When more is better: Underused advanced imaging exams that can improve outcomes and reduce cost of care

Am J Med. 2021 Apr 2;S0002-9343(21)00203-5. doi: 10.1016/j.amjmed.2021.02.020. Online ahead of print.


Appropriate use of resources is a tenant of care transformation efforts, with a national campaign to reduce low value imaging. The next level of performance improvement is to bolster evidence-based screening, imaging surveillance and diagnostic innovation, which can avert more costly, higher risk elements of unnecessary care like emergent interventions. Clinical scenarios where underused advanced imaging can improve outcomes and reduce total cost of care are reviewed: abdominal aortic aneurysmsurveillance, coronary artery disease diagnosis, and renal mass characterization. Reliable abdominal aortic aneurysm surveillance imaging reduces emergency surgery and can be driven by radiologists incorporating best practice standardized recommendations in imaging interpretations. Coronary computed tomography angiography in patients with stable and unstable chest pain can reduce downstream resource utilization while improving outcomes. Pre-operative 99mTc-sestamibi single-photon emission computed tomography (SPECT) reliably distinguishes oncocytoma from renal cell carcinoma to obviate unnecessary nephrectomy. As technological advances in diagnostic, molecularand interventional radiologyimprove our ability to detect and cure disease, analyses of cost effectiveness will be critical to radiology leadership and sustainability in the transition to a value-based reimbursement model.

Keywords: 99m Tc-sestamibi single-photon emission computed tomography; Value-based care; abdominal aortic aneurysm; coronary computed tomography angiography; surveillance imaging.

Publication types

  • Review