RSNA2023 Leading Through Change
Daily Bulletin

Radiologists Can Help Reduce Patient Cancellations/No-Shows

Thursday, Nov. 30, 2023

By Lynn Antonopoulos

Cancellations and no-shows are more common in certain sociodemographic subgroups and can lead to disparities that have devastating consequences in patient outcomes.



Radiologists can play a role in mitigating the negative impact of these occurrences by creating and enacting interventions that address disparities and ensure all patient groups receive timely and necessary diagnostic imaging.

"It's important that interventions are made to limit the number of cancellations via an imaging center/ordering provider checklist, or even through addressing important health-related social risks," said Arham Aijaz, BS, first author of a study conducted under Gelareh Sadigh, MD, director of health services and comparative outcome research at the University of California, Irvine.

Speaking to an engaged audience during a Wednesday morning session, Aijaz shared the results of a study he and his colleagues developed to identify sociodemographic factors associated with cancellations and no-shows in an outpatient radiology setting. Because these events can lead to delayed care and worsened outcomes, the researchers also sought to evaluate the prevalence of these events.

Using clinical data from an urban academic health center, the team identified adult patients who either canceled or did not arrive for outpatient imaging appointments between January 2022 and January 2023. The study examined 19,262 missed encounters, predominantly women (67.1%), with a mean age of 60.8 years.

They identified a cancellation prevalence of 22.3% and a no-show prevalence of 2%. Among cancellations, 70.19% were patient-initiated, 18.68% were provider-initiated, and 11.03% were imaging center-initiated. They also assessed and compared the sociodemographic factors associated with no-shows versus cancellations.

Social Factors Play Role

Factors associated with increased likelihood of being a no-show as opposed to a cancellation included being Black, Hispanic, single, divorced/separated, without commercial insurance (i.e., Medicare, Medicaid, self-pay) or those living in the most disadvantaged neighborhoods. Older adults, women, Asians, English speakers, and those undergoing any other modality than CT were less likely to have no-shows.

"Our research highlights an increased number of cancellations for imaging appointments in our study. It also highlights potential disparities with regards to certain sociodemographic subgroups having an increased likelihood of no-shows," Aijaz said.

The results support findings in some prior studies, yet Aijaz noted that the study revealed some surprises. "One finding that was quite unexpected was how elevated our institution's cancellation rates were (22.3%) compared to previously reported literature (8%)," he said. "However, it's possible that this elevation is due to the flexibility of self-scheduling and being able to cancel and reschedule your appointments."

Aijaz added that at his institution, mammography, as compared to CT, was associated with a decreased likelihood of no-show, a finding he said was also different from prior studies.

Despite the results, Aijaz noted that identifying the specific reasons for no-shows remained a challenge in this study. "We were not aware of the exact reasons for patient no-shows as they were not recorded. This is something we aim to address in the future with a prospective survey study assessing reasons for no-shows," he said.

"Providing education on the consequences of no-shows to these sociodemographic subgroups also remains important to limit the likelihood of no-shows. By enacting these interventions, we can benefit patient outcomes," Aijaz said.

Access the presentation, "Assessing the Role of Patient Social Factors on Radiology Cancellations and No-Shows," (W1-SSNPM04-04) on demand at