Frequency and Follow-up of Radiologist Recommendations for Additional Orbital Imaging

Recommendations for additional imaging (RAI) are common in radiology reports and are intended to facilitate timely diagnosis and patient management. However, adherence to these recommendations is often low and little is known about recommendations for dedicated orbital imaging following head and neck CT or MRI examinations. We therefore extracted radiology reports containing recommendations for additional orbital CT or MRI from an available data set of head and neck CT and MRI radiology reports from 6/1/2021 to 5/31/2022 from a single large healthcare system with multiple academic and community radiology practices. 133/60,543 (0.2%) of reports included recommendations for additional orbit CT or MRI. Follow-up CT or MRI of the orbits was performed within 1 year for 34% (45/133), of which 93% (42/45) showed pathological findings (62% neoplastic; 22% inflammatory; 16% infection, traumatic, or vascular). Patients with retrobulbar pathology were significantly more likely to undergo follow-up imaging (p<0.001). The high prevalence of pathological findings among completed follow-up examinations may reflect the clinical importantance of the recommendation, however many examinations may have been performed as part of planned surveillance rather and not as a direct result of the radiologist's recommendation.