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STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate the clinical relevance, usefulness, and financial implications of intraoperative radiograph interpretation by radiologists in spine surgery. SUMMARY OF BACKGROUND DATA: Due to rising health care costs, spine surgery is under scrutiny to maximize value-based care. Formal radiographic analysis remains a potential source of unnecessary health care costs, especially for intraoperative radiographs. MATERIALS AND METHODS: A retrospective cohort analysis was performed on all adult elective spine surgeries at a single institution between July 2020 and July 2021. Demographic and radiographic data were collected, including intraoperative localization and post-instrumentation radiographs. Financial data were obtained through the institution's price estimator. Radiographic characteristics included time from radiographic imaging to completion of radiologist interpretation report, completion of radiologist interpretation report before the conclusion of surgical procedure, clinical relevance, and clinical usefulness. Reports were considered clinically relevant if the spinal level of the procedure was described and clinically useful if completed before the conclusion of the procedure and deemed clinically relevant. RESULTS: Four hundred eighty-one intraoperative localization and post-instrumentation radiographs from 360 patients revealed a median delay of 128 minutes between imaging and completion of the interpretive report. Only 38.9% of reports were completed before the conclusion of surgery. There were 79.4% deemed clinically relevant and only 33.5% were clinically useful. Localization reports were completed more frequently before the conclusion of surgery (67.2% vs. 34.4%) but with lower clinical relevance (90.1% vs. 98.5%) and clinical usefulness (60.3% vs. 33.6%) than post-instrumentation reports. Each patient was charged $32 to $34 for the interpretation fee, cumulating a minimum total cost of $15,392. CONCLUSIONS: Formal radiographic interpretation of intraoperative spine radiographs was of low clinical utility for spine surgeons. Institutions should consider optimizing radiology workflows to improve timeliness and clinical relevance or evaluate the necessity of reflexive consultation to radiology for intraoperative imaging interpretation to ensure that value-based care is maximized during spine surgeries. LEVEL OF EVIDENCE: 3.

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Background: Radiology is a fundamental tool on outpatient Family Medicine practice. Its adverse effects include its abuse, given that the patient is exposed to unnecessary radiation, and health care costs increase. Objective: To evaluate the implementation of a radio-diagnostic congruence strategy (RDCS) in a first-level unit in Mexico City. Material and methods: It was carried out an experimental, longitudinal study that covered both a previous period of time and another one after implementing the RDCS. It was evaluated the congruence between the diagnosis and the appropriateness of the imaging studies on the basis of the correspondent clinical practice guidelines. It was applied as well a bivariate statistical analysis that associated the diagnosis, the anatomical region and the patients' sex. Results: The number of imaging studies diminished substantially, while the congruence increased; this was associated to the anatomical region and the diagnosis; sex was not a decisive variable. Conclusions: Implementing the RDCS shows positive effects, since the number of requests for imaging diminished (in 43.7%), and the radio-diagnostic congruence increased (8.5%) after implementing the RDCS. The reduction of requests for imaging could have been influenced by the fact that the medical staff could have been inhibited after been monitored, which could have led them to dispatch only the necessary requests for imaging. Our findings concur with the literature in the number of imaging studies requested in the first level of care, and the necessity to check out its appropriateness in order to increase its effectivity.

Introducción: la radiología es un recurso fundamental en la consulta externa de Medicina Familiar. Sus efectos adversos incluyen su abuso, pues se expone al paciente a radiación innecesaria y se eleva el gasto en los servicios públicos. Objetivo: evaluar la implementación de una estrategia de congruencia radiodiagnóstica (ECR) en una unidad del primer nivel de atención en Ciudad de México. Material y métodos: se hizo un estudio experimental, longitudinal, que abarcó un periodo previo y uno posterior a la ECR. Se evaluó la congruencia entre el diagnóstico y la pertinencia del estudio con base en las guías de práctica clínica correspondientes. Se aplicó un análisis bivariado con cálculo de medidas de asociación y significación estadística entre el diagnóstico, la región anatómica y el sexo de los pacientes. Resultados: disminuyó sustancialmente el número de estudios y aumentó la congruencia. Esta estuvo asociada a la región anatómica y al diagnóstico. El sexo no fue una variable que influyera. Conclusiones: implementar la ECR muestra efectos positivos, pues disminuyó el número de estudios radiológicos solicitados (en un 43.7%) y se elevó la congruencia radiodiagnóstica en el periodo expost (en un 8.5%). En la disminución de estudios realizados pudo influir una inhibición del personal médico, que quizás se percibió auditado y restringió la solicitud de radiografías solo a los casos necesarios. Nuestros hallazgos coinciden con la literatura en el número de estudios radiológicos que se solicitan en el primer nivel de atención y la necesidad de revisar su correcta indicación para elevar su efectividad.

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Objetivo Analizar, desde la perspectiva del pagador, la costo efectividad de la adición de resonancia magnética a la radiografía convencional en pacientes con pie diabético y signos de infección, en Colombia. Métodos Mediante un modelo de Markov, se identificó la relación de costo-efectividad de la adición de resonancia magnética a la radiografía convencional en pacientes con pie diabético y signos de infección en Colombia. La perspectiva es la del pagador. Los costos se valoraron en pesos colombianos de 2008, la efectividad se mide en años de vida ajustados por discapacidad, AVAD y el umbral de costo efectividad fue el PIB per cápita colombiano de 2008, $ 10 761 691. Resultados Usar resonancia magnética además de radiografía convencional en estos pacientes tiene un indicador de costo efectividad incremental por AVAD de $ 1 532 778 y de $ 1 741 311 sin y con descuento respectivamente. Los resultados son robustos a pruebas de sensibilidad. Conclusiones La resonancia magnética unida a la radiografía convencional en la evaluación del pie diabético con signos de infección es costo-efectiva para Colombia.

Objective Performing a cost-effectiveness analysis of adding magnetic resonance to conventional radiography in patients suffering from diabetic foot and signs of infection from the payer's point of view. Material and methods The cost effectiveness (from the payer's point of view) of conventional radiography plus magnetic resonance was calculated for patients having diabetic foot and signs of infection by means of a Markov model. Costs were measured in 2008 Colombian pesos and effectiveness in terms of disability adjusted life years (DALY). The cost-effectiveness threshold was the Colombian 2008 per capita GDP, $ 10,761,691. Results Using magnetic resonance in addition to conventional radiography in this population had a $ 1,532,778 and $ 1,741,311 incremental cost-effectiveness ratio, without and with discount, respectively; the results were robust to sensitivity analysis. Conclusions Using magnetic resonance in addition to conventional radiography in patients suffering from diabetic foot and signs of infection was cost-effective for Colombia.

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OBJECTIVE: Performing a cost-effectiveness analysis of adding magnetic resonance to conventional radiography in patients suffering from diabetic foot and signs of infection from the payer's point of view. MATERIAL AND METHODS: The cost effectiveness (from the payer's point of view) of conventional radiography plus magnetic resonance was calculated for patients having diabetic foot and signs of infection by means of a Markov model. Costs were measured in 2008 Colombian pesos and effectiveness in terms of disability adjusted life years (DALY). The cost-effectiveness threshold was the Colombian 2008 per capita GDP, $ 10,761,691. RESULTS: Using magnetic resonance in addition to conventional radiography in this population had a $ 1,532,778 and $ 1,741,311 incremental cost-effectiveness ratio, without and with discount, respectively; the results were robust to sensitivity analysis. CONCLUSIONS: Using magnetic resonance in addition to conventional radiography in patients suffering from diabetic foot and signs of infection was cost-effective for Colombia.

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O Programa de Garantia de Qualidade, implementado no Serviço de Radiologia do Hospital da Polícia Militar - RJ, propiciou a reduçäo de 70 por cento na taxa de rejeiçäo de filmes e de 75 por cento nos custos. Entretanto, a descontinuidade do Programa tem conduzido ao retorno a situaçäo anterior a implementaçäo.

A Quality Assurance Program, implemented at the Radiology Service of the Hospital of the Military Police in Rio de Janeiro, brought about a reduction of 70% in the number of rejected films and 75% in the costs. The discontinuation of the program has however lead to a return to the former conditions.

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The authors address three issues associated with the implementation of the model proposed by Hsiao, et al. First, the mathematical model used and its underlying assumption, in particular as it relates to "time," is questioned. Second, the authors argue that measured rather than perceived (surveyed) data should be used whenever possible. This is particularly true for "time." Third, the authors raise the possibility that adjustments can and should be made based on the type and average complexity of examinations performed at different facilities. The potential implications of RBRVS reimbursement schemes on the practice of diagnostic radiology are significant and, once implement, they will be difficult to alter.

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