Reining in recalls: Curbing excessive imaging by correcting human error

Improved training for radiology technologists, particularly regarding proper administration and communication involving MRI procedures, could help reduce patient recall for repeat examinations and prevent imaging overutilization, according to results of a study published in the April issue of the American Journal of Roentgenology.

Concerns over the exorbitant costs and unnecessary patient exposure to radiation resulting from excessive imaging have led to coordinated efforts within radiology to improve the quality and effectiveness of imaging through proper utilization.

One of the easiest strategies to reduce excessive imaging is by reining in repeat examinations caused by incomplete or inadequate procedures, wrote Soterios Gyftopoulos, MD, and his colleagues from NYU Langone Medical Center in New York.

“Intentional duplicative imaging examinations may be the lowest hanging fruit in reducing improper utilization, because they are typically the result of a correctable error,” they wrote. “However, systematic contributors to the need for patient recall–associated duplicative imaging have not been described, making it difficult to engage in quality improvement efforts to reduce the frequency of recalls.”

Gyftopoulos and his team set out to assess the rate of patient recalls for outpatient imaging and determine why the recalls occurred. To do so, they performed a retrospective review of all requests for repeat imaging resulting from an inadequate initial imaging study between January 2012 and March 2015 at the researchers’ own facility.

They found a total of 100 recall requests during that time period, or between 2-3 per month, with approximately 1 in 8,046 ambulatory studies and 1 in 1,684 MRI studies resulting in a repeat imaging request. Most of the facility’s recalls involved adults (98 percent) and MRI examinations (95 percent).

Additionally, the researchers found the most common cause of imaging recall requests were incomplete examinations (24 percent), followed by inadequate coverage of the area of interest (22 percent), protocoling errors (20 percent), poor imaging quality (15 percent), additional imaging to clarify a finding (11 percent), insufficient contrast visualization (7 percent) and incorrect patient information (1 percent).

“We found that patient recalls for imaging in the outpatient setting at our institution are not common,” the authors concluded. “Improved technologist education on MRI protocoling and enhanced communication between ordering clinicians and radiologists to clarify the purpose of imaging might reduce the need for repeat ambulatory imaging.”