News | December 23, 2014

Chest CT Proven Effective Follow-Up to Chest X-rays

Study finds that 41.4 percent of X-ray follow-ups revealed abnormalities requiring further treatment

December 23, 2014 — A substantial percentage of patients who receive radiologist recommendations for chest computed tomography (CT) to evaluate abnormal findings on outpatient chest X-rays have clinically relevant findings, including cancer, according to a new study published online in the journal Radiology.

Researchers said the findings show that radiologist recommendations for additional imaging (RAIs) after chest X-rays represent valuable contributions to patient care.

RAIs, which have grown 200 percent since 1995, have attracted scrutiny in recent years as healthcare moves from volume-driven to value-based payment models. The scrutiny makes it increasingly important for the radiology community to validate the clinical impact of its work, said study author Tarik K. Alkasab, M.D., Ph.D., from Massachusetts General Hospital and Harvard Medical School in Boston.

“There has been a great deal of research on how radiologists recommend an imaging exam, but little on what comes out of the exams that they recommend,” Alkasab said. “Prior studies were very broad, so in our study we tried to focus on a specific clinical scenario.”

Alkasab and colleagues looked at chest X-rays, one of the most common outpatient diagnostic imaging studies performed in the United States. As many as half of all RAIs arising from thoracic diagnostic exams are prompted by chest X-rays.

The researchers combed through more than 29,000 reports of outpatient chest X-rays performed at a large academic center over one year to identify studies that included a recommendation for a chest CT. They found that radiologists interpreting outpatient chest X-rays made recommendations for CT in 4.5 percent of cases—a result in line with existing research. Increasing patient age and positive smoking history were associated with an increased likelihood of a chest CT recommendation.

When the researchers looked at the chest CTs obtained within one year of the index chest X-ray, they found that 41.4 percent detected a corresponding abnormality requiring treatment or further diagnostic workup. One in every 13 yielded a corresponding abnormality representing a newly-diagnosed, biopsy-proven malignancy.

“In this era of concern about radiation dose risk, these findings suggest that the extremely low predicted risk of radiation-induced cancer associated with a chest CT is orders of magnitude less than the potential clinical benefits,” said study co-author H. Benjamin Harvey, M.D., J.D., from Massachusetts General Hospital and Harvard Medical School. “If ordering physicians see a recommendation for chest CT, they need to ensure that the patient gets the recommended imaging.”

More than one-third of patients in the study group who were recommended for follow-up chest CT did not receive the exam within one year—an oversight that could result in missed or delayed diagnoses, the researchers said.

“More research is needed to understand the possible reasons for the less-than-optimal adherence to RAIs after chest X-ray,” Harvey said. “One thing we’re looking at is how the recommendation language affects recommendation adherence.”

The researchers hope that their study helps improve awareness of the importance of follow-up CT.

“These results show that radiologists should be confident their recommendations are adding value and protecting patients,” Alkasab said.

For more information: www.radiologyinfo.org

Related Content

Hospital for Special Surgery Invests in Sectra Orthopedic 3-D Planning Software
News | Orthopedic Imaging | January 18, 2018
January 18, 2018 – International medical imaging IT and cybersecurity company Sectra announces that Hospital for Spec
Philips Introduces Technology Maximizer Program for Imaging Equipment Upgrades
Technology | Imaging | January 17, 2018
January 17, 2018 — Philips recently announced the launch of Technology Maximizer, a cross-modality program designed t
Transpara Deep Learning Software Matches Experienced Radiologists in Mammogram Reading
News | Computer-Aided Detection Software | January 12, 2018
Deep learning and artificial intelligence improves the efficiency and accuracy of reading mammograms, according to...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Smartphone Addiction Creates Imbalance in Brain
News | Mobile Devices | January 11, 2018
Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet,...
Emergency Radiologists See Inner Toll of Opioid Use Disorders

Rates of Imaging Positivity for IV-SUDs Complications. Image courtesy of Efren J. Flores, M.D.

News | Clinical Study | January 11, 2018
January 11, 2018 – Emergency radiologists are seeing a high prevalence of patients with complications related to opio
Minimally Invasive Treatment Provides Relief from Back Pain

Lumbar spine MRI showing disc herniation and nerve root at baseline and one month after treatment

News | Interventional Radiology | January 11, 2018
The majority of patients were pain free after receiving a new image-guided pulsed radiofrequency treatment for low back...
Study Finds No Evidence that Gadolinium Causes Neurologic Harm

MR images through, A, C, E, basal ganglia and, B, D, F, posterior fossa at level of dentate nucleus. Images are shown for, A, B, control group patient 4, and the, C, D, first and, E, F, last examinations performed in contrast group patient 13. Regions of interest used in quantification of signal intensity are shown as dashed lines for globus pallidus (green), thalamus (blue), dentate nucleus (yellow), and pons (red).

News | Contrast Media | January 11, 2018
January 11, 2018 — There is no evidence that accumulation in the brain of the element gadolinium speeds cognitive dec
CT Shows Enlarged Aortas in Former Pro Football Players

3-D rendering from a cardiac CT dataset demonstrating mild dilation of the ascending aorta.

News | Computed Tomography (CT) | January 11, 2018
Former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at...

Size comparison between 3-D printed prosthesis implant and a penny.

News | 3-D Printing | January 11, 2018
January 11, 2018 — Researchers using...
Overlay Init