# Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting

> **NIH AHRQ R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $340,462

## Abstract

A recent 15-year study of six large integrated health systems estimated 1.18 imaging tests per patient per year
were performed in the United States, which amounts to an estimated 400 million imaging tests performed each
year, at a cost of approximately $100 billion annually. Three quarters of these tests are performed in the
ambulatory setting and although diagnostic imaging is predominantly non-invasive, it carries safety risks that
could potentially harm patients. In addition, diagnostic errors are magnified when diagnostic imaging is utilized
inappropriately and/or when there is no closed-loop system to monitor diagnostic follow-up. Thus, identifying
contributing factors to diagnostic imaging failures in ambulatory care is of utmost importance.
Cancer is one of the most common leading missed diagnoses in diagnostic litigation cases. Lung cancer is the
leading cause of cancer deaths in the United States, followed by breast cancer in women. The most common
suspicious abnormality for lung cancer on CT scan include lung nodules. Thus, standardized follow-up of lung
nodules impacts early cancer detection, which provides the best chance for survival in lung cancer patients.
Similarly, breast cancer screening is a mainstay of public health in the country with over 33 million women
receiving mammograms each year. Recommendation for Breast Imaging Reporting and Data System
(BIRADS) category 3 breast findings typically includes 6-month follow-up imaging. We therefore plan to assess
suboptimal follow-up for patients with lung nodules and BIRADS category 3 breast findings.
We propose a project that assesses diagnostic failures that are related to diagnostic imaging from two sources:
(1) safety events related to all modalities of diagnostic imaging from an electronic safety reporting system, and
(2) the institution's Patient Safety Net Initiative (PSNI), which combines Health Information Technology (HIT)
and Care Coordination approaches for monitoring imaging follow-up. We focus on two specific aims to identify,
characterize and evaluate contributing factors to diagnostic failures. These include (1) To measure the
incidence of safety events that are related to diagnostic imaging from safety reports submitted to an electronic
safety reporting system; and (2) To measure the incidence of suboptimal follow-up and comprehensively
assess the impact of socio-technical factors on suboptimal diagnostic exam follow-up care in the ambulatory
setting, specifically for two clinically significant findings with follow-up requirements: lung nodules and BIRADS
category 3 breast findings.
Diagnostic imaging in the ambulatory setting is influenced by socio-technical factors that contribute to
performance of inappropriate exams as well as suboptimal follow-up care, all leading to diagnostic imaging
failures. This study will identify these factors and assess their impact on diagnostic exam follow-up care in the
ambulatory setting using the Patient Safety Net Initiative.

## Key facts

- **NIH application ID:** 9927588
- **Project number:** 5R01HS024722-05
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Ronilda Lacson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $340,462
- **Award type:** 5
- **Project period:** 2016-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9927588

## Citation

> US National Institutes of Health, RePORTER application 9927588, Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting (5R01HS024722-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9927588. Licensed CC0.

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