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Kuo Y, Lee KL, Chen YL, Weng CY, Chang FC, Chen TJ, Wu HM, Wu CH. Recommendations for additional magnetic resonance imaging in abdominal computed tomography. J Chin Med Assoc 2023; 86:240-245. [PMID: 36346207 DOI: 10.1097/jcma.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reporting the findings from radiologic images is an important method for radiologists to communicate with referring physicians. The purpose of this study was to evaluate the effectiveness of the recommendations for additional imaging (RAIs) after abdominal computed tomography (CT) studies for abdominal magnetic resonance (MR) imaging. METHODS The institutional review board approved this retrospective study, which includes data collected from the radiology information system (RIS) database of a tertiary medical referral center. Associations between abdominal CT and subsequent abdominal MR were recorded. The effectiveness of RAIs in an abdominal report was determined. The influence of the wording and the location of the RAIs were also analyzed. RESULTS The presence of RAIs in an abdominal CT report for an abdominal MR examination was more likely to result in a subsequent MR examination within 120 days (36.7% vs. 4.0%). RAIs were also associated with a reduction in the time interval between the CT and MR examinations (29.0 days vs. 39.0 days). The most effective recommendations included wording that advocated for further evaluation and were mentioned in both the context and conclusion of the report. CONCLUSION RAIs have a significant influence on clinical decisions. Radiologists should be aware of the power of RAIs and be prudent and conscientious when making recommendations in radiology reports.
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Affiliation(s)
- Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei,Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Lun Chen
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei,Taiwan, ROC
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Office of the Superintendent, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei,Taiwan, ROC
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Calvillo AÁG, Kodaverdian LC, Garcia R, Lichtensztajn DY, Bucknor MD. Patient-level factors influencing adherence to follow-up imaging recommendations. Clin Imaging 2022; 90:5-10. [PMID: 35907273 DOI: 10.1016/j.clinimag.2022.07.006] [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: 04/29/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine which, if any, patient-level factors were associated with differences in completion of follow-up imaging recommendations at a tertiary academic medical center. METHODS In this IRB-approved, retrospective cohort study, approximately one month of imaging recommendations were reviewed from 2017 at a single academic institution that contained key words recommending follow-up imaging. Age, gender, race/ethnicity, insurance, smoking history, primary language, BMI, and home address were recorded via chart extraction. Home addresses were geocoded to Census Block Groups and assigned to a quintile of neighborhood socioeconomic status. A multivariate logistic regression model was used to evaluate each predictor variable with significance set to p = 0.05. RESULTS A total of 13,421 imaging reports that included additional follow-up recommendations were identified. Of the 1013 included reports that recommended follow-up, 350 recommended additional imaging and were analyzed. Three hundred eight (88.00%) had corresponding follow-up imaging present and the insurance payor was known for 266 (86.36%) patients: 146 (47.40%) had commercial insurance, 35 (11.36%) had Medicaid, and 85 (27.60%) had Medicare. Patients with Medicaid had over four times lower odds of completing follow-up imaging compared to patients with commercial insurance (OR 0.24, 95% CI 0.06-0.88, p = 0.032). Age, gender, race/ethnicity, smoking history, primary language, BMI, and neighborhood socioeconomic status were not independently associated with differences in follow-up imaging completion. CONCLUSION Patients with Medicaid had decreased odds of completing follow-up imaging recommendations compared to patients with commercial insurance.
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Affiliation(s)
- Andrés Ángel-González Calvillo
- University of California San Francisco School of Medicine, 513 Parnassus Ave., Suite S-245, San Francisco, CA 94143, USA.
| | | | - Roxana Garcia
- University of California San Francisco School of Medicine, 513 Parnassus Ave., Suite S-245, San Francisco, CA 94143, USA.
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd floor, San Francisco, CA 94158, USA.
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St., Suite 350, Lobby 6, San Francisco, CA 94107, USA.
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Vijayasarathi A, Duszak R. How Radiologists Can Benefit From Direct Communication With Patients. Curr Probl Diagn Radiol 2020; 49:224-226. [DOI: 10.1067/j.cpradiol.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
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Radiologists’ Self-Assessment Versus Peer Assessment of Perceived Probability of Recommending Additional Imaging. J Am Coll Radiol 2020; 17:504-510. [DOI: 10.1016/j.jacr.2019.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022]
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Cochon LR, Kapoor N, Carrodeguas E, Ip IK, Lacson R, Boland G, Khorasani R. Variation in Follow-up Imaging Recommendations in Radiology Reports: Patient, Modality, and Radiologist Predictors. Radiology 2019; 291:700-707. [PMID: 31063082 PMCID: PMC7526331 DOI: 10.1148/radiol.2019182826] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Variation between radiologists when making recommendations for additional imaging and associated factors are, to the knowledge of the authors, unknown. Clear identification of factors that account for variation in follow-up recommendations might prevent unnecessary tests for incidental or ambiguous image findings. Purpose To determine incidence and identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions. Materials and Methods This retrospective study analyzed 318 366 reports obtained from diagnostic imaging examinations performed at a large urban quaternary care hospital from January 1 to December 31, 2016, excluding breast and US reports. A subset of 1000 reports were randomly selected and manually annotated to train and validate a machine learning algorithm to predict whether a report included a follow-up imaging recommendation (training-and-validation set consisted of 850 reports and test set of 150 reports). The trained algorithm was used to classify 318 366 reports. Multivariable logistic regression was used to determine the likelihood of follow-up recommendation. Additional analysis by imaging subspecialty division was performed, and intradivision and interradiologist variability was quantified. Results The machine learning algorithm classified 38 745 of 318 366 (12.2%) reports as containing follow-up recommendations. Average patient age was 59 years ± 17 (standard deviation); 45.2% (143 767 of 318 366) of reports were from male patients. Among 65 radiologists, 57% (37 of 65) were men. At multivariable analysis, older patients had higher rates of follow-up recommendations (odds ratio [OR], 1.01 [95% confidence interval {CI}: 1.01, 1.01] for each additional year), male patients had lower rates of follow-up recommendations (OR, 0.9; 95% CI: 0.9, 1.0), and follow-up recommendations were most common among CT studies (OR, 4.2 [95% CI: 4.0, 4.4] compared with radiography). Radiologist sex (P = .54), presence of a trainee (P = .45), and years in practice (P = .49) were not significant predictors overall. A division-level analysis showed 2.8-fold to 6.7-fold interradiologist variation. Conclusion Substantial interradiologist variation exists in the probability of recommending a follow-up examination in a radiology report, after adjusting for patient, examination, and radiologist factors. © RSNA, 2019 See also the editorial by Russell in this issue.
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Affiliation(s)
- Laila R Cochon
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Neena Kapoor
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Emmanuel Carrodeguas
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Ivan K Ip
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Ronilda Lacson
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Giles Boland
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Ramin Khorasani
- From the Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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National Testing of the Emergency Department Patient Experience of Care Discharged to Community Survey and Implications for Adjustment in Scoring. Med Care 2019; 57:42-48. [DOI: 10.1097/mlr.0000000000001005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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The fate of radiology report recommendations at a pediatric medical center. Pediatr Radiol 2017; 47:1724-1729. [PMID: 28852809 DOI: 10.1007/s00247-017-3960-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/13/2017] [Accepted: 08/01/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The American College of Radiology (ACR) practice parameters for communication dictate that follow-up recommendations be suggested when appropriate. Radiologists assume that referring physicians read their reports and heed their advice. In reality, recommendations might not be carried out or even acknowledged. OBJECTIVE We aimed to determine the proportion of imaging recommendations that are acknowledged and acted upon. MATERIALS AND METHODS We conducted a retrospective review of all consecutive radiology reports containing "recommend" in the impression at a single academic children's hospital over a 1-month period. We documented point of care (emergency department, inpatient, outpatient), study type, recommendation wording, and communication method (report only or direct verbal). We reviewed medical records to ascertain whether the recommendations were acknowledged or executed. We used chi-square tests to evaluate associations between variables. P<0.05 was considered significant. RESULTS We reviewed 526 reports and excluded 73. We included the remaining 453 reports, from 370 unique patients (201 male, 169 female). Inpatients comprised most reports (n=223), followed by emergency department (ED) patients (n=118) and outpatients (n=112). Among these reports, 69% (n=313) of recommendations were executed. Of the 140 recommendations not carried out, 14% were acknowledged in clinical notes. Compliance correlated with point of care (ED>inpatient>outpatient; P=0.001) but not with additional verbal communication (P=0.33), study type (radiograph vs. other; P=0.35) or type of follow-up recommendation (follow-up imaging vs. other; P=0.99). CONCLUSION Nearly one-third of radiology report follow-up recommendations are not executed. Recommendations are most commonly neglected for outpatient imaging reports. The radiology community should take steps to improve recommendation adherence.
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Zygmont ME, Shekhani H, Kerchberger JM, Johnson JO, Hanna TN. Point-of-Care Reference Materials Increase Practice Compliance With Societal Guidelines for Incidental Findings in Emergency Imaging. J Am Coll Radiol 2016; 13:1494-1500. [DOI: 10.1016/j.jacr.2016.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
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Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines. Emerg Radiol 2016; 23:169-74. [DOI: 10.1007/s10140-016-1378-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022]
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Bosma MS, Morden KL, Klein KA, Neal CH, Knoepp US, Patterson SK. Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours. Emerg Radiol 2015; 23:29-33. [PMID: 26433916 DOI: 10.1007/s10140-015-1352-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/25/2015] [Indexed: 01/25/2023]
Abstract
In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.
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Affiliation(s)
- Melissa S Bosma
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA
| | - Kasey L Morden
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA
| | - Katherine A Klein
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA.
| | - Colleen H Neal
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA
| | - Ursula S Knoepp
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA
| | - Stephanie K Patterson
- Department of Radiology, University of Michigan Health System, 2910H Taubman Center, 1500 E. Medical Center Dr., SPC 5326, Ann Arbor, MI, 48109-5326, USA
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