Need for Additional Imaging in PET/CT Oncologic Reports Reexamined

Radiologists and nuclear medicine physicians recommended additional imaging approximately 30% of the time in oncologic positron emission/computed tomography (PET/CT) reports, with about half of those recommendations being unnecessary, a new study shows.

The study, conducted at Brigham and Women’s Hospital (Boston, MA, USA), included 250 patients. The study’s findings revealed that there were 84 recommendations made for additional imaging. When study reviewers studied the patients’ records, they concluded that 43 of those recommendations were unnecessary, according to Atul Shinagare, MD, one of the authors of the study. No adverse patient outcome would have occurred by not recommending further imaging tests in these 43 cases, according to Dr. Shinagare.

The study did not particularly address the motivating factors behind the recommendations for additional imaging, however, “we feel that some of the most important factors leading to unnecessary recommendations include reluctance of physicians to accept uncertainty regarding diagnosis, partly driven by medicolegal concerns combined with a failure to fully consider the patients’ clinical circumstances, and the likely cost-effectiveness of additional imaging tests,” said Dr. Shinagare.

The study also found that 70% of the time, referring physicians did not follow through on the radiologists’ recommendation for additional imaging. Radiologists and nuclear medicine physicians may not have access to the complete medical history of patients referred for PET/CT imaging, according to Dr. Shinagare. “On the other hand, ordering clinicians usually know the patient record and history, which may put them in a better position to judge the necessity of some recommended additional imaging,” Dr. Shinagare said.

The study was presented May 8, 2012, at the American Roentgen Ray Society annual meeting held in Vancouver (BC, Canada).

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