Actionability of Recommendations for Additional Imaging in Head and Neck Radiology.

OBJECTIVE: Measure actionability of recommendations for additional imaging (RAI) in head and neck CT and MRI, where there is a near-complete absence of best practices or guidelines, identify the most common recommendations, and assess radiologist factors associated with actionability.

METHODS: We retrospectively reviewed all head and neck CT and MRI radiology reports across our multi-institution, multi-practice healthcare system from 6/1/2021-5/31/2022. Actionability of RAI was scored using a validated taxonomy. The most common recommendations for additional imaging were identified. Actionability association with radiologist factors (sex, years out of training, fellowship training, practice type) and with trainees was measured with a mixed effects model.

RESULTS: 209 radiologists generated 60,543 reports. 7.2% (4,382/60,543) contained RAI. Only 3.9% of RAI (170/4,382) were actionable. Over 60% of RAI were for eight examinations: thyroid ultrasound (14.1%), neck CT (12.6%), brain MRI (6.9%), chest CT (6.5%), neck CTA (5.5%), temporal bone CT (5.3%), temporal bone MRI (5.2%), and pituitary MRI (4.6%). Radiologists >23 years out of training (OR 0.39, 95% CI 0.15-1.02, p=0.05) and community radiologists (OR 0.53, 95% CI 0.22-1.31, p=0.17) had substantially lower estimated odds of making actionable RAI than radiologists <7 years out of training and academic radiologists, respectively.

DISCUSSION: The studied radiologists rarely made actionable RAI, which makes it difficult to identify and track clinically necessary RAI to timely performance. Multi-faceted quality improvement initiatives including peer comparisons, clinical decision support at the time of reporting, and development of evidence-based best practices may help improve tracking and timely performance of clinically necessary RAI.