TY - JOUR
T1 - Neuroimaging in patients referred to a neuro-ophthalmology service
T2 - The rates of appropriateness and concordance in interpretation
AU - McClelland, Collin
AU - Van Stavern, Gregory P.
AU - Shepherd, J. Banks
AU - Gordon, Mae
AU - Huecker, Julia
N1 - Funding Information:
Supported by DOVS (core grant no.: 5 P30 EY02687 ); the Institute for Clinical and Translational Sciences (grant no.: RR023496 ); Biostat (core grant no.: U54 RR023496 ); an unrestricted grant from Research to Prevent Blindness, Inc, New York , New York; and the National Institutes of Health , Bethesda, Maryland (core vision grant no.: P30 EY02687 ).
PY - 2012/8
Y1 - 2012/8
N2 - Objective: Neuroimaging studies frequently are ordered to investigate neuro-ophthalmic symptoms. When misused, these studies are expensive and time consuming. This study describes the type and frequency of neuroimaging errors in patients referred to an academic neuro-ophthalmology service and measures how frequently these neuroimaging studies were reinterpreted. Design: Prospective cohort study. Participants: Eighty-four consecutive patients referred to an academic neuro-ophthalmology practice. Methods: From November 2009 through July 2010, 84 consecutive new patients who had undergone a neuroimaging study in the last 12 months specifically to evaluate their presenting neuro-ophthalmic symptoms were enrolled prospectively. Participants then underwent a complete neuro-ophthalmic evaluation, followed by a review of prior neuroimaging. Questions regarding appropriateness of the most recent imaging, concordance of radiologic interpretation, and re-evaluation of referring diagnoses were answered by the attending physician. Main Outcome Measures: The frequency and types of errors committed in the use of neuroimaging and the frequency of reinterpretation of prereferral neuroimaging studies after neuro-ophthalmic history and examination. Results: Most study participants (84.5%; 71/84) underwent magnetic resonance imaging before referral; 15.5% (13/84) underwent only computed tomography. The rate of suboptimal neuroimaging studies was 38.1% (32/84). The 3 most common reasons for suboptimal studies were incomplete area of imaging (34.4%; 11/32), wrong study type (28.1%; 9/32), and poor image quality (21.9%; 7/32). Twenty-four of 84 subjects (28.6%) required additional neuroimaging. The authors agreed with the radiology interpretation of the prior neuroimaging studies in most patients (77.4%; 65/84). The most common anatomic locations for discordance in interpretation were the intraorbital optic nerve (35%; 7/20) and the brainstem (20%; 4/20). Conclusions: There was a high rate of suboptimal neuroimaging studies performed in patients referred for neuro-ophthalmology examination. These findings have significant implications given the increasing attention to resource use currently and in the near future. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
AB - Objective: Neuroimaging studies frequently are ordered to investigate neuro-ophthalmic symptoms. When misused, these studies are expensive and time consuming. This study describes the type and frequency of neuroimaging errors in patients referred to an academic neuro-ophthalmology service and measures how frequently these neuroimaging studies were reinterpreted. Design: Prospective cohort study. Participants: Eighty-four consecutive patients referred to an academic neuro-ophthalmology practice. Methods: From November 2009 through July 2010, 84 consecutive new patients who had undergone a neuroimaging study in the last 12 months specifically to evaluate their presenting neuro-ophthalmic symptoms were enrolled prospectively. Participants then underwent a complete neuro-ophthalmic evaluation, followed by a review of prior neuroimaging. Questions regarding appropriateness of the most recent imaging, concordance of radiologic interpretation, and re-evaluation of referring diagnoses were answered by the attending physician. Main Outcome Measures: The frequency and types of errors committed in the use of neuroimaging and the frequency of reinterpretation of prereferral neuroimaging studies after neuro-ophthalmic history and examination. Results: Most study participants (84.5%; 71/84) underwent magnetic resonance imaging before referral; 15.5% (13/84) underwent only computed tomography. The rate of suboptimal neuroimaging studies was 38.1% (32/84). The 3 most common reasons for suboptimal studies were incomplete area of imaging (34.4%; 11/32), wrong study type (28.1%; 9/32), and poor image quality (21.9%; 7/32). Twenty-four of 84 subjects (28.6%) required additional neuroimaging. The authors agreed with the radiology interpretation of the prior neuroimaging studies in most patients (77.4%; 65/84). The most common anatomic locations for discordance in interpretation were the intraorbital optic nerve (35%; 7/20) and the brainstem (20%; 4/20). Conclusions: There was a high rate of suboptimal neuroimaging studies performed in patients referred for neuro-ophthalmology examination. These findings have significant implications given the increasing attention to resource use currently and in the near future. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
UR - http://www.scopus.com/inward/record.url?scp=84864445942&partnerID=8YFLogxK
U2 - 10.1016/j.ophtha.2012.01.044
DO - 10.1016/j.ophtha.2012.01.044
M3 - Article
C2 - 22484117
AN - SCOPUS:84864445942
SN - 0161-6420
VL - 119
SP - 1701
EP - 1704
JO - Ophthalmology
JF - Ophthalmology
IS - 8
ER -