Availability of Prior Imaging Studies

Abstract

AJR 2012; 199:W530 0361–803X/12/1994–W530 © American Roentgen Ray Society Availability of Prior Imaging Studies In James Brink’s ARRS presidential address [1], one thing particularly struck me. He quoted Clyde Stevenson [2], a fellow Washington radiologist and president of the ARRS. As Dr. Brink noted, Dr. Stevenson stated, “The need for solid clinical information coupled with high-quality images and access to prior imaging studies is critical to our success.” Dr. Brink addresses the importance of clinical information and high-quality images but does not pursue the last point, about which Dr. Stevenson was most passionate. Dr. Stevenson’s 1966 speech continued, “All of us could flood the literature with instances in which lack of previous roentgenograms for review and comparison led to delay, increased cost, erroneous diagnosis, harm, and even death of the patient. An intense educational program is overdue” [2]. In 2011, we are still waiting for that intense educational program. How often have we heard the hospitalist say, “We can’t find the CD, so we’ll just have to repeat the scan?” How often have we recommended follow-up CT of a pulmonary nodule without knowing that a prior outside CT of the chest or abdomen identified the same nodule? Do we really expect an internist to realize that a CT of the kidneys, ureters, and bladder performed down the street 2 years ago should be requested? Another Washington radiologist, Norm Beauchamp, did mention the cost of repeat medical imaging in the emergency department in a recent Masters of Radiology panel discussion [3], but, in general, I find the radiology community strangely silent on this topic. The American College of Radiology white paper, “Radiation Dose in Medicine” [4] barely refers to the need for access to prior studies. Does it seem logical that we require patients to request their prior mammograms, but we don’t ask about a prior chest CT? We are undertaking huge efforts to decrease the dose of an individual CT, which is admirable. Now it is time to address exposure from repeat examinations and unnecessary follow-up. How can each practice optimize the chance that outside images are available to the interpreting radiologist? How can we leverage our ability to share digital images to create a single imaging record for our highly mobile patients? Is not that what “meaningful use” in radiology should look like? I encourage radiologists to “flood the literature” and lead the charge to optimize the availability of prior images by improving institutional processes, championing meaningful use initiatives, and working with third-party vendors. It is yet another way all of us can become clinically exceptional and fully engaged. Dawna J. Kramer Virginia Mason Medical Center, Seattle, WA DOI:10.2214/AJR.12.8875 WEB—This is a Web exclusive article.