Recommendations for additional imaging of abdominal imaging examinations: frequency, benefit, and cost

Eur Radiol. 2020 Feb;30(2):1137-1144. doi: 10.1007/s00330-019-06382-7. Epub 2019 Aug 26.


Objectives: To investigate the frequency, determinants, clinical implications, and costs of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations.

Methods: This retrospective study included 2225 abdominal imaging examinations from outside institutions that were reinterpreted as part of standard clinical care at a tertiary care center in a one-year time frame.

Results: Two hundred forty-six RAIs were present in 231 of 2225 reports (10.4%) of secondary abdominal imaging interpretations. Patient age and experience of the radiologist who performed the secondary interpretation were independently significantly associated with the presence of an RAI (both p = 0.002), with odds ratios of 0.99 per year increase in patient age (95% confidence interval [CI], 0.98-1.00) and 1.06 per year increase in experience of the radiologist (95% CI, 1.02-1.10). If followed, RAIs changed clinical management in 31.2%. Total costs of all 246 RAIs, whether performed or not by the referring physicians, amounted to €71,032.21, thus resulting in €31.92 per secondary abdominal imaging interpretation. Total costs of the 140 RAIs that were actually performed by the referring physicians amounted to €42,683.08, resulting in €19.18 per secondary abdominal imaging interpretation.

Conclusions: The frequency of RAIs in reports of secondary interpretations of abdominal imaging examinations (which appear to be affected by patients' age and radiologists' experience) and associated costs are non-negligible. However, RAIs not infrequently change clinical management. The presented data may be helpful to radiology departments and healthcare policy makers to make well-informed decisions on the value and facilitation of the practice of secondary interpretations.

Key points: • Frequency of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations at a tertiary care center is approximately 10.4%. • RAIs appear to be more frequently issued in younger patients and by more experienced radiologists, and if followed by referring clinicians, change clinical management in about one third of cases. • RAI costs per secondary interpretation in the Dutch Healthcare system are €31.92 (considering all RAIs) or €19.18 (considering only those RAIs that are actually performed).

Keywords: Abdomen; Costs; Diagnostic imaging; Referral and consultation.

MeSH terms

  • Abdomen / diagnostic imaging*
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Clinical Competence
  • Cost-Benefit Analysis
  • Diagnostic Imaging / economics
  • Diagnostic Imaging / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Radiologists
  • Radiology Department, Hospital / economics
  • Radiology Department, Hospital / statistics & numerical data
  • Referral and Consultation*
  • Retrospective Studies
  • Tertiary Care Centers / economics
  • Tertiary Care Centers / statistics & numerical data
  • Young Adult