75% of imaging requests fall short of RI-RADS quality standards, new evidence shows
More than 75% of imaging requests lack enough clinical information to be considered adequate under the Reason for exam Imaging Reporting and Data System guidelines, according to a study published Thursday.
University of Southern California in Los Angeles researchers first unveiled RI-RADS in 2019 as a standardized system to enhance information within imaging orders and potentially improve such requests. The tool operates similarly to other systems such as BI-RADS and assigns a letter grade based on an order's impression, clinical findings and diagnostic question.
After Dutch providers graded more than 650 radiology exams from their tertiary care center using RI-RADS, most were considered inadequate and 20% were labeled “deficient requests,” first author Ömer Kasalak, MD, PhD, and colleagues reported in the European Journal of Radiology.
It’s the first attempt at applying RI-RADS to clinical data, the authors noted, but may serve as an initial benchmark to enhance requests going forward.
“Even for seemingly routine procedures, it is crucial that referring physicians provide an adequate impression, clinical information, and diagnostic question to the imaging request because the lack of this information has been recognized as a source of diagnostic errors,” Kasalak and co-authors with University Medical Center Groningen’s Department of Radiology in the Netherlands explained Thursday. “The results of the present study underline the necessity to improve the overall quality of imaging requests” they added later.
To reach their conclusions, Kasalak et al. had a radiologist assign RI-RADS grades to 673 exams performed in 2017, including an equal number of ultrasounds, CT scans, MRIs and radiography exams.
Overall, the researchers said request quality was lacking in about 75% of cases. In terms of grades, 159 (23.6%) exams were assigned an “A” (adequate request), 166 (24.7%) a barely adequate “B,” 214 (31.8%) tagged with a considerably limited “C,” and 134 (19.9%) graded a “D” and deemed deficient.
Further analysis showed both routine preoperative imaging and transplantation imaging requests had a higher risk of poorer RI-RADS grades. On the other hand, exams indicated for infection/inflammation, pediatric requests, and head, spine and upper extremity imaging requests were all associated with a lower risk of poor grades.
The authors said their findings align with prior investigations revealing providers often submit low-quality imaging requests. Using RI-RADS to standardize radiology requisition forms may address this problem and machine learning software may be effective at ensuring requests are up-to-par in busy departments.
“This should be the topic of future research,” Kasalak and colleagues concluded.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.