MITA Says New Study Underscores Value of Imaging as a Diagnostic Tool

10.09.15

Physician Diagnoses and Admission Decisions Substantially Change
After CT in the Emergency Department

Washington, D.C. – The Medical Imaging & Technology Alliance (MITA) today said a new study published in Radiology underscores the potential value of medical imaging to alleviating the misdiagnosis epidemic documented in a recent Institute of Medicine (IOM) report. In the study, researchers at Massachusetts General Hospital (MGH) found that more than half of physician diagnoses changed after computed tomography (CT) exams were administered to patients presenting with abdominal pain in the emergency department (ED).

“Our research aimed to answer critical questions about the role of CT in the ED, in particular the potential effects of CT results on physicians’ decisions and diagnostic confidence,” said Pari V. Pandharipande, MD, MPH, of the Institute for Technology Assessment at MGH, the lead author of the study. “For three common referral indications, we found that ED physicians’ diagnoses and admission decisions changed frequently after CT, and that diagnostic uncertainty was alleviated. Together, our findings suggest that current ordering practices in the ED for these indications are clinically justified.”

In the prospective, multi-center study, “CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making,” researchers surveyed 245 physicians who treated 1,280 patients who were referred for CT in the ED with abdominal pain, chest pain and/or dyspnea, or headache. The physicians were surveyed before and after CT exams were completed, to elicit information on their leading diagnosis, diagnostic confidence (on a scale of zero to 100 percent), alternative “rule out” diagnosis, and management decisions.

Key findings from the study include the following:

  • Physicians’ leading diagnoses changed after CT for 51 percent of patients presenting with abdominal pain, 42 percent of patients presenting with chest pain and/or dyspnea, and 24 percent of patients presenting with headache.
  • Physicians’ decisions about whether to admit a patient changed after CT in 25 percent of abdominal pain cases, 19 percent of chest pain and/or dyspnea cases, and 19 percent of headache cases.
  • CT helped to confirm or exclude at least 95 percent of alternative diagnoses across the three referral indications studied.
  • Median changes in diagnostic confidence were substantial and significant (increases of 25 percent, 20 percent, and 13 percent, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache) and median post-CT confidence was high (95 percent for all three groups).

“This study clearly demonstrates the value that radiologists provide as part of the clinical care team. At a time when many are questioning the value of CT scans and other imaging exams for our patients, it is clear from the data presented in this study that, when appropriately used, imaging continues to serve an important role in expeditiously reaching the correct diagnosis and excluding clinically suspected illness or injury. This often allows patients to forego more invasive or expensive care and helps conserve precious health care resources,” said Bibb Allen, Jr., MD, FACR, chair of the American College of Radiology Board of Chancellors.

“This study adds to a wealth of existing research demonstrating how CT and other imaging modalities are integral to an accurate and timely diagnosis – particularly in the ED, where time is of the essence – while helping patients avoid more invasive surgical procedures,” said Patrick Hope, executive director of MITA. “We are especially encouraged by these findings in light of the recent IOM report on the prevalence of diagnostic errors. Policymakers ought to consider the proven benefits of imaging as a tool to aid in the diagnosis of myriad diseases when making budget decisions that will impact patient care.”

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The Medical Imaging & Technology Alliance (MITA), a division of NEMA, is the collective voice of medical imaging equipment, radiation therapy and radiopharmaceutical manufacturers, innovators and product developers. It represents companies whose sales comprise more than 90 percent of the global market for medical imaging technology. For more information, visit www.medicalimaging.org. Follow MITA on Twitter @MITAToday.