Ultrasound self-referral does not increase utilization in pediatric urology

Costs of radiologic imaging are rising. The goal of this study is to examine the utilization practices of pediatric urologists who have access to in-office ultrasound imaging when managing children with primary hydronephrosis.

A retrospective cross sectional study was performed of children ≤ 5 years old with an isolated diagnosis of hydronephrosis. Ultrasound utilization was evaluated by tallying the number of ultrasounds obtained during the time each child was followed. Imaging frequency was determined from orders given by each overseeing physician. Ultrasounds were performed at either the practitioner's clinic or at outside radiology facilities based on insurance regulations. Analysis compared ordering frequency between imaging completed at the clinic versus outside radiology facilities.

Of 1,816 ultrasounds ordered, 1,102 were performed at the practitioner's clinic and 714 at outside radiology centers. Overall, the number of ultrasounds obtained in the practitioner's clinic was 0.33 ultrasound studies per patient per month, in contrast to 0.38 obtained in outside radiology settings. Ultrasound utilization for low, intermediate and high grades of hydronephrosis in practitioner's clinic versus outside was 0.39 versus 0.31, 0.31 versus 0.31, and 0.37 versus 0.39 respectively. There were no significant differences in ultrasound ordering frequency for all groups compared.

There is no increase in ultrasound utilization for managing primary hydronephrosis in children, regardless of whether the study was self or outside referral. Honest and ethical utilization of self-owned radiologic equipment is possible and allows for timing monitoring, physician and patient convenience, and potential cost savings.