Using Evidence-Based Criteria to Decrease CT Utilization for Liver Imaging

Overutilization of imaging in radiology increases costs without improvement in patient outcomes. As a part of the regular quality measures, the Centers for Medicare and Medicaid Services deemed our institution to be overutilizing abdomen and abdominopelvic computer tomography (CT) with and without intravenous (IV) contrast. We implemented a quality improvement (QI) effort to reduce use of abdomen CT with and without IV contrast.

We found high use of abdomen CT with and without IV contrast for liver imaging and implemented an intervention from July 2018 to June 2020. The intervention included updating the liver imaging protocols in alignment with LI-RADS guidelines and hosting educational sessions with the clinical and radiology team to review the updates. Control charts were generated to display changes in the number of CT examinations over time with phase variables indicating two averages, pre- and post-intervention.

Guidelines combined with targeted educational and engaged interventions with providers demonstrated a downshift in the use of abdomen CT with and without IV contrast and upshift in the concurrent abdomen CT with IV contrast only for liver imaging.

Our quality improvement effort suggests that a combination of national quality metrics guidelines and radiology-led interventions such as education and engagement can reduce overutilization.