Clinical practice management
Imaging stewardship in the age of value
R-SCAN: Imaging for Uncomplicated Acute Rhinosinusitis

https://doi.org/10.1016/j.jacr.2016.08.018Get rights and content

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Obstacles to Change

Multiple reasons can be identified for the continued widespread use of imaging in the diagnosis and management of uncomplicated acute rhinosinusitis.

CT sinus scans are fast and widely available, and technology is rapidly evolving to reduce associated radiation exposure. The ability to quickly rule out sinusitis with sinus CT may be a reason for clinicians to rely on sinus imaging in acute sinusitis, even if there is no change in patient outcome. Our current fee-for-service system has placed

Resources to Make Change

It is therefore crucial to reduce the number of CT scans ordered for patients with acute rhinosinusitis. These scans are associated with radiation exposure and unnecessary health care expenses, and they do not change patient outcomes. Reducing unnecessary imaging can be achieved through evidence-based principles, such as the ACR Appropriateness Criteria, and their implementation through various clinical decision-making programs, such as the R-SCAN initiative and the American College of

Conclusions

Uncomplicated acute rhinosinusitis is a common medical problem leading to significant health care expenditures, in part owing to frequent imaging overutilization. Although CT imaging has a role in complicated or recurrent sinusitis, chronic sinusitis, and sinusitis in the immunocompromised patient, CT imaging of patients with uncomplicated acute rhinosinusitis does not lead to improved patient outcomes, increases the patient radiation exposure, and is costly to the patient and the health care

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Cited by (3)

The authors have no conflicts of interest related to the material discussed in this article.

The Radiology Support, Communication, and Alignment Network (R-SCAN; www.rscan.org) is a CMS-sponsored effort leveraging the collaboration between radiologists and referring physicians to improve the appropriate utilization of imaging in patient care. R-SCAN is aligned with the American Board of Internal Medicine Foundation’s Choosing Wisely® campaign and the American College of Physicians’ High Value Care Initiative and targets a number of emergency and outpatient imaging topics, including imaging for uncomplicated acute rhinosinusitis. Max Wintermark, MD is a clinical advisor for R-SCAN.

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