Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec;50(12):5774-5781.
doi: 10.1007/s00261-025-05022-7. Epub 2025 May 29.

Decreasing inappropriate MRCP with contrast exams: impact of an EMR-Embedded clinical care pathway

Daniella Asch  1 , Gowthaman Gunabushanam  2 , Kelsey Cole  3 , Christine Holland  3 , Jay K Pahade  2
Affiliations

Decreasing inappropriate MRCP with contrast exams: impact of an EMR-Embedded clinical care pathway

Daniella Asch et al. Abdom Radiol (NY). 2025 Dec.

Abstract

Purpose: Decrease unnecessary abdominal MRI with intravenous contrast with MRCP exams for emergency department and inpatients.

Methods: Our institution's two MRCP orders were removed from the electronic medical record (one with intravenous (IV) contrast and the other without), with all providers directed to a new MRCP clinical care pathway containing clinical guidance and links to the appropriate orders based on indication and patient characteristics. Before and after deployment, a random set of MRCP with contrast orders were reviewed for clinical appropriateness of needing IV contrast. A manual tracking of "patient in room" time was performed to compare MRI resource use for MRCP exams with contrast vs. non-contrast. A commercial clinical decision support (CDS) tool was active throughout the study period. Statistical significance was assessed with Chi-square test.

Results: At baseline, 71% (142/200) of MRCP exams were completed with contrast and 29% (58/200) without contrast. After two plan-do-study-act (PDSA) cycles, percentage of MRCPs performed with contrast decreased to 56% (p = 0.003), a 22% relative decrease, and MRCPs performed without contrast increased to 44%, a 53% relative increase. At baseline, contrast use was deemed inappropriate in 54% (29/54) of MRCP studies. Reassessment after PDSA cycle 1 showed a decrease in inappropriate MRCP with contrast orders to 25% (9/36), a 53% relative decrease (p = 0.007). Mean "in room" time was 11.5 min longer for MRCP with contrast exams.

Conclusion: Despite CDS, MRCP with contrast orders were deemed inappropriate 54% of the time at baseline. Redesigning the MRCP ordering process via creation of a pathway with embedded clinical guidance significantly decreased the proportion of contrast-enhanced MRCP exams by 22% and improved relative clinical appropriateness of MRCP with contrast exams by 62%. Properly directing ordering providers to non-contrast MRCP orders can help reduce healthcare costs, reduce unnecessary gadolinium exposure, and improve MR scanner efficiency.

Keywords: Clinical pathway; Contrast; MRCP; Order entry; Quality improvement.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

References

    1. Kang SK, Heacock L, Doshi AM, Ream JR, Sun J, Babb JS. Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients. Abdominal Radiology. 2017;42:1650–8. - DOI - PubMed
    1. Tso DK, Almeida RR, Prabhakar AM, Singh AK, Raja AS, Flores EJ. Accuracy and timeliness of an abbreviated emergency department MRCP protocol for choledocholithiasis. Emergency Radiology. 2019;26:427–32. - DOI - PubMed
    1. McDonald RJ, Weinreb JC, Davenport MS. Symptoms Associated with Gadolinium Exposure (SAGE): A Suggested Term. Radiology. 2022;302(2):270–3. Epub 20211116. doi: https://doi.org/10.1148/radiol.2021211349 . PubMed PMID: 34783590. - DOI - PubMed
    1. American College of Radiology ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. 2024.
    1. Ludwig DR, Itani M, Childs DD, Revzin MV, Das KK, Anderson MA, et al. Biliary Duct Dilatation: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. 2024;222(4):e2329671. Epub 20230726. doi: https://doi.org/10.2214/ajr.23.29671 . PubMed PMID: 37493325. - DOI - PubMed

MeSH terms

LinkOut - more resources