Assessing Adherence to US LI-RADS Follow-up Recommendations in Vulnerable Patients Undergoing Hepatocellular Carcinoma Surveillance

Purpose To assess adherence to the US Liver Imaging Reporting and Data System (LI-RADS) recommendations for hepatocellular carcinoma (HCC) surveillance and associated patient-level factors in a vulnerable, diverse patient sample. Materials and Methods The radiology report database was queried retrospectively for patients who underwent US LI-RADS-based surveillance examinations at a single institution between June 1, 2020, and February 28, 2021. Initial US and follow-up liver imaging were included. Sociodemographic and clinical data were captured from electronic medical records. Adherence to radiologist recommendation was defined as imaging (US, CT, or MRI) follow-up in 5-7 months for US-1, imaging follow-up in 3-6 months for US-2, and CT or MRI follow-up in 2 months for US-3. Descriptive analysis and multivariable modeling that adjusted for age, sex, race, and time since COVID-19 pandemic onset were performed. Results Among 936 patients, the mean age was 59.1 years; 531 patients (56.7%) were male and 544 (58.1%) were Asian or Pacific Islander, 91 (9.7%) were Black, 129 (13.8%) were Hispanic, 147 (15.7%) were White, and 25 (2.7%) self-reported as other race. The overall adherence rate was 38.8% (95% CI: 35.7, 41.9). The most common liver disease etiology was hepatitis B (60.6% [657 of 936 patients]); 19.7% of patients (183 of 936) had current or past substance use disorder, and 44.8% (416 of 936) smoked. At adjusted multivariable analysis, older age (odds ratio [OR], 1.20; P = .02), male sex (OR, 1.62; P = .003), hepatology clinic attendance (OR, 3.81; P < .001), and recent prior US examination (OR, 2.44; P < .001) were associated with full adherence, while current smoking (OR, 0.39; P < .001) was negatively associated. Conclusion Adherence to HCC imaging surveillance was suboptimal, despite US LI-RADS implementation. Keywords: Liver, Ultrasound, Screening, Abdomen/GI, Cirrhosis, Metabolic Disorders, Socioeconomic Issues Supplemental material is available for this article. © RSNA, 2024.

Effects of Changing the Reporting System from Decentralized/Modality-Based to Centralized/Subspecialized Radiology on Radiologists, Radiologic Technicians and Referring Physicians of a Multi-Center Radiology Network

Objectives:

To determine the effects of reorganizing a radiology institute from decentralized/modality-based to centralized/subspecialized radiology on radiologists, radiologic technicians, and referring physicians at a multi-center radiology network.

Material and Methods:

In 2017/2018 our multi-center radiology network was changed from decentralized/modality-based to centralized/subspecialized reporting. A survey was conducted among radiologists, technicians and two groups of referring physicians (main hospital and non-main hospitals). The following items were tested: Overall satisfaction, perceived quality of radiological reports, subjective productivity/efficiency, confidence of radiologists in their subspecialty, availability of radiologists and turnaround time. Two of five answering options on a 5-point Likert scale were considered to represent agreement. The Mann-Whitney-U-test served for statistical analyses in agreement before and after reorganization in each group.

Results:

For radiologists, a significant difference was observed in perceived quality of radiological reports 42/46 (91.3%) compared to 51/52 (98.1%; p = 0.013).

For technicians, no significant differences were observed. In the group of main hospital referring physicians, significant differences were observed in overall satisfaction 129/152 (84.9%) compared to 164/174 (94.3%; p < 0.001) and in perceived quality of radiological reports 125/148 (72.8%) compared to 157/170 (92.4%; p = 0.001). In the group of non-main hospital referring physicians no significant differences were observed.

Conclusion:

The reorganization resulted in a significantly higher perceived quality of radiological reports for the groups of radiologists and main hospital referring physicians besides overall satisfaction for main hospital referring physicians. Specialized main hospital referring physicians value reports of specialized radiology, whereas less specialized, non-main hospital referring physicians did not experience any significant effect.