Frequency, Determinants, and Costs of Recommendations for Additional Imaging in Clinical ¹⁸F-FDG PET/CT Reports

Our purpose was to determine the frequency, determinants, and costs of recommendations for additional imaging (RAIs) in clinical ¹⁸F-FDG PET/CT reports. Methods: This retrospective study included a random sample of 2,643 ¹⁸F-FDG PET/CT scans that were performed for various clinical reasons at a tertiary-care academic medical center without financial incentives for self-referral, within a 1.5-y period. Results: Ninety-eight (3.7%) of 2,643 ¹⁸F-FDG PET/CT reports contained an RAI. None of the investigated variables (patient age, hospital status [inpatient or outpatient], indication for ¹⁸F-FDG PET/CT scanning [oncologic, infection/inflammation, or miscellaneous], type of ¹⁸F-FDG PET/CT scan [low-dose ¹⁸F-FDG PET/CT or low-dose ¹⁸F-FDG PET/CT combined with diagnostic CT of any body region], or years of experience of the [most senior] signing author) was univariately associated with the presence of an RAI in the ¹⁸F-FDG PET/CT report. The hypothesis that RAIs more frequently occur when the anatomic area to which the RAI relates is not covered by a diagnostic CT scan (as part of the ¹⁸F-FDG PET/CT examination) was also rejected (P = 0.419). The total costs of all RAIs (regardless of whether they were actually performed by the referring clinicians) were €23,922.21 ($27,065.47), which corresponds to an average of €9.08 ($10.27) RAI costs per ¹⁸F-FDG PET/CT exam. The total costs of all RAIs that were actually performed by the referring clinicians were €16,498.62 ($18,666.46), which corresponds to an average of €6.26 ($7.08) RAI costs per ¹⁸F-FDG PET/CT exam. Conclusion: RAIs in ¹⁸F-FDG PET/CT reports in a European tertiary-care academic medical center without financial incentives for self-referral are infrequent, cannot be anticipated, and result in relatively low overall costs.