Reducing excessive follow-up imaging through multidisciplinary collaboration

Collaborative institutional guidelines can assist in clinical decision making and reduce unnecessary imaging utilization for ovarian cysts on follow-up, according to results of a study published online March 4 in the Journal of the American College of Radiology.

When it comes to the topic of excessive imaging, much of the focus is placed on reducing the number of scans and examinations ordered by referring clinicians. However, needless follow-up imaging as a result of incidental findings is also an area where significant waste in resources and costs occurs.

One common source of such incidental findings are asymptomatic ovarian cysts, the vast majority of which are benign. But despite consensus recommendations on how to proceed when a cyst is detected on unrelated imaging exams, adherence to these guidelines has been hard to predict, said lead author Danny Kim, MD, and his colleagues from New York University Langone Medical Center.

“Both the Society of Radiologists in Ultrasound (SRU) and the ACR have recently published recommendations regarding follow-up of asymptomatic ovarian and adnexal cysts on ultrasound, CT, and MRI,” they wrote. “However, radiologist adherence to SRU recommendations remains variable. Contributing factors may include radiologists’ lack of knowledge of these society recommendations, variability of the societal recommendations, lack of emphasis on the importance of providing standardized recommendations, concerns about missing potential cancer, clinical workflow demands, and lack of feedback from referring clinicians.”

After finding some disparities in their own facility, the researchers set out to develop institutional standards for appropriate follow-up management of asymptomatic ovarian cyst detected via imaging at an institutional level. They sought the collaboration of their hospital’s radiology, gynecology and oncology departments to develop guidelines using both SRU and ACR recommendations, which were then integrated into a radiologist decision support tool. After nine months, they compared data from before and from the time directly after introducing the new guidelines.

They found that radiologist adherence to recommendations improved from 50 percent to 80 percent following implementation, while excessive follow-up of asymptomatic ovarian cysts decreased from 34 percent to 10 percent during the same time.

“Collaborative institutional recommendations for the management of ovarian and adnexal cysts may help improve radiologist adherence to management algorithms and reduce overutilization,” the authors concluded. “Radiology departments can benefit by demonstrating the capability to increase the quality and value of their radiologic services by incorporating such educational material and decision support tools that help clinicians care for their patients.”