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Sumner C, Kietzman A, Kadom N, Frigini A, Makary MS, Martin A, McKnight C, Retrouvey M, Spieler B, Griffith B. Medical Malpractice and Diagnostic Radiology: Challenges and Opportunities. Acad Radiol 2024; 31:233-241. [PMID: 37741730 DOI: 10.1016/j.acra.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
Medicolegal challenges in radiology are broad and impact both radiologists and patients. Radiologists may be affected directly by malpractice litigation or indirectly due to defensive imaging ordering practices. Patients also could be harmed physically, emotionally, or financially by unnecessary tests or procedures. As technology advances, the incorporation of artificial intelligence into medicine will bring with it new medicolegal challenges and opportunities. This article reviews the current and emerging direct and indirect effects of medical malpractice on radiologists and summarizes evidence-based solutions.
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Affiliation(s)
- Christina Sumner
- Department of Radiology and Imaging Sciences, Emory University (C.S., N.K.), Atlanta, GA
| | | | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University (C.S., N.K.), Atlanta, GA
| | - Alexandre Frigini
- Department of Radiology, Baylor College of Medicine (A.F.), Houston, TX
| | - Mina S Makary
- Department of Radiology, Ohio State University Wexner Medical Center (M.S.M.), Columbus, OH
| | - Ardenne Martin
- Louisiana State University Health Sciences Center (A.M.), New Orleans, LA
| | - Colin McKnight
- Department of Radiology, Vanderbilt University Medical Center (C.M.), Nashville, TN
| | - Michele Retrouvey
- Department of Radiology, Eastern Virginia Medical School/Medical Center Radiologists (M.R.), Norfolk, VA
| | - Bradley Spieler
- Department of Radiology, University Medical Center, Louisiana State University Health Sciences Center (B.S.), New Orleans, LA
| | - Brent Griffith
- Department of Radiology, Henry Ford Health (B.G.), Detroit, MI.
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Bunch PM, Aribindi S, Gorris MA, Randle RW. Opportunistic CT Assessment of Parathyroid Glands: Utility of Radiologist-Recommended Biochemical Evaluation for Diagnosing Primary Hyperparathyroidism. AJR Am J Roentgenol 2023; 221:218-227. [PMID: 36946894 DOI: 10.2214/ajr.23.29049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND. Existing gaps in primary hyperparathyroidism (PHPT) diagnosis and treatment have prompted calls for systemic change in the approach to this disease. One proposed change is opportunistic assessment for enlarged parathyroid glands on routine CT examinations, to target biochemical testing to individuals most likely to have un-diagnosed PHPT. OBJECTIVE. The purpose of our study was to assess the utility of a radiologist recommendation for biochemical testing in patients with a suspected enlarged parathyroid gland on routine CT for identifying previously undiagnosed PHPT. METHODS. This retrospective study included patients without known or suspected PHPT who underwent routine CT (i.e., performed for reasons other than known or suspected parathyroid disease) between August 2019 and September 2021 in which the clinical CT report included a radiologist recommendation for biochemical testing to evaluate for possible PHPT because of a suspected enlarged parathyroid gland. Neuroradiologists at the study institution included this recommendation on the basis of individual judgment without formal criteria. The EHR was reviewed to identify patients who underwent subsequent laboratory evaluation for PHPT. An endocrine surgeon used available laboratory results and clinical data to classify patients as having PHPT, secondary hyper-parathyroidism, or no parathyroid disorder independent of the CT findings. RESULTS. The sample comprised 39 patients (median age, 68 years; 20 women, 19 men) who received the radiologist recommendation for biochemical evaluation. Of these patients, 13 (33.3%) received the recommended biochemical evaluation. Of the 13 tested patients, three (23.1%) were classified as having PHPT, four (30.8%) as having secondary hyperparathyroidism, and six (46.2%) as having no parathyroid disorder. Thus, the number of patients needing to receive a radiologist recommendation for biochemical testing per correct PHPT diagnosis was 13.0, and the number of patients needing to undergo laboratory testing per correct PHPT diagnosis was 4.3. One of the three patients classified as having PHPT underwent surgical resection of the lesion identified by CT, which was shown on histopathologic evaluation to represent hypercellular parathyroid tissue. CONCLUSION. Radiologist recommendations for biochemical testing in patients with suspected enlarged parathyroid glands on routine CT helped to identify individuals with undiagnosed PHPT. CLINICAL IMPACT. Opportunistic assessment for enlarged parathyroid glands on routine CT may facilitate PHPT diagnosis.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Swetha Aribindi
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157
| | - Matthew A Gorris
- Department of Endocrinology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Reese W Randle
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
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Voreis S, Mattay G, Cook T. Informatics Solutions to Mitigate Legal Risk Associated With Communication Failures. J Am Coll Radiol 2022; 19:823-828. [PMID: 35654145 DOI: 10.1016/j.jacr.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
Communication failures are a documented cause of malpractice litigation against radiologists. As imaging volumes have increased, and with them the number of findings requiring further workup, radiologists are increasingly expected to communicate with ordering clinicians. However, communication may be unsuccessful for a variety of reasons that expose radiologists to potential malpractice risk. Informatics solutions have the potential to improve communication and decrease this risk. We discuss human-powered, purely automated, and hybrid approaches to closing the communications loop. In addition, we describe the Patient Test Results Information Act (Pennsylvania Act 112) and its implications for closing the loop on noncritical actionable findings.
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Affiliation(s)
- Shahodat Voreis
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Govind Mattay
- John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Tessa Cook
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Chief, 3-D and Advanced Imaging; Codirector, Center for Practice Transformation in Radiology; Fellowship Director, Imaging Informatics; Member, ACR Informatics Commission; Vice Chair, ACR Commission on Patient- and Family-Centered Care; Past Cochair, ACR Informatics Summit.
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Kadom N, Venkatesh AK, Shugarman SA, Burleson JH, Moore CL, Seidenwurm D. Novel Quality Measure Set: Closing the Completion Loop on Radiology Follow-up Recommendations for Noncritical Actionable Incidental Findings. J Am Coll Radiol 2022; 19:881-890. [PMID: 35606263 DOI: 10.1016/j.jacr.2022.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Care gaps occur when radiology follow-up recommendations are poorly communicated or not completed, resulting in missed or delayed diagnosis potentially leading to worse patient outcomes. This ACR-led initiative assembled a technical expert panel (TEP) to advise development of quality measures intended to improve communication and drive increased completion rates for radiology follow-up recommendations. MATERIALS AND METHODS A multistakeholder TEP was assembled to advise the development of quality measures. The project scope, limited to noncritical actionable incidental findings (AIFs), encourages practices to develop and implement systems ensuring appropriate communication and follow-up to completion. RESULTS A suite of nine measures were developed: four outcome measures include closing the loop on completion of radiology follow-up recommendations for nonemergent AIFs (with pulmonary nodule and abdominal aortic aneurysm use cases) and overall cancer diagnoses. Five process measures address communication and tracking of AIFs: inclusion of available evidence or guidelines informing the recommendation, communication of AIFs to the practice managing ongoing care, identifying when AIFs have been communicated to the patient, and employing tracking and reminder systems for AIFs. CONCLUSION This ACR-led initiative developed a measure set intended to improve patient outcomes by ensuring that AIFs are appropriately communicated and followed up. The intent of these measures is to focus improvement on specific areas in which gaps in communication and AIF follow-up may occur, prompting systems to devote resources that will identify and implement solutions to improve patient care.
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Johansson ED, Hughes RT, Meegalla NT, Porosnicu M, Patwa HS, Lack CM, Bunch PM. Neck Imaging Reporting and Data System Category 3 on Surveillance Computed Tomography: Incidence, Biopsy Rate, and Predictive Performance in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2022; 132:1792-1797. [PMID: 35043989 DOI: 10.1002/lary.30025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system for head and neck cancer surveillance. Imaging findings of high suspicion for recurrence are assigned Category 3 and recommended for "Biopsy, if clinically indicated." After implementing NI-RADS for surveillance neck computed tomography (CT), our objectives are to determine the incidence of squamous cell carcinoma (SCC) Category 3 lesions in the year post-implementation, the associated biopsy rate, and the positive predictive value of NI-RADS 3 for SCC recurrence. STUDY DESIGN Retrospective cohort study. METHODS Neck CTs reported with NI-RADS between February 2020 and February 2021 were reviewed to identify patients undergoing surveillance for SCC assigned NI-RADS 3. Cancer recurrence, defined as positive biopsy result or treatment of clinically determined recurrence, was determined by electronic medical record review. RESULTS During the study period, 580 neck CTs were reported with NI-RADS, of which 39 (7%) CTs obtained in 37 unique patients (28 male, 9 female, mean age 66.6 years) formed the study cohort. Biopsies were obtained in 23 lesions (45%), of which 17 (74%) were positive for recurrent SCC. One nondiagnostic biopsy was clinically determined to represent recurrence. Of 28 (55%) lesions not biopsied, 18 (64%) were ultimately treated as clinically determined recurrence. Thus, among 51 individual NI-RADS 3 lesions (32 primary, 19 neck), 36 (71%) represented recurrence. CONCLUSION The incidence of NI-RADS 3 lesions in our cohort was 7%. The biopsy rate was 45%, and the overall positive predictive value of NI-RADS 3 for recurrent SCC was 71%. Category 3 lesions are associated with substantial SCC recurrence risk and should be managed accordingly. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Erik D Johansson
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nuwan T Meegalla
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Christopher M Lack
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, U.S.A
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Alsharif S, Alasaad G, Bukhari MK, Sharkar A, Altaf M, Milibari S, Alsulimani R, Alshamrani KM. Assessment of the Response to Abdominal and Pelvic Computed Tomography Report Recommendations: A Single-Center, Retrospective, Chart Review Study. Cureus 2022; 14:e21190. [PMID: 35186516 PMCID: PMC8844232 DOI: 10.7759/cureus.21190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives The radiology report is the primary form of communication between the radiologists and referring clinicians. It is a structured document containing several key components pertaining to the interpretation of radiological examinations and may require the addition of follow-up imaging recommendations to optimize patient outcomes. This study aims to determine whether follow-up imaging recommendations are being acknowledged and acted upon by referrers. Methods This retrospective study was conducted at a single tertiary hospital. Prerecorded BESTCare data of patients who underwent abdominal and pelvic computed tomography (CT) scans between October 1, 2017, and December 31, 2017, and received recommendations for further evaluation were collected after obtaining ethical approval from the local authority. Data of patients younger than 14 years old, patients who did not receive a recommendation, and patients who had CT scans that were uploaded to the BESTCare system but were performed outside the institution were excluded. The collected data were recorded in a password-protected Microsoft Excel file for further analysis. Results A total of 523 report recommendations from 422 abdominal and pelvic CT reports were analyzed. The most common organs indicated for CT scan evaluation were the breast (N = 54, 10.33%), kidney (N = 46, 8.80%), lymph node (N = 36, 6.88%), and colon (N = 33, 6.31%). The most common type of further evaluation recommended was further imaging (N = 410, 78.39%). A total of 278 (53.15%) recommendations were not performed, with 199 (71.58%) not having a documented rationale for noncompliance. Conclusion The majority of the follow-up imaging recommendations to ordering physicians were not carried out. This study highlights the need for notification and audit systems to monitor compliance with follow-up recommendations. Improving the communication between radiologists and referring physicians is key to optimizing patient healthcare.
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Andronikou S, Otero HJ, Belard S, Heuvelings CC, Ruby LC, Grobusch MP. Radiologists should support non-radiologist point-of-care ultrasonography in children: a case for involvement and collaboration. Pediatr Radiol 2022; 52:604-607. [PMID: 34559280 PMCID: PMC8475878 DOI: 10.1007/s00247-021-05185-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/08/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401, Civic Center Blvd., Philadelphia, PA 19104, USA. .,Department of Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hansel J Otero
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Department of Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Sabine Belard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin, Berlin, Germany ,Berlin Institute of Health, Berlin, Germany
| | - Charlotte Carina Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa C. Ruby
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin, Berlin, Germany
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
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Kadom N, Fredericks N, Moore CL, Seidenwurm D, Shugarman S, Venkatesh A. Closing the Compliance Loop on Follow-Up Imaging Recommendations: Comparing Radiologists' and Administrators' Attitudes. Curr Probl Diagn Radiol 2021; 51:486-490. [PMID: 34565635 DOI: 10.1067/j.cpradiol.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare non-physician healthcare professional and radiologists' survey responses regarding attitudes and current practices, policies, and procedures related to the follow-up of nonemergent actionable incidental findings (AIF). MATERIALS AND METHODS The American College of Radiology (ACR) developed a survey with input from a technical expert panel (TEP). Survey items were developed by TEP members, refined by an ACR market research expert, and were examined for face and construct validity. The survey was distributed among ACR membership and various medical professional organizations. Responses from non-physician responders and radiologists were analyzed and compared using descriptive statistics. RESULTS The analysis included 375 responses, 247 from radiologists and 128 from non-physicians. All respondent groups stated that radiology follow-up recommendations are evidence-based. Both respondent groups indicated that there is up to moderate risk associated with AIF follow-up. Both respondent groups similarly favored that the accountability for communicating AIF lies first with the ordering provider, followed by primary care providers, then the patient, and lastly an automated process that is managed by a staff member and/or the radiologist. All respondent groups indicated that tracking processes were more commonly funded by the healthcare system than through the radiology budget. CONCLUSION There is alignment between non-physicians and radiologists regarding the implementation of tracking systems that assure completion of radiology follow-up recommendations. Building tracking systems represents an opportunity for multi-disciplinary collaboration to address care transition communication and process gaps.
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Affiliation(s)
- Nadja Kadom
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | | | - Christopher L Moore
- Section of Emergency Ultrasound, Emergency Ultrasound Fellowship, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | | | | | - Arjun Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Engaging patients and families in pediatric radiology. Pediatr Radiol 2020; 50:1492-1498. [PMID: 32935240 DOI: 10.1007/s00247-020-04742-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/17/2020] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
While patient and family-centered care (PFCC) is currently a hot topic in medicine, it has long been a specific focus of pediatrics. The concept of PFCC includes a change in culture where physicians and patients move away from paternalism and instead view patients and families as partners in care. Although there are many ways in which adult-focused radiologists can learn from pediatric radiologists as leaders in PFCC, there remain many opportunities for improvement for all radiologists.
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Bucknor MD, Lichtensztajn DY, Lin TK, Borno HT, Gomez SL, Hope TA. Disparities in PET Imaging for Prostate Cancer at a Tertiary Academic Medical Center. J Nucl Med 2020; 62:695-699. [PMID: 32978283 DOI: 10.2967/jnumed.120.251751] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to evaluate differences between patients receiving 18F-fluciclovine and 68Ga-prostate-specific membrane antigen (68Ga-PSMA-11) for biochemically recurrent prostate cancer at a tertiary medical center. Methods: All 18F-fluciclovine and 68Ga-PSMA-11 PET studies performed at the University of California San Francisco from October 2015 to January 2020 were reviewed. Age, race/ethnicity, primary language, body mass index, insurance type, and home address were obtained through the electronic medical record. A logistic regression model was used to evaluate the predictor variables. Results: In total, 1,502 patients received 68Ga-PSMA-11 and 254 patients received 18F-fluciclovine. Black patients had increased odds of receiving imaging with 18F-fluciclovine versus 68Ga-PSMA-11 compared with non-Hispanic White patients (odds ratio, 3.88; 95% CI, 1.90-7.91). There were no other statistically significant differences. Conclusion: In patients receiving molecular imaging for prostate cancer at a single U.S. tertiary medical center, access to 68Ga-PSMA-11 for Black patients was limited, compared with non-Hispanic White patients, by a factor of nearly 4.
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Affiliation(s)
- Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Tracy K Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California; and
| | - Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
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Prevalence and Clinical Significance of Incidental Vertebral Marrow Signal Abnormality in Thoracolumbar Spine MRI. Spine (Phila Pa 1976) 2020; 45:390-396. [PMID: 31593057 DOI: 10.1097/brs.0000000000003278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs. SUMMARY OF BACKGROUND DATA Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist. METHODS The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as "malignancy." Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA. RESULTS The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma). CONCLUSION While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers. LEVEL OF EVIDENCE 3.
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Recommendations in Second Opinion Radiology Reports of Abdominal Imaging Examinations: Referring Clinicians' Compliance and Diagnostic Outcome. AJR Am J Roentgenol 2020; 214:400-405. [DOI: 10.2214/ajr.19.21790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE. The purpose of this article was to analyze trends in follow-up recommendations made on musculoskeletal MRI reports. MATERIALS AND METHODS. An IRB-approved retrospective study identified 790 musculoskeletal MRI reports from our database between January 1, 2016, and January 1, 2018, containing follow-up recommendations made by the interpreting radiologist. Metadata were automatically extracted and classification of the recommendations was performed by manual review. Clinical outcome data were collected from the electronic health record. After exclusion criteria were applied, 654 reports were included in the study. Descriptive statistics, Fisher exact tests, and chi-square tests were used for analysis. RESULTS. Clinicians acknowledged 83% and followed 73% of the recommendations. Follow-up compliance varied with the type of recommendation made: 98% for clinical intervention versus 67% for additional imaging (p < 0.001). Subspecialties acknowledged and followed recommendations at different rates: 92% and 85% for internists versus 76% and 64% for orthopedists (p < 0.001 and p < 0.001), respectively. Patient age, practice setting, radiologist experience, recommendation conditionality, and specified follow-up time intervals made no difference in compliance rate (all p > 0.05). There was no difference in compliance rate among various pathologic findings of concern (p = 0.995). Compliance rate increased significantly after direct communication between the radiologist and clinician compared with when there was no direct communication (93% vs 71%, p < 0.001). Concern for neoplasm comprised the greatest number of unacknowledged recommendations (73%). CONCLUSION. Musculoskeletal MRI recommendations are followed independent of the finding of concern and compliance is lowest for requests of additional imaging. Direct communication improves compliance and may be particularly helpful for orthopedic referrers.
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Itri JN, Raghavan K, Patel SB, Broder JC, Tierney S, Gray D, Burleson J, MacDonald S, Seidenwurm DJ. Developing Quality Measures for Diagnostic Radiologists: Part 2. J Am Coll Radiol 2018; 15:1366-1384. [DOI: 10.1016/j.jacr.2018.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/23/2018] [Accepted: 05/05/2018] [Indexed: 12/21/2022]
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Communication errors in radiology – Pitfalls and how to avoid them. Clin Imaging 2018; 51:266-272. [DOI: 10.1016/j.clinimag.2018.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 05/11/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022]
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Heller RE. Follow-up recommendations: the challenge, the opportunity and our future. Pediatr Radiol 2017; 47:1721-1723. [PMID: 28844087 DOI: 10.1007/s00247-017-3966-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Richard E Heller
- Radiology Partners, 2101 El Segundo Blvd., Suite 401, El Segundo, CA, 90245, USA.
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