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Yield and Compliance of Radiologist-Recommended Chest CT

Yield and Compliance of Radiologist-Recommended Chest CT. Tarik K. Alkasab, MD, PhD Matthew S. Cushing, MD Matthew D. Gilman, MD Jeannette Ryan Alkasab, SB Jo‑Anne O. Shepard, MD Mitchell A. Harris, PhD Hani H. Abujudeh, MD, MBA. Radiologist Recommendations.

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Yield and Compliance of Radiologist-Recommended Chest CT

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  1. Yield and Compliance of Radiologist-Recommended Chest CT Tarik K. Alkasab, MD, PhD Matthew S. Cushing, MD Matthew D. Gilman, MD Jeannette Ryan Alkasab, SB Jo‑Anne O. Shepard, MD Mitchell A. Harris, PhD Hani H. Abujudeh, MD, MBA

  2. Radiologist Recommendations • Radiologists recommended follow-up imaging for 10% of cases • Concern for role in increasing health care costs • Challenge: Measure the value of these recommendations

  3. Chest CT Recommendations • Examined reports for chest radiographs (CXRs) for recommendations for follow-up chest CT • All outpatient CXRs from a six-week period in early 2008 • Definite recommendations for chest CT to evaluate an ambiguous radiographic finding • Excluded patients with chest CT in the past 5 years • For each recommendation, find the recommended CT • Where recommended exam found, correlate CXR findings with CT findings • No corresponding finding • Incidental corresponding finding • Significant corresponding finding

  4. Example Case #1

  5. Example Case #1

  6. Example Case #2

  7. Example Case #2

  8. Results

  9. Non-obtained Exams Why not? • Not clinically indicated • Obtained outside our system • Patient lost to follow-up • Recommendation missed

  10. Recommendation Value • Significant finding: treat appropriately • Incidental finding: confident in no further workup • No corresponding finding: potentially still valuable

  11. Toward Rational Recommending • Evidence-based standards • Feedback to individual radiologists

  12. Acknowledgements • Steven Graham • Thomas Schultz • Michael Zalis, MD • Keith Dreyer, DO, PhD • Daniel Rosenthal, MD • James Thrall, MD Supported by a Resident Research Grant from the RSNA Research and Education Foundation.

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