway.
Patients Want Information About Radiation Risks
A study has shown that most patients reported that their health care provider did not initiate discussion about the benefits and risks of radiation from imaging tests, with most obtaining information from self-directed internet searches. Patients wanted information about the rationale for ordering specific examinations, intervals for follow-up imaging, and testing alternatives. Furthermore, they wanted to get such information from their physician rather than a radiologist (albeit the former may not be as well informed) or from readily available and endorsed reference materials. View the report
The current website provides a Radiation Training Module to assist with the education of non-radiologist physicians (among others). Access the module
The website provides access to information for consumers, developed using an accredited process. Access the materials
The website also provides links to information developed by the Royal Australian and New Zealand College of Radiologists. Access the information
Improving The Health System And Saving
It’s reported that the Australian Healthcare & Hospitals Association (AHHA) argues that the government can achieve a better functioning health system as well as savings by implementing sensible, evidence-based changes. There is mention of the Choosing Wisely campaign, first launched in the US in 2012 to minimise low-value interventions, and the NPS work with medical colleges to identify tests, treatments and procedures that are commonly used but have no or limited benefit. View the report
Recommendations in the diagnostic imaging pathways that are published at this website are supported by the best available evidence and broad clinical consensus. The primary objective is to:
- Reduce the incidence of unnecessary examinations which may expose patients to risk without benefit, including the risk of false-positive results.
- Increase the incidence of appropriate examinations which will result in cost-effective diagnosis.
Improving The Predictive Value Of Ultrasound
It is reported by Anandalwar et al that the use of white blood cell count and polymorphonuclear leukocyte differential substantially improves the predictive value of ultrasound for suspected appendicitis in children. View the report
This finding will be taken into account in a review of the Paediatric, Abdominal Pain (Acute Non-Traumatic) pathway. Access the current pathway
The American Journal of Roentgenology reported an evaluation of the level of readability of resources made available on the European Society of Radiology website to determine whether the materials met the health literacy needs of the general public. It was concluded that the education resources are written at a comprehension level well above that of the average internet viewer. View the report
Information for Consumers that is published at this website was developed in close collaboration with the Health Consumers’ Council of WA. It is presented in plain English and uses 'everyday' language and familiar words to be understood by 'most of the people, most of the time’.
Patients' Understanding Of Radiation
A survey of patients’ knowledge about the use of ionising radiation in medical imaging was reported at the 2014 meeting of the RSNA. View the report
Results of the survey showed that most patients don’t know what ionising radiation is, and poorly understand radiation risks. On the other hand, the patients believed that the investigations they undergo offer a benefit that is large compared to the risk. The authors concluded that providers therefore “owe it to them to ensure that this is the case”.
The suite of Diagnostic Imaging Pathways provides guidance and recommendations for referrers and providers to justify the use of diagnostic imaging investigations. In addition, Information for Consumers is provided to assist in their education.
Evidence-Based Decision Support
The Journal of the American College of Radiology reported a Canadian study that presented data on the overuse of MRI to diagnose back problems. The Ontario government attempted to reduce inappropriate lumbar MRI referrals through the distribution of guidelines and decision-aids to physicians. The interventions significantly decreased but did not eliminate inappropriate referrals. The authors concluded that “Investing in evidence-based infrastructure such as mandated point-of-care decision-support referral forms will likely improve the appropriateness of imaging in Canada without sacrificing high-quality patient care”. Review the report
The low back pain diagnostic imaging pathway that is published at this website gives evidence and consensus-based recommendations including the role of MRI. Access this pathway