A new computer tool helps physicians order the most appropriate imaging exams.

Imaging plays a critical role in helping physicians make accurate and timely diagnoses, and, increasingly, in improving the precision of surgical treatments. But when used inappropriately, some imaging studies can be harmful to a patient’s health and add unnecessary costs to the health care system.

X-rays, CT scans, PET scans, and nuclear medicine use radiation to produce images, and patients who undergo a large number of these tests may be at risk of unsafe radiation exposure. However, in many cases, tests that don’t require radiation to produce images, such as MRI or ultrasound, may be just as effective as tests that use radiation.

To help referring physicians order the most appropriate imaging test, the Brigham and Women’s Hospital (BWH) Department of Radiology has developed a convenient, automated decision-support tool. When a referring doctor requests an imaging test through the BWH computerized order entry system, a built-in tool – called Decision Support – automatically compares the request to information in the patient’s medical record (such as prior imaging results) and to published high quality evidence or professional society imaging guidelines, and then displays advice for the doctor on the order entry screen. In some cases, doctors will cancel orders after seeing that prior imaging tests have already answered a key question. In other cases, the evidence or guidelines may suggest that the doctor order a different (more appropriate) test or that no imaging be performed. The automated advice may even suggest a follow-up consultation between the referring doctor and a radiologist.

“Our use of Decision Support has led to major improvements in quality and efficiency.  A good example is the rate of CT use to assess pulmonary embolism in the ER,” said Dr. Ramin Khorasani, director of the Radiology Department’s Division of Medical Imaging and Information Technology. “And pulmonary embolism is just one of the hundreds of clinical situations for which Decision Support can be a guide.”

The use of imaging, and advanced imaging techniques in particular, has skyrocketed over the past 15 years, which has raised another concern – cost.  Tools like Decision Support, however, can help address these concerns by eliminating unnecessary exams and suggesting tests that are cost-effective, as well as medically appropriate.

How do you feel about your doctor using tools like Decision Support to make decisions about imaging?

Bryan M, Chris P

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