AUA QI Summit 2017: Resources from the American College of Radiology to Support Stewardship of Imaging Radiology Support, Communication and Alignment Network (R-SCAN)

Linthicum, Maryland ( Dr. Erick Remer from the Cleveland Clinic Foundation and Ms. Nancy Fredericks from the American College of Radiology (ACR) provided an overview of the Radiology Support, Communication and Alignment Network (R-SCAN) with regards to stewardship. Dr. Remer noted that CMS established a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging services. The ACR-derived AUC is evidence-based and assists professionals who order imaging to make the most appropriate decisions for a specific clinical condition.

The reasons for inappropriate imaging are several-fold, including patient expectations and demands, concerns for liability exposure if the diagnosis is delayed, conflict of interest presented by physician ownership of imaging equipment, lack of specific guidance from radiologists, and lack of knowledge by the ordering physician and other providers. The appropriateness criteria patient safety goal is to maximize the benefits of performing medical imaging and radiological procedures, and to minimize the risk of harm to patients by eliminating unnecessary procedures and inappropriate utilization. Panel members for developing the appropriateness criteria include more than 100 physicians from more than 25 societies, including the AUA. When a topic is decided upon by the committee, a systematic literature search is performed, reviewed by the lead author, and a staff member subsequently creates an evidence table of appropriate studies. Studies are then given a Category 1 (well-designed and accounts for common biases) through 4 (not useful as primary evidence) score. The panel and appropriateness criteria committee then review this data and provide recommendations; an individual topic is updated every 3 years or more frequently when needed. As of the latest release in April 2017, there are 230 topics/clinical conditions that have been addressed for appropriateness criteria for imaging.

Ms. Fredericks then provided a review of the R-SCAN platform. R-SCAN is a collaborative between referring clinicians and radiologists to improve patient care. The specific aims of R-SCAN are (i) to ensure patients receive the most appropriate imaging exam based on evidence-based appropriate use criteria, (ii) reduce unnecessary imaging tests focused on imaging Choosing Wisely topics, and (iii) lower the cost of care. R-SCAN is funded primarily by a CMS-Transforming Clinical Practice Initiative grant awarded in September 2015. Ms. Fredericks highlights several reasons why individuals should participate in R-SCAN, including (i) it’s the right thing to do for patients, (ii) it’s a data-driven way to demonstrate improved imaging utilization, and (iii) it fosters communication and collaboration. Furthermore, R-SCAN supports fulfilling the Quality Payment Program requirements under the Merit-based Incentive Payment System (MIPS) track.

Anyone with an interest in improving imaging care can initiate an R-SCAN project, which may include physicians, nurse practitioners, residents, medical students, physician assistants, or imaging technologists. Two examples of R-SCAN Choosing Wisely topics pertinent to urology are (1) avoiding ordering CTs of the abdomen in otherwise healthy ED patients age <50 with a known history of renal colic, and (2) avoiding ordering PET/CTs and radionuclide bone scans in the staging of early prostate cancer at low risk of metastases.

Ms. Fredericks concluded by highlighting the next steps for R-SCAN, including (i) exploring the expansion of R-SCAN Choosing Wisely imaging urology topics, (ii) helping with outreach to practices, and (iii) providing webinars for individual practices.

Speaker(s): Erick Remer, Cleveland Clinic Foundation, Cleveland, OH, USA; Nancy Fredericks, American College of Radiology, Philadelphia, PA, USA

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the AUA Quality Improvement Summit - October 21, 2017- Linthicum, Maryland