Sex differences in inappropriate imaging requests: insights from the Medical Imaging Decision And Support (MIDAS) study.

Abstract

Inappropriate diagnostic imaging can lead to unnecessary radiation exposure, delayed diagnoses, and increased healthcare costs. While multiple factors contribute to inappropriate imaging, sex-based disparities remain understudied. This study investigates whether inappropriate imaging requests differ among women and men. We analyzed baseline data from the MIDAS study, a multi-center cluster-randomized trial conducted in three academic hospitals in Germany. Imaging requests submitted via computerized physician order entry systems were evaluated for appropriateness using the ESR iGuide, a clinical decision support tool based on the American College of Radiology Appropriateness Criteria. Requests were classified as appropriate, conditionally appropriate, or inappropriate. We compared the proportion of inappropriate requests between male and female patients using chi-square tests and calculated odds ratios, applying Bonferroni corrections for multiple comparisons. Among 61,220 scored imaging requests, 31,025 were for women and 30,195 for men. The proportion of inappropriate requests was significantly higher in women (7.32%) compared to men (6.08%) (OR 1.22, 99% CI: 1.12-1.33, p < 0.001), with significant differences observed in subgroups for MR and among patients aged 25-65. Women were more likely than men to receive inappropriate imaging requests, suggesting potential disparities in diagnostic decision-making. Addressing these gaps will require further research and more sex- and gender-sensitive approaches in clinical decision-making and guideline development to ensure equitable imaging practices. Question Inappropriate diagnostic imaging incurs radiation exposure and costs. Sex-based disparities in this context are understudied; do inappropriate imaging requests differ between men and women? Findings Among 61,220 requests, inappropriate orders were significantly higher in women (7.32%) than in men (6.08%). Clinical relevance Our results suggest sex differences in diagnostic decision-making. Further research and sex- and gender-sensitive approaches in guideline development are needed to ensure equitable imaging practices.