Varying Radiologist Decisions Contribute to Additional Head and Neck Imaging

Radiologist-specific decision-making behaviors remain a significant factor contributing to recommendations for additional imaging (RAI) on head and neck examinations, according to a paper published in American Journal of Roentgenology (AJR)

“Interradiologist variation in RAI rates for head and neck imaging was substantial,” wrote lead researcher Jeffrey P. Guenette, MD, MPH, from the Center for Evidence-Based Imaging at Brigham and Women’s Hospital in Boston, MA. “RAI appeared to be more substantially associated with individual radiologist-specific behavior than with measurable systemic factors.”

The manuscript included 39,200 patients (median age, 58 years) who underwent 39,200 head and neck CT or MRI examinations, interpreted by 61 radiologists (June 1, 2021–May 31, 2022). Guenette et al. used a natural language processing (NLP) tool and manually reviewed results to identify RAI in report impressions. After assessing interradiologist variation in RAI rates, a mixed-effects model determined associations between RAI and three factors: examination, patient, and radiologist.

Ultimately, RAI rates in head and neck imaging reports varied 27.5-fold (from 0.8% to 22.0%) across 61 radiologists. Of explainable likelihood of RAI in a multivariable model, 25.7% was attributable to fixed examination, patient, and radiologist factors. Meanwhile, the remaining 74.3% could be attributed to individual radiologist-specific behaviors.

“Quality improvement initiatives, incorporating best practices for incidental findings management, may help reduce radiologist preference-sensitive decision-making in issuing RAI for head and neck imaging and associated care variation,” the authors added.