The Overuse of Hepatobiliary Scintigraphy (HIDA) Scans: Are We Unnecessarily Using Nuclear Medicine Resources Instead of Proven Clinical Guidelines for Diagnosing Acute Cholecystitis?

Background Gallstone disease significantly burdens the United States healthcare system. While ultrasonography (US), physical exam, and laboratory findings are the recommended primary workup and diagnostic modalities, hepatobiliary scintigraphy (HIDA) scans are occasionally used as an adjunct for diagnosis. This study evaluates HIDA scan utilization in comparison to clinical and US findings based on the Tokyo guidelines for diagnosing acute cholecystitis. Methods This retrospective study included 159 patients admitted with gallbladder disease from January 1, 2019, to December 31, 2020. Patients were classified by the Tokyo guidelines as having no cholecystitis, suspected, or definite cholecystitis. The primary outcome was HIDA scan overutilization, defined as HIDA scans performed despite clinical criteria for cholecystitis. Secondary outcomes included HIDA scan use in complicated gallbladder disease and the effect of admission day on HIDA scan ordering. Results Of the 159 patients who underwent cholecystectomy, 101 (63.5%) met the Tokyo guidelines for suspected or definite cholecystitis. Over half, 54 (53.5%) of these patients received HIDA scans, indicating overutilization. Additionally, no significant difference in HIDA scan utilization was observed based on the day of admission. Among patients with complicated gallbladder disease, 29 (38.2%) underwent a HIDA scan, which was deemed unnecessary. Conclusion HIDA scans are significantly overutilized in patients meeting clinical criteria for cholecystitis based on the Tokyo guidelines and those with complicated gallbladder disease. Overuse increases healthcare costs and delays care. HIDA scans should be reserved for cases with inconclusive US results but high clinical suspicion for cholecystitis. Proper utilization and reduction of unnecessary HIDA scans could improve patient care efficiency and reduce healthcare expenditures.