Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

J Am Coll Radiol. 2015 Dec;12(12 Pt B):1371-1379.e3. doi: 10.1016/j.jacr.2015.09.014.


Introduction: Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization.

Methods: Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models.

Results: A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias.

Conclusions: Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings.

Keywords: Health information exchange; data sharing; evaluation; radiology information systems; utilization.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Diagnostic Imaging / statistics & numerical data*
  • Efficiency, Organizational / statistics & numerical data*
  • Electronic Health Records / statistics & numerical data*
  • Hospital Shared Services / statistics & numerical data
  • Internationality
  • Medical Overuse / prevention & control*
  • Medical Overuse / statistics & numerical data*
  • Radiology Information Systems / statistics & numerical data*
  • Utilization Review