ACR Select Identifies Inappropriate Underutilization of Magnetic Resonance Imaging in British Columbia

Area of Science:

• Radiology and Medical Imaging
• Health Informatics

Background:

• The ACR Select software, based on the ACR Appropriateness Criteria, is designed to guide medical imaging decisions.
• Evaluating the real-world performance of such decision support tools is crucial for optimizing healthcare resource utilization.

Purpose of the Study:

• To assess the accuracy and utility of the ACR Select software in determining the appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) orders within Island Health, British Columbia.

Main Methods:

• 1228 consecutive CT and MRI studies were analyzed using the ACR Select software.
• A subset underwent manual review for validation.
• The software successfully analyzed 93% of the entered studies.

Main Results:

• The ACR Select software identified a 2.5% inappropriate imaging rate, while manual review indicated an even lower rate of 0.6%.
• Manual review confirmed the software's appropriateness ranking in all reviewed cases.
• The software suggested MRI over CT in 20% of cases where CT was initially ordered.

Conclusions:

• ACR Select software is a valuable tool for assessing CT and MRI appropriateness, though it may slightly overestimate inappropriate studies.
• Imaging is generally ordered appropriately in Island Health.
• The frequent recommendation for MRI over CT may indicate potential MRI resource limitations in the region.