Clinical Neuroradiology: Appropriate Imaging and Beyond

Purpose: Imaging 3.0 aims to undo the isolation between radiologists and clinicians caused by the introduction of PACs and EHR. The purpose of this study is to evaluate the value of a neuroradiologist on neurology inpatient rounds.

Methods/Materials: A board-certified neuroradiologist with 12 years of experience attended neurology inpatient rounds at a tertiary care institution. During the rounds, the neuroradiologist interpreted radiological findings and guided new optimal imaging investigations. Recorded outcomes included the number of suboptimal images (not to have a reasonable likelihood of answering the clinical question or if a different imaging investigation was better suited), changes in management, decreased patient length of stay, ACR Appropriateness Rating, and whether an educational value was provided to neurology residents. The Appropriateness Ratings between suboptimal and optimal imaging were compared using the Mann-Whitney U test.

Results: The neuroradiologist was present while 100 clinical cases were discussed. Neurology inpatient teams wished to obtain 44 new inpatient imaging studies. 25 (57%) of new neurology inpatient orders were found to be suboptimal. There were no structured scenarios in ACR Appropriateness Guidelines in 12 (48%) suboptimal imaging orders. There was no significant difference between the ACR Appropriateness Criteria rating of suboptimal and optimal imaging (p>0.9). (Table 1)
The neuroradiologist changed management in 38 (38%) cases and decreased the length of stay in 19 (19%) cases. Additionally, the neuroradiologist provided educational value to neurology residents in 60 (60%) cases.

Conclusions: The challenges involved in optimizing neurology inpatient imaging at tertiary care institutions may exceed the scope of ACR’s Appropriateness Criteria. A clinical neuroradiologist embedded in neurology inpatient rounds may be able to optimize new inpatient imaging orders, affect patient management, and decrease length of stay.