Neuroradiology Update 2015 Thomas B. Sanders, MD...Neuroradiology Update 2015 Thomas Sanders MD IHC...
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Neuroradiology Update 2015
Thomas B. Sanders, MD Neuroradiologist, Utah Radiology Associates; Provo, Utah
Objectives:
• Review MRI L-spine appropriateness pilot project • Discuss the role of headache imaging • Review headache imaging indications project • List future projects
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IHCNeuroradiologyUpdate2015
Thomas Sanders MDIHC Neuroradiology Section LeadUtah Radiology Associates Neuroradiology
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OBJECTIVES
•Review MRI L‐spine appropriateness pilot project
•Discuss the role of headache imaging•Review headache imaging indications project
•Highlight future projects
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AppropriatenessPilotObjective:
• Assess % of MRI‐L spine exams that meet appropriateness guidelines.
• Assess how efficiently a working radiologist can clearly determine appropriateness of a MRI L‐spine exam.
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AppropriatenessPilotDescription:
• Retrospectively reviewed USR MR L‐Spine exams (600 Cases)
• Reviewed documentation currently available in RW (USR Patient Screening Form, RIS History, Order, Tech Notes, ED Notes)
• Appropriateness Criteria utilized: ACR and ACP guidelines
• Two Reviewers: TS and DC
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ACR AppropriatenessCriteria
Recent Significant Trauma Unexplained Weight loss Unexplained Fever (history of infection) Immunosuppressed (Diabetes Mellitus) Cancer History IV Drug Use Prolonged Corticosteroid/ Age >50 with Osteoporosis Age >70 Focal Deficit with Progressive or Disabling Symptoms,
Cauda Equina Duration > 6 weeks Prior Surgery
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AppropriatenessPilotPrimary Findings:
• 97% of exams had adequate info for assessment
• Minimal additional time to assess appropriateness
• 87% of exams were deemed appropriate
• 10% of exams were deemed inappropriate
• 3% of exams were indeterminate
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AppropriatenessPilotAdditional Findings:
• Surgical patients • Repeat exams• Tech training to ensure key questions on the patient survey are completed (length of symptoms/progressive nature)
• Inpatient/ED patients would benefit from utilizing outpatient screening form
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HEADACHEIMAGING
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HEADACHEIMAGING
• Headache is a frequent patient presentation
• Most often the patient’s headache cause or type can be determined with a careful history & physical
• Headache Imaging has a low yield • Non‐traumatic HA yield ~0.4%
• Estimated cost to detect a lesion• $100,000 with CT• $225,000 with MR
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HEADACHEIMAGING
• Positive predictive value for intracranial pathology if the neurologic exam is abnormal = 39%
• A normal neurologic exam reduced the odds of a positive finding on neuroimaging by 30%
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HEADACHEIMAGING
• Neuroimaging ordered in ~12% of US outpatient headache visits
• Headache Imaging cost ~1 billion annually
• Studies document increased HA imaging utilization despite imaging guidelines
• What is the True Value of a Negative Imaging Study??? (Not Zero)
• Imaging guidelines should be focused on defining patients with treatable lesions
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HeadacheImagingIndicationsWorkGroup
• Multispecialty: Neurology, Internal Medicine, Emergency Medicine, Radiology
• Review established guidelines
• Formulate local best practice standard
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HeadacheImagingIndicationsWorkGroup
• Adult• Non‐traumatic Acute• Non‐traumatic chronic• Mild TBI
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References
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FutureProjects
• Tele‐stroke (Neuro‐Science Clinical Program)
• Service Process Models• Standardized Templates• Standardized Protocols• Educational Modules• Appropriateness Work‐groups