Clinical Scorecard: Gender Variations in Unwarranted Imaging Requests: Findings from the Medical Imaging Decision And Support (MIDAS) Research
At a Glance
Category
Detail
Condition
Inappropriate diagnostic imaging requests
Key Mechanisms
Sex-based differences in imaging appropriateness influenced by clinical uncertainty, physician biases, guideline adherence, and systemic factors
Target Population
Adult patients undergoing diagnostic imaging in German academic hospitals
Care Setting
Hospital-based diagnostic imaging departments using Computerized Physician Order Entry systems
Key Highlights
Women and men exhibit differences in the appropriateness of diagnostic imaging requests across multiple modalities and clinical settings.
The ESR iGuide decision support system was used to classify imaging requests as appropriate, conditionally appropriate, or inappropriate based on clinical guidelines.
Prior studies show mixed international results on sex-based appropriateness rates, highlighting the need for systematic evaluation.
Guideline-Based Recommendations
Diagnosis
Use validated clinical decision support systems like the ESR iGuide to assess imaging appropriateness based on established criteria.
Ensure imaging requests align with clinical indications and guideline-based risk-benefit assessments.
Management
Address potential unconscious biases and guideline gaps that may contribute to sex-based disparities in imaging utilization.
Implement decision support tools to improve appropriateness of imaging requests prior to ordering.
Monitoring & Follow-up
Regularly audit imaging requests for appropriateness stratified by patient sex to identify disparities.
Exclude non-standard or unmatched indication-exam combinations from appropriateness analyses to maintain data integrity.
Risks
Overutilization of imaging leads to unnecessary radiation exposure, increased healthcare costs, and potential delays in diagnosis.
Sex-based disparities may result in under- or over-imaging, impacting patient outcomes and resource allocation.
Patient & Prescribing Data
Patients with recorded binary sex (male or female) undergoing imaging requests in German academic hospitals
Baseline imaging requests prior to decision support intervention reveal sex-related differences in appropriateness, underscoring the need for tailored strategies to optimize imaging use.
Clinical Best Practices
Incorporate structured indication input in computerized order entry systems to facilitate appropriateness scoring.
Blind physicians to appropriateness scores during baseline data collection to capture unbiased imaging request patterns.
Use highest appropriateness score when multiple indications are selected for a single imaging request.
Exclude imaging exams performed outside formal order entry systems (e.g., point-of-care ultrasounds) from appropriateness analyses.
