Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Elin Kjelle; Eivind Richter Andersen; Arne Magnus Krokeide; Lesley J J Soril; Leti van Bodegom-Vos; Fiona M Clement; Bjørn Morten Hofmann

doi:10.1186/s12880-022-00798-2

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

BMC Med Imaging. 2022 Apr 21;22(1):73. doi: 10.1186/s12880-022-00798-2.

Authors

Elin Kjelle¹, Eivind Richter Andersen², Arne Magnus Krokeide², Lesley J J Soril³, Leti van Bodegom-Vos⁴, Fiona M Clement³, Bjørn Morten Hofmann^{2

5}

Affiliations

¹ Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway. elin.kjelle@ntnu.no.
² Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
³ Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
⁴ Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
⁵ Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway.

Abstract

Background: Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children.

Methods: A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included.

Results: A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations.

Conclusions: A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally.

Systematic review registration: PROSPERO: CRD42020208072.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Diagnostic Imaging*
Humans