Imaging Pearls ❯ Practice Management ❯ CAD Systems
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- Decision Support
“Overall, radiologists from health care systems involved in the Medicare Imaging Demonstration did not perceive that decision support had a substantial effect, either positive or negative, on their professional roles and responsibilities. Radiologists expressed a desire to improve efficiencies and quality of care by having greater involvement in future efforts.” JOURNAL CLUB: Radiologists' Perceptions of Computerized Decision Support: A Focus Group Study From the Medicare Imaging Demonstration Project Lee CI et al. AJR 2015 205:5, 947-955 - “One potential reason for this future optimism may be the financial benefits to radiologists of widespread adoption of CDS. CDS may eventually eliminate the need for radiology benefit managers and prior authorization programs. These programs have typically caused work-flow burdens and shifting of costs from payers to practices, sometimes increasing overall costs. Further financial incentives for adopting CDS include meaningful use criteria under the Health Information Technology for Economic and Clinical Health Act of 2009 and the mandated use of CDS for targeted ambulatory imaging services under the Protecting Access to Medicare Act of 2014. The latter will be a requirement for payment for imaging services beginning in 2017.” JOURNAL CLUB: Radiologists' Perceptions of Computerized Decision Support: A Focus Group Study From the Medicare Imaging Demonstration Project Lee CI et al. AJR 2015 205:5, 947-955
- “In summary, radiologists from health care systems involved in the MID did not perceive that CDS had a substantial effect, either positive or negative, on their professional roles and responsibilities. Although radiologists did not perceive greater appropriateness of advanced imaging orders within the MID, they seemed to agree that the potential benefits of using CDS, with improvements over time, outweigh its limitations. Greater radiologist engagement and involvement in future decision support education, development, and implementation may have a positive effect on both patient care and on the radiology profession.” JOURNAL CLUB: Radiologists' Perceptions of Computerized Decision Support: A Focus Group Study From the Medicare Imaging Demonstration Project Lee CI et al. AJR 2015 205:5, 947-955
- OBJECTIVE: To evaluate the impact of a multimodality appropriate use criteria decision support tool (AUC-DST) on rates of appropriate testing and clinical decision-making
CONCLUSIONS: A point-of-order AUC-DST enabled rapid determination of test appropriateness for CAD evaluation and was associated with increased and decreased testing for appropriate and inappropriate indications, respectively. These changes in test ordering were associated with greater intended changes in post-test medical therapy.
Impact of an Automated Multimodality Point-of-Order Decision Support Tool on Rates of Appropriate Testing and Clinical Decision Making for Individuals with Suspected Coronary Artery Disease: A Prospective Multicenter Study
Lin FY et al
J Am Coll Cardiol 2013 May 22 pii: S0735-1097(13)01984-0. doi: 10.1016/j.jacc.2013.04.059. [Epub ahead of print] - “100 physicians used the AUC-DST for 472 patients (55.6 ± 9.6 years, 61% male, 52% prior known CAD) over 8 months for MPS (72%), STE (24%) and CCTA (5%). The AUC-DST required an average of 137 ± 360 seconds to determine appropriateness category that, by American College of Cardiology AUC were considered appropriate in 241 (51%), uncertain in 96 (20%), inappropriate in 85 (18%) and not addressed in 50 (11%). For tests ordered in the first 2 months compared to the last 2 months, appropriate tests increased from 49% to 61% (p=0.02), while inappropriate tests decreased from 22% to 6% (p<0.001). During this period, intended changes in medical therapy increased from 11% to 32% (p = 0.001).”
Impact of an Automated Multimodality Point-of-Order Decision Support Tool on Rates of Appropriate Testing and Clinical Decision Making for Individuals with Suspected Coronary Artery Disease: A Prospective Multicenter Study
Lin FY et al
J Am Coll Cardiol 2013 May 22 pii: S0735-1097(13)01984-0. doi: 10.1016/j.jacc.2013.04.059. [Epub ahead of print] - “The American College of Cardiology Appropriate Use Criteria (AUC) were developed to guide use of myocardial perfusion single-photon emission computed tomography (MPS), stress echocardiography, and cardiac computed tomographic angiography (CCTA). To date, cardiologist application of AUC from a patient-based multiprocedure perspective has not been evaluated. A Web-based survey of 15 clinical vignettes spanning a wide spectrum of indications for MPS, STE, and CCTA in coronary artery disease was administered to cardiologists who rated the ordered test as appropriate, inappropriate, or uncertain by AUC application and suggested a preferred alternative imaging procedure, if any. In total 129 cardiologists responded to the survey (mean age 49.5 years, board certification for MPS 65%, echocardiography 39%, CCTA 32%).”
Cardiologist concordance with the American College of Cardiology appropriate use criteria for cardiac testing in patients with coronary artery disease
Lin FY
Am J Cardiol 2012 Aug1;110(3):337-44 - “ Cardiologists agreed with published AUC ratings 65% of the time, with differences in all categories (appropriate, 50% vs 53%; inappropriate, 42% vs 20%; uncertain, 9% vs 27%, p <0.0001 for all comparisons). Physician age, practice type, or board certification in MPS or echocardiography had no effect on concordance with AUC ratings, with slightly higher agreement for those board certified in CCTA (68% vs 64%, p = 0.04). Cardiologist procedure preference was positively associated with active clinical interpretation of MPS and CCTA (p = 0.03 for the 2 comparisons) but not for ownership of the respective imaging equipment. In conclusion, cardiologist agreement with published AUC ratings is generally high, although physicians classify more uncertain indications as inappropriate. Active clinical interpretation of a procedure contributes most to increased procedure preference.”
Cardiologist concordance with the American College of Cardiology appropriate use criteria for cardiac testing in patients with coronary artery disease
Lin FY
Am J Cardiol 2012 Aug1;110(3):337-44
"Preliminary assessment of this approach shows excellent retrieval results for three types of liver lesions visible on portal venous CT images, warranting continued development and validation in larger and more comprehensive database."
Automated Retrieval of CT Images of Liver Lesions on the Basis of Image Similarity: Method and preliminary reults
Napel SA et al.
Radiology 2010; 256;243-252"When used individually, groups of semantic, texture, and boundary features resulted in various levels of performance in retrieving relevant lesions. However, combining all features produced the best overall results. Mean precision was greater than 90% at all values of recall, and mean, best and worst case retrieved accuracy was greater than 95%, 100% and greater than 78% respectively with NDGC."
Automated Retrieval of CT Images of Liver Lesions on the Basis of Image Similarity: Method and preliminary reults
Napel SA et al.
Radiology 2010; 256;243-252"To develop a system to facilitate the retrieval of radiologic images that contain similar appearing lesions and to perform a preliminary evaluation of this system with a database of computed tomographic (CT) images of the liver and an external standard of image similarity."
Automated Retrieval of CT Images of Liver Lesions on the Basis of Image Similarity: Method and preliminary reults
Napel SA et al.
Radiology 2010; 256;243-252