1
|
Aripoli A, Gurney M, Sourk RF, Ash R, Walker CM, Peterson J, Huppe A, Smith C, Walter C, Clark L, Winblad O. The Impact of Closed-Loop Imaging on Actionable CT-Detected Breast Findings. J Am Coll Radiol 2024; 21:1024-1032. [PMID: 38220037 DOI: 10.1016/j.jacr.2024.01.004] [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: 10/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE Closed-loop imaging programs (CLIPs) are designed to ensure that patients receive appropriate follow-up, but a review of incidental CT-detected breast findings in the setting of CLIPs has not been performed. METHODS A retrospective review was conducted of CT reports at a single academic institution from July 1, 2020, to January 31, 2022, to identify reports with recommendations for breast imaging follow-up. Medical records were reviewed to evaluate patient adherence to follow-up, CLIP intervention, subsequent BI-RADS assessment, and diagnosis. Adherence was defined as diagnostic breast imaging performed within 6 months of the CT recommendation. RESULTS Follow-up recommendations for breast imaging were included in CT report impressions for 311 patients. Almost half of patients (47.3% [147 of 311]) underwent follow-up breast imaging within 6 months, yielding breast cancer diagnoses in 12.9% (19 of 147) and a biopsy-proven positive predictive value of 65.5% (19 of 29). Most patients who returned for follow-up within 6 months did so without CLIP intervention. The majority of CT report impressions in the follow-up group (85.0% [125 of 147]) contained specific recommendations for "diagnostic breast imaging." For patients who did not receive follow-up, the CLIP team tracked all cases and intervened in 19.1% (28 of 147). The most common intervention was a phone call and/or fax to the primary care provider. Outpatient CT examination setting and specific recommendation for diagnostic breast imaging were significantly associated with higher follow-up adherence (P < .0001). CONCLUSIONS Actionable CT-detected breast findings require follow-up diagnostic breast imaging because of a relevant cancer detection rate of 12.9%. Although many patients return for breast imaging without intervention, almost half of patients did not receive follow-up and may account for a significant number of missed cancer diagnoses. Specific CT recommendation verbiage is associated with higher follow-up adherence, which can be addressed across settings even without CLIPs.
Collapse
Affiliation(s)
- Allison Aripoli
- Department of Radiology, Breast Imaging Section, University of Kansas Medical Center, Kansas City, Kansas.
| | - Madeleine Gurney
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Rebecca Flynn Sourk
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Ryan Ash
- Vice Chair, Vice Chair of Quality and Safety, and Medical Director, Department of Radiology, Abdominal Imaging Section, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher M Walker
- Department of Radiology, Cardiothoracic Imaging Section, University of Kansas Medical Center, Kansas City, Kansas
| | - Jessica Peterson
- Department of Radiology, Breast Imaging Section, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashley Huppe
- Department of Radiology, Breast Imaging Section, University of Kansas Medical Center, Kansas City, Kansas
| | - Camron Smith
- Department of Radiology, Breast Imaging Section, University of Kansas Medical Center, Kansas City, Kansas
| | - Carissa Walter
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Lauren Clark
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Onalisa Winblad
- Division Director of Breast Imaging, Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
2
|
Guenette JP, Lynch E, Abbasi N, Schulz K, Kumar S, Haneuse S, Kapoor N, Lacson R, Khorasani R. Actionability of Recommendations for Additional Imaging in Head and Neck Radiology. J Am Coll Radiol 2024; 21:1040-1048. [PMID: 38220042 DOI: 10.1016/j.jacr.2024.01.005] [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] [Received: 11/17/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The aims of this study were to measure the actionability of recommendations for additional imaging (RAIs) in head and neck CT and MRI, for which there is a near complete absence of best practices or guidelines; to identify the most common recommendations; and to assess radiologist factors associated with actionability. METHODS All head and neck CT and MRI radiology reports across a multi-institution, multipractice health care system from June 1, 2021, to May 31, 2022, were retrospectively reviewed. The actionability of RAIs was scored using a validated taxonomy. The most common RAIs were identified. Actionability association with radiologist factors (gender, years out of training, fellowship training, practice type) and with trainees was measured using a mixed-effects model. RESULTS Two hundred nine radiologists generated 60,543 reports, of which 7.2% (n = 4,382) contained RAIs. Only 3.9% of RAIs (170 of 4,382) were actionable. More than 60% of RAIs were for eight examinations: thyroid ultrasound (14.1%), neck CT (12.6%), brain MRI (6.9%), chest CT (6.5%), neck CT angiography (5.5%), temporal bone CT (5.3%), temporal bone MRI (5.2%), and pituitary MRI (4.6%). Radiologists >23 years out of training (odds ratio, 0.39; 95% confidence interval, 0.15-1.02; P = .05) and community radiologists (odds ratio, 0.53; 95% confidence interval, 0.22-1.31; P = .17) had substantially lower estimated odds of making actionable RAIs than radiologists <7 years out of training and academic radiologists, respectively. CONCLUSIONS The studied radiologists rarely made actionable RAIs, which makes it difficult to identify and track clinically necessary RAIs to timely performance. Multifaceted quality improvement initiatives including peer comparisons, clinical decision support at the time of reporting, and the development of evidence-based best practices, may help improve tracking and timely performance of clinically necessary RAIs.
Collapse
Affiliation(s)
- Jeffrey P Guenette
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Director, Head and Neck Imaging and Interventions and Medical Director, Brigham Research Imaging Core, Boston, Massachusetts.
| | - Elyse Lynch
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nooshin Abbasi
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathryn Schulz
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shweta Kumar
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sebastien Haneuse
- Director, Graduate Studies and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Neena Kapoor
- Associate Chair, Patient Experience and Clinically Significant Results and Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronilda Lacson
- Associate Director, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Vice Chair, Radiology Quality and Safety, Distinguished Chair, Medical Informatics, and Director, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
3
|
Predictors of Completion of Clinically Necessary Radiologist-Recommended Follow-Up Imaging: Assessment Using an Automated Closed-Loop Communication and Tracking Tool. AJR Am J Roentgenol 2023; 220:429-440. [PMID: 36287625 DOI: 10.2214/ajr.22.28378] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND. Patients with adverse social determinants of health may be at increased risk of not completing clinically necessary follow-up imaging. OBJECTIVE. The purpose of this study was to use an automated closed-loop communication and tracking tool to identify patient-, referrer-, and imaging-related factors associated with lack of completion of radiologist-recommended follow-up imaging. METHODS. This retrospective study was performed at a single academic health system. A tool for automated communication and tracking of radiologist-recommended follow-up imaging was embedded in the PACS and electronic health record. The tool prompted referrers to record whether they deemed recommendations to be clinically necessary and assessed whether clinically necessary follow-up imaging was pursued. If imaging was not performed within 1 month after the intended completion date, the tool prompted a safety net team to conduct further patient and referrer follow-up. The study included patients for whom a follow-up imaging recommendation deemed clinically necessary by the referrer was entered with the tool from October 21, 2019, through June 30, 2021. The electronic health record was reviewed for documentation of eventual completion of the recommended imaging at the study institution or an outside institution. Multivariable logistic regression analysis was performed to identify factors associated with completion of follow-up imaging. RESULTS. Of 5856 recommendations entered during the study period, the referrer agreed with 4881 recommendations in 4599 patients (2929 women, 1670 men; mean age, 61.3 ± 15.6 years), who formed the study sample. Follow-up was completed for 74.8% (3651/4881) of recommendations. Independent predictors of lower likelihood of completing follow-up imaging included living in a socioeconomically disadvantaged neighborhood according to the area deprivation index (odds ratio [OR], 0.67 [95% CI, 0.54-0.84]), inpatient (OR, 0.25 [95% CI, 0.20-0.32]) or emergency department (OR, 0.09 [95% CI, 0.05-0.15]) care setting, and referrer surgical specialty (OR, 0.70 [95% CI, 0.58-0.84]). Patient age, race and ethnicity, primary language, and insurance status were not independent predictors of completing follow-up (p > .05). CONCLUSION. Socioeconomically disadvantaged patients are at increased risk of not completing recommended follow-up imaging that referrers deem clinically necessary. CLINICAL IMPACT. Initiatives for ensuring completion of follow-up imaging should be aimed at the identified patient groups to reduce disparities in missed and delayed diagnoses.
Collapse
|
4
|
Griffith JF. Tips for Reporting Musculoskeletal Imaging Studies: Lessons Learned. Semin Musculoskelet Radiol 2021; 25:646-651. [PMID: 34861709 DOI: 10.1055/s-0041-1739313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper is designed to be read by radiological trainees who are starting out with reporting musculoskeletal imaging studies. Based on the author's experience of over 25 years, it provides tips on how to report musculoskeletal imaging succinctly and effectively using a prose style report.
Collapse
Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
5
|
Iyengar KP, Jun Ngo VQ, Jain VK, Ahuja N, Hakim Z, Sangani C. What does the orthopaedic surgeon want in the radiology report? J Clin Orthop Trauma 2021; 21:101530. [PMID: 34386345 PMCID: PMC8333142 DOI: 10.1016/j.jcot.2021.101530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
Complementary imaging is crucial in the diagnosis and management of the spectrum of Musculoskeletal (MSK) pathologies. Like in all medical specialities, its role in trauma and orthopaedic conditions has evolved. A radiology report following an imaging study should provide an accurate, timely interpretation of images and be presented in a format that allows formal analysis or clarification of a patient's diagnostic dilemma. It is essential that it is descriptive enough to allow clinico-pathological correlation to a patient's condition. A high-quality report follows clinical governance processes, provides clinical feedback, and when appropriate, incorporates advice regarding differential diagnosis or further investigation/management that can be undertaken, permitting the attending clinician to formulate a suitable treatment plan for their patient. In this narrative we explore common radiological investigations and reporting information in trauma and orthopaedic conditions, which would be useful to the attending surgeon.
Collapse
Affiliation(s)
- Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vivien Qi Jun Ngo
- Foundation Year 2 Doctor in Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Neeraj Ahuja
- Consultant Orthopaedic and Shoulder Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Zuned Hakim
- Consultant Trauma and Upper Limb Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Chetan Sangani
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| |
Collapse
|
6
|
Facilitating Surveillance of Incidental Findings Using a Novel Reporting Template: Proof of Concept in Patients With Pancreatic Abnormalities. J Am Coll Radiol 2021; 18:1246-1257. [PMID: 34283988 DOI: 10.1016/j.jacr.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the surveillance impact of utilizing a discrete field in structured radiology reports in patients with incidental pancreatic findings. METHODS We implemented a dictation template containing a discrete structured field element to auto-trigger listing of patients with incidental pancreatic findings on a pancreas clinic registry in the electronic health record. We isolated CT and MRI reports with incidental pancreatic findings over a 24-month period. We stratified patients by presence or absence of the discrete field element in reports (flagged versus unflagged) and evaluated the impact of report flagging on likelihood of clinic follow-up, follow-up imaging, endoscopic ultrasound, surgical intervention, genetics referral, obtaining pathologic diagnosis, and time interval between index imaging to various outcomes. RESULTS Patients with flagged reports were more likely to be seen or discussed in a pancreas clinic compared with those with unflagged reports (189 of 376, 50.3% versus 79 of 474, 16.7%; P <. 001). Patients with flagged reports were more likely to get follow-up imaging than patients with unflagged reports (188 of 376, 50.0% versus 121 of 474, 25.5%; P < .001) and were more likely to undergo appropriate management of actionable findings compared with patients in the unflagged group (23 of 62, 37.1% versus 28 of 129, 21.7%; P = .036). DISCUSSION Implementation of a structured discrete field element for reporting of patients with incidental pancreatic findings had positive impact on surveillance measures and can be applied in other organ systems with established surveillance guidelines to standardize patient care.
Collapse
|
7
|
Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [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: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
Collapse
Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
| |
Collapse
|