Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations

Radiology. 2009 Nov;253(2):453-61. doi: 10.1148/radiol.2532090200. Epub 2009 Aug 25.


Purpose: To quantify the rates of recommendation for additional imaging (RAI) in a large number of radiology reports of different modalities and to estimate the effects of 11 clinically relevant factors.

Materials and methods: This HIPAA compliant research was approved by the institutional review board under an expedited protocol for analyzing anonymous aggregated radiology data. All diagnostic imaging examinations (n = 5 948 342) interpreted by radiologists between 1995 and 2008 were studied. A natural language processing technique specifically designed to extract information about any recommendations from radiology report texts was used. The analytic data set included three quantitative variables: the interpreting radiologist's experience, the year of study, and patient age. Categoric variables described patient location (inpatient, outpatient, emergency department), whether a resident dictated the case, patient sex, modality, body area studied, ordering service, radiologist's specialty division, and whether the examination result was positive. A multivariable logistic regression model was used to determine the effect of each of these factors on likelihood of RAI while holding all others equal.

Results: Recommendations increased during the 13 years of study, with the unadjusted rate rising from roughly 6% to 12%. After accounting for all other factors, the odds of any one examination resulting in an RAI increased by 2.16 times (95% confidence interval: 2.12, 2.21) from 1995 to 2008. As radiologist experience increased, the odds of an RAI decreased by about 15% per decade. Studies that had positive findings were more likely (odds ratio = 5.03; 95% confidence interval: 4.98, 5.07) to have an RAI. The remaining factors also had significant effects on the tendency for an RAI.

Conclusion: The likelihood of RAI increased by 15% for each decade of radiologist experience and roughly doubled over 13 years of study.

MeSH terms

  • Diagnostic Imaging / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Medicine
  • Middle Aged
  • Multivariate Analysis
  • Radiology*
  • Referral and Consultation / statistics & numerical data*