McMaster University

McMaster University

Faculty of
Health Sciences

Many not receiving recommended follow-up testing

By Laura Thompson
Published: June 28, 2010
John You
John You, an assistant professor in the Department of Medicine of the Michael G. DeGroote School of Medicine


Less than 38 per cent of Ontarians are receiving recommended follow-up testing six months after an initial CT or MRI scan.

New research led by McMaster University physician-scientist John You shows many computed tomography (CT) or magnetic resonance imaging (MRI) reports contain suggestions for further diagnostic testing, but these suggestions are often not followed.

John You, an assistant professor in the Department of Medicine of the Michael G. DeGroote School of Medicine, led the study for the Institute for Clinical Evaluative Sciences (ICES). The study is published in the June 2010 issue of the American Journal of Medicine.

The study of almost 16,000 patients who received an outpatient CT or MRI scans in Ontario in 2005 found further diagnostic testing was recommended in one in eight (13 per cent) of test reports, most often after CT scans of the chest, but almost two-thirds had not been done by six months after the initial scan.

The study authors suggest these findings might be explained in three different ways:

  • Radiologists reading the CT or MRI scan images were erring on the side of caution because they had not been given enough information about the patient to say with confidence that there wasn’t a serious disease present. As a result, they were recommending further testing when sometimes it wasn’t necessary.
  • There may be poor continuity of care with gaps in the delivery or tracking of imaging test results.
  • Physicians, after discussing the results with their patients, may make a decision not to proceed with the recommended testing because of patient preferences or because the further testing is judged to be of limited use.

"In this study we could not determine the reasons for the ‘missed testing,’ so we can't say which of the above explanations is the main driver of the patterns of care," said You, who is also an associate member of the Department of Clinical Epidemiology and Biostatistics at McMaster and an adjunct scientist at ICES.

"However, we believe that improved exchange of information between physicians seeing patients and radiologists reading the scans would help improve the situation."

The researchers recommended the use of electronic or web-enabled CT/MRI requisitions that ask referring physicians to provide more targeted, disease-specific information which may help radiologists give more useful information in their test reports.

Study Article

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