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Zafar U, Ahmad MN, Nadeem N, Muhammad Zohaib Uddin M, Khan N, Alam MM, Hafeez A, Pervez H, Zafar F. Improved Diagnostic Confidence Imparted by Radiologists in Radiology Reports After Educational Interventions on Reporting Styles. Cureus 2024; 16:e53926. [PMID: 38465114 PMCID: PMC10924976 DOI: 10.7759/cureus.53926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Background Radiology reports are important medico-legal documents facilitating communication between radiologists and referring doctors. Language clarity and precision are crucial for effective communication in these reports. Radiology reporting has changed with the evolution of imaging technology, prompting the adoption of precise terminology. Diagnostic certainty phrases (DCPs) play an important role in communicating diagnostic confidence in radiology reports. Objective The aim of this study was to evaluate the use of DCPs in radiology reports, before and after targeted educational interventions. Materials and methods The study was approved by the Aga Khan University Hospital's Ethical Review Committee and includes cross-sectional radiology reports. It involved three cycles of retrospective evaluation, with educational interventions in between to improve the use of DCPs. Results The study found a dynamic shift in the use of DCPs during the three cycles. Initially, intermediate-certainty phrases prevailed, followed by an increase in high-certainty phrases and a drop in low-certainty phrases. Later cycles showed a significant decline in DCPs and an increase in the use of definitive language. Across all subspecialties, there was a consistent decrease in intermediate- and low-certainty DCPs. Conclusion The study validates the transformative impact of educational interventions on the use of DCPs in radiology reports. The radiology reports frequently used DCPs with intermediate to low diagnostic certainty with improvement in the subsequent cycles of the study after educational interventions. It emphasizes the significance of continuing education to ensure the use of precise nomenclature.
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Affiliation(s)
- Uffan Zafar
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Naila Nadeem
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Noman Khan
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Anam Hafeez
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Hafsa Pervez
- Medicine and Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Fariha Zafar
- Epidemiology and Public Health, Quaid-E-Azam Medical College, Bahawalpur, PAK
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2
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Pencharz D, Wagner T. Actionable reporting versus unwanted advice in PET-CT reports. Clin Radiol 2023:S0009-9260(23)00228-3. [PMID: 37349201 DOI: 10.1016/j.crad.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023]
Abstract
AIM To investigate the opinions of clinician referrers on the presence and type of management advice in reports of positron-emission tomography (PET)-computed tomography (CT) examinations. MATERIALS AND METHODS Eighteen clinicians were interviewed using a structured questionnaire about their opinions on further management advice in PET-CT reports. RESULTS Opinions varied amongst clinicians, but some themes predominated: (1) advice on further imaging tests and areas outside the referrer's area of expertise are more welcome than other types of advice; (2) a differential diagnosis or clinical significance is of greater value than specific management advice; (3) some referrers do not want any further advice. CONCLUSION Before advising on further management, reporters should consider clinicians' opinions regarding this. Seeking the opinion of clinicians in other hospitals may be necessary. A review of the Royal College of Radiologists Actionable Reports standard to ensure it is more in line with the opinions of clinicians may be useful.
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Affiliation(s)
- D Pencharz
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, London NW3, UK.
| | - T Wagner
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond Street, London NW3, UK
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3
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Bobba PS, Sailer A, Pruneski JA, Beck S, Mozayan A, Mozayan S, Arango J, Cohan A, Chheang S. Natural language processing in radiology: Clinical applications and future directions. Clin Imaging 2023; 97:55-61. [PMID: 36889116 DOI: 10.1016/j.clinimag.2023.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
Natural language processing (NLP) is a wide range of techniques that allows computers to interact with human text. Applications of NLP in everyday life include language translation aids, chat bots, and text prediction. It has been increasingly utilized in the medical field with increased reliance on electronic health records. As findings in radiology are primarily communicated via text, the field is particularly suited to benefit from NLP based applications. Furthermore, rapidly increasing imaging volume will continue to increase burden on clinicians, emphasizing the need for improvements in workflow. In this article, we highlight the numerous non-clinical, provider focused, and patient focused applications of NLP in radiology. We also comment on challenges associated with development and incorporation of NLP based applications in radiology as well as potential future directions.
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Affiliation(s)
- Pratheek S Bobba
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Anne Sailer
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | | | - Spencer Beck
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Ali Mozayan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Sara Mozayan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Jennifer Arango
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Arman Cohan
- Department of Computer Science, Yale University, New Haven, CT, United States
| | - Sophie Chheang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States.
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Prieto VG, Vollmer RT, Shea CR. Use of modifying phrases in surgical pathology reports: is there a different understanding between pathologists and treating physicians? Virchows Arch 2022; 481:759-766. [PMID: 36098817 DOI: 10.1007/s00428-022-03407-3] [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: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
When not all the histopathologic and clinical features necessary for a pathology diagnosis are present in a particular specimen, pathologists may use modifying phrases to convey various degrees of certainty, e.g., "consistent with…" and "suggestive of…." However, it is unclear whether pathologists use such phrases consistently or whether treating physicians fully understand their intended meaning. A questionnaire concerning six common modifying phrases ("consistent with, suggestive of, suspicious for, highly consistent with, highly suggestive of, some features of") was sent to all physicians from a single institution who either issued or routinely received surgical pathology reports. Physicians were asked to rank their understanding of each phrase on a printed scale between 1 ("no evidence of") and 10 ("diagnostic of"). One hundred sixty physicians (74.3%) responded. Despite wide variation, there was a hierarchy (from more to less diagnostic): highly consistent > highly suspicious > consistent > suspicious > suggestive > some features (p < 1 × 10-7). There were no significant differences between pathologists and treating physicians (p = 0.72) or attendings and residents (p = 0.9). Pathologists and treating physicians share an overall common understanding of their hierarchical relationship, albeit with wide ranges. Based upon our results, we propose to use only three qualifying phrases to convey the degree of certainty for a particular diagnosis: "suggestive of" (> 25 ≤ 50% certainty), "suspicious for" (> 50 ≤ 75%), and "consistent with" (> 75%). The phrase "no evidence of" should probably be used only when there is ≤ 5% confidence in a diagnosis, and conversely, "diagnostic of" should probably be used only when there is ≥ 95% confidence in a diagnosis.
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Affiliation(s)
- V G Prieto
- Department of Pathology, University of Texas-MD Anderson Cancer Center, Box 85, Houston, TX, 77030, USA. .,Department of Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - R T Vollmer
- Department of Pathology, Veterans Administration Hospital, Duke University Medical Center, Durham, 27710, NC, UK
| | - C R Shea
- Departments of Pathology and Medicine, University of Chicago, Chicago, IL, 60611, USA
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Bregendahl S, Bondeven P, Grønborg TK, Brown G, Laurberg S, Pedersen BG. Training of radiology specialists in local staging of primary rectal cancer on MRI: a prospective intervention study exploring the impact of various educational elements on the interpretive performance. BMJ Open Qual 2022; 11:bmjoq-2021-001716. [PMID: 35944932 PMCID: PMC9367186 DOI: 10.1136/bmjoq-2021-001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundMRI interpretation and accurate radiological staging are crucial to the important treatment decisions and a consequent successful patient outcome in rectal cancer.AimsTo investigate the effect of intensive training on rectal cancer MRI staging performance of radiologists and the impact of different course elements on learning outcomes.MethodsIn this prospective intervention study, 17 radiology specialists and 1 radiology registrar participated in a training programme including a 6-hour imaging workshop, a 3-hour session of individual feedback and independent MRI readings of primary rectal cancer cases. Their rectal MRI interpretive performance was evaluated through repeated readings of 30 training cases before and after each course element and a time interval with no educational intervention. A proforma template for MRI staging of primary rectal cancer was used and the results were compared with a reference standard of an expert panel. Participants repeatedly reported on confidence scores and self-assessed learning outcome. Outcomes were analysed using mixed-effects models.ResultsAt baseline the quality of rectal MRI assessment varied significantly, with a higher interpretive performance among participants with shorter radiological experience (10.2 years vs 19.9 years, p=0.02). The ability to perform correct treatment allocation improved from 72% to 82% (adjusted OR=2.36, 95% CI 1.64 to 3.39). The improvement was largely driven by the participants with lower performance at baseline and by prevention of overstaging. Individual feedback had a significant impact on the improved interpretive performance (adjusted OR=1.82, 95% CI 1.27 to 2.63), whereas no significant change was seen after workshop or case readings only. Confidence scores increased significantly during training.ConclusionsTargeted and individualised training improves the rectal cancer MRI interpretive performance essential to successful patient treatment, especially among radiology specialists with lower performance at baseline.
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Affiliation(s)
- Sidse Bregendahl
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Bondeven
- Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Therese Koops Grønborg
- Research Unit for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Gina Brown
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Ogawa M, Lee CH, Friedman B. Multicenter survey clarifying phrases in emergency radiology reports. Emerg Radiol 2022; 29:855-862. [PMID: 35701617 DOI: 10.1007/s10140-022-02057-x] [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: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Interactions between radiologists and emergency physicians are often diminished as imaging volume increases and more radiologists read off site. We explore how several commonly used phrasings are perceived by radiologists and emergency physicians to decrease ambiguity in reporting. METHODS An anonymous survey was distributed to attendings and residents at seven academic radiology and emergency departments across the USA via a digital platform as well as to an email group consisting of radiologists across the country with an interest in quality assurance. Physicians were asked to assign a percent score to probabilistic phrases such as, "suspicious of," or "concerned for." Additional questions including, "how often the report findings are reviewed," "what makes a good radiology report," and "when is it useful to use the phrase 'clinical correlation are recommended.'" Median scores and confidence intervals were compared using an independent Student's T-test. RESULTS Generally, there was agreement between radiologists and emergency room physicians in how they interpret probabilistic phrases except for the phrases, "compatible with," and "subcentimeter liver lesions too small to characterize." Radiologists consider a useful report to answer the clinical question, be concise, and well organized. Emergency physicians consider a useful report to be concise, definitive or include a differential diagnosis, answer the clinical question, and recommend a next step. Radiologists and emergency physicians did not agree on the usefulness of the phrase, "clinical correlation recommended," in which radiologists found the phrase more helpful under particular circumstances. CONCLUSION The survey demonstrated a wide range of answers for probabilistic phrases for both radiologists and emergency physicians. While the medians and means of the two groups were often different by statistical significance, the actual percent difference was minor. These wide range of answers suggest that use of probabilistic phrases may sometimes lead to misinterpretation between radiologist and emergency room physician and should be avoided or defined if possible.
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Affiliation(s)
- Makoto Ogawa
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1000 Tenth Ave., New York, NY, 10019, USA.
| | - Cheng-Han Lee
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1000 Tenth Ave., New York, NY, 10019, USA
| | - Barak Friedman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1000 Tenth Ave., New York, NY, 10019, USA
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7
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Learning from the research process: An advanced practitioner reporting radiographer reflective narrative. J Med Imaging Radiat Sci 2022; 53:334-340. [DOI: 10.1016/j.jmir.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022]
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8
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Petraszko A, Chagarlamudi K, Ramaiya N. Enhancing the value of radiology reports: a primer for residents. Emerg Radiol 2022; 29:671-682. [DOI: 10.1007/s10140-022-02045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
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9
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Rizzo S, Del Grande M, Espeli V, Stathis A, Nicolino GM, Del Grande F. Do oncologists prefer subspecialty radiology reports? A quality care study. Insights Imaging 2021; 12:64. [PMID: 34037872 PMCID: PMC8155173 DOI: 10.1186/s13244-021-01007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background The main objective was to assess whether CT reports of radiologists subspecialized in oncologic imaging respond better to oncological referrals than reports from general radiologists. The secondary objective was to assess differences in ratings between a senior and junior oncologist. Two hundred radiological reports pertaining to oncological patients were retrospectively selected of which 100 each were written by subspecialized radiologists and general radiologists, respectively. The senior and junior oncologists each rated all CT reports using a Likert scale from 1 to 5 (1 = very poor, 5 = excellent) for the following information: anatomical details; interpretation of findings; need for further explanations; appropriateness of conclusions; overall satisfaction. Comparisons between ratings assigned to reports from generalist radiologists and subspecialty radiologists were performed using the Mann–Whitney U test. Agreement between both oncologists was assessed through Gwet's coefficient. Results For all but two of the five items obtained from the senior oncologist, oncologists' ratings were significantly higher for subspecialty radiologists' reports (p < 0.01); mean values from both oncologists were generally higher for subspecialty reports (p < 0.001). Agreement between the senior and junior oncologist in the rating of reports from general and subspecialty radiologists was either moderate to substantial (0.5986–0.6788) or substantial to almost perfect (0.6958–0.8358). Conclusions According to a senior and junior oncologist, CT reports performed by subspecialized radiologists in oncologic imaging are clearer, more accurate, and more appropriate in the interpretation and conclusions compared to reports written by general radiologists. Likewise, the overall satisfaction of the oncologist from a subspecialized radiologist report is higher. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01007-4.
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Affiliation(s)
- Stefania Rizzo
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland. .,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Vittoria Espeli
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Gabriele Maria Nicolino
- Post-Graduate School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Filippo Del Grande
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland.,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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Ahmed S, Mitsky J, Rawal U, Sheth S, Bronner J. Asymptomatic Abdominal Aortic Aneurysm: Standardizing Reporting Recommendations at a Large Multistate Radiology Practice. J Am Coll Radiol 2021; 18:1317-1323. [PMID: 33984286 DOI: 10.1016/j.jacr.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Although often asymptomatic at initial diagnosis, abdominal aortic aneurysms (AAAs) require careful surveillance to prevent rupture, with rupture-associated mortality rates as high as 90%. The purpose of this study was to explore if a performance improvement initiative implemented across a large radiology practice successfully increased inclusion of best practice recommendations (BPRs) within the radiology report across the practice. METHODS After BPRs for asymptomatic AAA surveillance were developed, a structured reporting macro for follow-up recommendation was integrated into dictation software. Following a training period, inclusion of recommendations within the radiology report was monitored across 345 facilities within the practice. Performance was reported on scorecards distributed monthly. To measure practice improvement, inclusion of appropriate recommendation in radiology reports postimplementation was compared with pre-implementation data. RESULTS During the period before AAA BPRs implementation, from 64,090 consecutive cross-sectional radiology reports reviewed during a 6-month period, 855 incidental AAAs (1.3%) were identified, with 783 aneurysms measuring 2.6 to 5.4 cm requiring imaging surveillance; only 17 (2.1%) included follow-up recommendations within the radiology report. Postimplementation, 2,641 of 148,807 cross-sectional imaging studies were positive for 2.6- to 5.4-cm AAAs requiring further management; 1,533 (58.0%) of these radiology reports included follow-up imaging recommendations (97.0% of which followed our AAA BPRs). DISCUSSION Quality improvement initiatives to develop BPRs for AAA surveillance and include these recommendations within the radiology report can be successfully implemented across large practices and are imperative to ensure imaging surveillance and avert AAA rupture.
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Affiliation(s)
- Sameer Ahmed
- Johns Hopkins Hospital Department of Radiology, Baltimore, Maryland
| | - Jason Mitsky
- Director of Clinical Value Management, Radiology Partners Research Institute, El Segundo, California
| | - Upma Rawal
- Director of Clinical Quality, Radiology Partners Research Institute, El Segundo, California.
| | - Sheila Sheth
- Director, Ultrasound; Associate Director, Diagnostic Imaging; Director Cross Sectional Imaging Fellowship, Johns Hopkins Hospital Department of Radiology, Baltimore, Maryland
| | - Jay Bronner
- President and Chief Medical Officer, Radiology Partners Research Institute, El Segundo, California
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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.
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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
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Chen KJ, Dedhia PH, Imbus JR, Schneider DF. Thyroid Ultrasound Reports: Will the Thyroid Imaging, Reporting, and Data System Improve Natural Language Processing Capture of Critical Thyroid Nodule Features? J Surg Res 2020; 256:557-563. [PMID: 32799005 PMCID: PMC8102071 DOI: 10.1016/j.jss.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical thyroid nodule features are contained in unstructured ultrasound (US) reports. The Thyroid Imaging, Reporting, and Data System (TI-RADS) uses five key features to risk stratify nodules and recommend appropriate intervention. This study aims to analyze the quality of US reporting and the potential benefit of Natural Language Processing (NLP) systems in efficiently capturing TI-RADS features from text reports. MATERIALS AND METHOD This retrospective study used free-text thyroid US reports from an academic center (A) and community hospital (B). Physicians created "gold standard" annotations by manually extracting TI-RADS features and clinical recommendations from reports to determine how often they were included. Similar annotations were created using an automated NLP system and compared with the gold standard. RESULTS Two hundred eighty-two reports contained 409 nodules at least 1-cm in maximum diameter. The gold standard identified three nodules (0.7%) which contained enough information to calculate a complete TI-RADS score. Shape was described most often (92.7% of nodules), whereas margins were described least often (11%). A median number of two TI-RADS features are reported per nodule. The NLP system was significantly less accurate than the gold standard in capturing echogenicity (27.5%) and margins (58.9%). One hundred eight nodule reports (26.4%) included clinical management recommendations, which were included more often at site A than B (33.9 versus 17%, P < 0.05). CONCLUSIONS These results suggest a gap between current US reporting styles and those needed to implement TI-RADS and achieve NLP accuracy. Synoptic reporting should prompt more complete thyroid US reporting, improved recommendations for intervention, and better NLP performance.
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Affiliation(s)
- Kallie J Chen
- Division of Endocrine Surgery at University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin.
| | - Priya H Dedhia
- Division of Endocrine Surgery at University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin
| | - Joseph R Imbus
- Division of Endocrine Surgery at University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin
| | - David F Schneider
- Division of Endocrine Surgery at University of Wisconsin School of Medicine and Public Health, Department of Surgery, Madison, Wisconsin
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Hartung MP, Bickle IC, Gaillard F, Kanne JP. How to Create a Great Radiology Report. Radiographics 2020; 40:1658-1670. [DOI: 10.1148/rg.2020200020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Comments on "Optimizing Radiology Reports for Patients and Referring Physicians: Mitigating the Curse of Knowledge". Acad Radiol 2020; 27:1340. [PMID: 32739078 DOI: 10.1016/j.acra.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
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Audi S, Pencharz D, Wagner T. Behind the hedges: how to convey uncertainty in imaging reports. Clin Radiol 2020; 76:84-87. [PMID: 32883516 DOI: 10.1016/j.crad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
The imaging report is a summary document of findings and the primary form of communication of such to referring clinicians. Expressing uncertainty in the summary report is clearly difficult and the literature is unanimous that there is no agreement between imaging consultants and clinicians, and even between imaging consultants themselves, as to the meaning of uncertainty phrases. It is important for the imaging consultants to express uncertainty in the imaging report, but it is equally important that the referring clinician understands the degree of that uncertainty. Individual terminology does not bridge that gap. The present study reviews the literature in order to differentiate between uncertainty phrasing and hedging, and to find best practice examples to inform practice. We suggest three approaches that may be applied.
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Affiliation(s)
- S Audi
- Nuclear Medicine, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - D Pencharz
- Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, UK
| | - T Wagner
- Nuclear Medicine, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
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Use of an Online Crowdsourcing Platform to Assess Patient Comprehension of Radiology Reports and Colloquialisms. AJR Am J Roentgenol 2020; 214:1316-1320. [PMID: 32208006 DOI: 10.2214/ajr.19.22202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The purpose of this study was to use an online crowdsourcing platform to assess patient comprehension of five radiology reporting templates and radiology colloquialisms. MATERIALS AND METHODS. In this cross-sectional study, participants were surveyed as patient surrogates using a crowdsourcing platform. Two tasks were completed within two 48-hour time periods. For the first crowdsourcing task, each participant was randomly assigned a set of radiology reports in a constructed reporting template and subsequently tested for comprehension. For the second crowdsourcing task, each participant was randomly assigned a radiology colloquialism and asked to indicate whether the phrase indicated a normal, abnormal, or ambivalent finding. RESULTS. A total of 203 participants enrolled for the first task and 1166 for the second within 48 hours of task publication. The payment totaled $31.96. Of 812 radiology reports read, 384 (47%) were correctly interpreted by the patient surrogates. Patient surrogates had higher rates of comprehension of reports written in the patient summary (57%, p < 0.001) and traditional unstructured in combination with patient summary (51%, p = 0.004) formats than in the traditional unstructured format (40%). Most of the patient surrogates (114/203 [56%]) expressed a preference for receiving a full radiology report via an electronic patient portal. Several radiology colloquialisms with modifiers such as "low," "underdistended," and "decompressed" had low rates of comprehension. CONCLUSION. Use of the crowdsourcing platform is an expeditious, cost-effective, and customizable tool for surveying laypeople in sentiment- or task-based research. Patient summaries can help increase patient comprehension of radiology reports. Radiology colloquialisms are likely to be misunderstood by patients.
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Kumbhar SS, Baheti AD, Itani M, Nikam R. Ambiguous Findings on Radiographs. Curr Probl Diagn Radiol 2019; 50:4-10. [PMID: 31706692 DOI: 10.1067/j.cpradiol.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/22/2022]
Abstract
Findings with uncertain clinical significance are frequently encountered on radiographs. A structure or opacity visible on radiographs could be due to several causes ranging from artifact or external structure to malignancy or a life-threatening process. The approach that a radiologist chooses to address ambiguous findings can have a significant impact on a patient's health. In this article we discuss the causes and impact of ambiguous findings on radiographs. We also discuss the various strategies radiologists can adopt to maximize clinical value and, when needed, reach a definite diagnosis.
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Affiliation(s)
| | | | - Malak Itani
- Washington University in St. Louis, St. Louis, MO
| | - Rahul Nikam
- Nemours Children's Health System, Wilmington DE
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Hiding in the Hedges: Tips to Minimize Your Malpractice Risks as a Radiologist. AJR Am J Roentgenol 2019; 213:1037-1041. [DOI: 10.2214/ajr.19.21428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Value in medicine is defined as the ratio of quality and service and health care outcomes to the costs and inefficiencies of providing care. Creating patient-centered value in radiology reporting requires radiologists to provide accurate diagnostic interpretations in an accessible format with useful advice on further imaging, as well as report-embedded reference materials desired by the referring provider. The value- and service-centered radiologist provides urgent communications when appropriate and is readily available for report consultations. Indirect costs or inefficiencies embedded in report style can erode value. Value is preserved when radiologists strive for concise, clear, and timely reporting. ©RSNA, 2018.
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Affiliation(s)
- Steven C Eberhardt
- From the Department of Radiology, University of New Mexico, 1 University of New Mexico, MSC 10.5530, Albuquerque, NM 87131-0001 (S.C.E.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
| | - Marta E Heilbrun
- From the Department of Radiology, University of New Mexico, 1 University of New Mexico, MSC 10.5530, Albuquerque, NM 87131-0001 (S.C.E.); and Department of Radiology and Imaging Sciences, Emory University Healthcare, Atlanta, Ga (M.E.H.)
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Lacson R, Odigie E, Wang A, Kapoor N, Shinagare A, Boland G, Khorasani R. Multivariate Analysis of Radiologists' Usage of Phrases that Convey Diagnostic Certainty. Acad Radiol 2019; 26:1229-1234. [PMID: 30503390 DOI: 10.1016/j.acra.2018.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES To quantify the use of Diagnostic Certainty Phrases (DCP) in radiology reports, including DCPs with good agreement (including "diagnostic of," "unlikely" and "represents") in connoting degree of certainty between providers based on previous studies; and to assess whether modality, presence of a trainee, radiologic subspecialty, and individual radiologists are associated with the usage of DCPs with good agreement. MATERIALS AND METHODS This retrospective, IRB-approved study was conducted at an academic medical center. Radiology reports that contain DCPs were identified using information retrieval from all reports generated in 2016, excluding mammograms, obstetrical ultrasound, bone densitometry, and interventional studies. DCPs connoting good agreement were further noted. Of the reports that contained DCPs, a two-level hierarchical generalized linear model with attending as the level-two variable was performed comparing the use of DCP with good agreement while considering trainee involvement, modality, and subspecialty. RESULTS A total of 159,151 reports out of 370,881 were found to have at least one DCP (43%). Reports of CT scans had the most number of DCP (68% of all CT reports). Breast and abdomen subspecialties were associated with use of DCP with good agreement. There was significant variation in use of DCP with good agreement between physicians that could not be explained by modality, trainee presence, and subspecialty. CONCLUSION Phrases to convey diagnostic certainty were commonly used in radiology reports. There is wide variation in usage of DCP with good agreement. Future interventions to reduce variation in use of DCPs may reduce ambiguity and improve quality of radiology reports.
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Lacson R, Babatunde V, Shinagare A, Khorasani R. Factors Impacting the Use of Terminology to Convey Diagnostic Certainty in Radiology Reports. Open Med Inform J 2018. [DOI: 10.2174/1874431101812010051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Variable use of phrases expressing diagnostic uncertainty can lead to ambiguous radiology reports, a concern for information processing.
Objective:
This study aimed to quantify the usage of phrases conveying diagnostic certainty for abdominal imaging findings and assess factors that impact use of phrases with “good agreement” between radiologists and referring providers.
Methods:
This retrospective, Institutional Review Board-Approved study included all diagnostic reports generated by the Abdominal Radiology Division at an academic medical center July-September 2016. We assessed the use of 16 diagnostic certainty phrases using information retrieval from the Impression section of radiology reports. Phrases with good provider agreement for conveying the level of certainty are defined as “good agreement” phrases - including “diagnostic of”, “represents” and “unlikely.” We assessed the impact of imaging modality, trainee contribution to report generation, and individual radiologists.
Results:
In 5,598 radiology reports, 2,071 (37%) contained diagnostic certainty phrases, 119 (6%) of which were “good agreement” phrases. There was a significant difference between how frequently “good agreement” phrases were used in Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and X-ray reports (p=0.0003). There was a significant variation among attending radiologists on the use of “good agreement” phrases (p<0.0019). There was no difference in the use of “good agreement” phrases in reports generated by attending radiologists alone compared to reports with trainees.
Conclusion:
Although phrases to convey diagnostic certainty were commonly used in radiology reports, the use of phrases with a good agreement was uncommon. Standardizing terminology to convey diagnostic certainty may reduce ambiguity in radiology reports and generate more accurate information processing tools.
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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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Trofimova A, Vey BL, Safdar NM, Duszak R, Kadom N. Radiology Report Readability: An Opportunity to Improve Patient Communication. J Am Coll Radiol 2018; 15:1182-1184. [DOI: 10.1016/j.jacr.2018.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
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Structured reporting of x-rays for atraumatic shoulder pain: advantages over free text? BMC Med Imaging 2018; 18:20. [PMID: 29970014 PMCID: PMC6029150 DOI: 10.1186/s12880-018-0262-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 06/12/2018] [Indexed: 11/17/2022] Open
Abstract
Background To analyse structured and free text reports of shoulder X-ray examinations evaluating the quality of reports and potential contributions to clinical decision-making. Methods We acquired both standard free text and structured reports of 31 patients with a painful shoulder without history of previous trauma who received X-ray exams. A template was created for the structured report based on the template ID 0000154 (Shoulder X-ray) from radreport.org using online software with clickable decision trees with concomitant generation of structured semantic reports. All reports were evaluated regarding overall quality and key features: content, information extraction and clinical relevance. Results Two experienced orthopaedic surgeons reviewed and rated structured and free text reports of 31 patients independently. The structured reports achieved significantly higher median ratings in all key features evaluated (P < 0.001), including facilitation of information extraction (P < 0.001) and better contribution to subsequent clinical decision-making (P < 0.001). The overall quality of structured reports was significantly higher than in free text report (P < 0.001). Conclusions A comprehensive structured template may be a useful tool to assist in clinical decision-making and is, thus, recommended for the reporting of degenerative changes regarding X-ray examinations of the shoulder. Electronic supplementary material The online version of this article (10.1186/s12880-018-0262-8) contains supplementary material, which is available to authorized users.
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Chung CY, Alson MD, Duszak R, Degnan AJ. From imaging to reimbursement: what the pediatric radiologist needs to know about health care payers, documentation, coding and billing. Pediatr Radiol 2018; 48:904-914. [PMID: 29552707 DOI: 10.1007/s00247-018-4104-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/15/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
Medical coding and billing processes in the United States are complex, cumbersome and poorly understood by radiologists. Despite the direct implications of radiology documentation on reimbursement, trainees and practicing radiologists typically receive limited relevant training. This article summarizes the payer structure including the state-based Children's Health Insurance Programs, discusses the essential processes by which radiologists request and receive reimbursement, details the mechanisms of coding diagnoses using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and imaging services using Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, and explores reimbursement and coding-related issues specific to pediatric radiology. Appropriate documentation, informed by knowledge of coding, billing and reimbursement fundamentals, facilitates appropriate payment for clinically relevant services provided by pediatric radiologists.
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Affiliation(s)
- Chul Y Chung
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Degnan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Abstract
This article reviews basic concepts of report documentation for abdominal imaging examinations, focusing on practical elements for ensuring appropriate physician reimbursement. Nuances of abdominal radiography, CT, MRI, and ultrasonography codes are highlighted. Special considerations for the coding of 3D-rendering and contrast administration are also described. Greater abdominal radiologist awareness of these codes and their reporting requirements can help ensure proper documentation within radiology reports, thereby optimizing legitimate reimbursement.
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Abstract
The reporting roles of sonographers in Australasia vary considerably. A large number of sonographers already routinely produce formal reports, while others are moving into clinical ultrasound roles where reporting is expected. This article summarises the best practice in reporting of ultrasound examinations based on international literature and addresses key topics including report structure, clinical content, style and language. Numerous examples and sample phrases are provided and common pitfalls are discussed.
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Affiliation(s)
- Martin Necas
- Department of Ultrasound Waikato Hospital Level 1 Waiora Building Pembroke Street Hamilton New Zealand
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Ross SL, Ascher SM, Somwaru AS, Filice R. Quantifying Language Before and After Instituting Structured CT Reports. J Am Coll Radiol 2017. [DOI: 10.1016/j.jacr.2017.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Radiology report "disclaimers" increase the use of abdominal CT in the work-up of pediatric abdominal pain. Am J Emerg Med 2017; 36:556-559. [PMID: 28982533 DOI: 10.1016/j.ajem.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a "disclaimer" is associated with additional imaging. METHODS Design: Retrospective cohort. SETTING Community ED with volume of 85,000 annual visits. POPULATION Consecutive ED patients <21-years-old with appendix U/S over 12-months. Radiologist reports were assessed for disclaimers and if definitive diagnoses of appendicitis were made. The incidence of subsequent CT imaging was determined and group differences between categories were calculated. RESULTS 441 eligible patients were identified with average age 11.7years. Of all U/S studies, 26% were definitive for appendicitis and 74% were non-definitive. Disclaimers were included on 60% of all studies, including 13% of definitive studies and 76% of non-definitive studies. 25% of all studies including a disclaimer had follow-up CT versus 10% of studies without a disclaimer (15% difference; 95% CI: 9-21). For patients with definitive interpretations, 6% had follow-up CT with no significant difference between groups with or without a disclaimer. For patients with non-definitive studies, 26% with a disclaimer had follow-up CT scans versus 13% without a disclaimer (13% difference; 95% CI: 4-22). CONCLUSIONS Appendix ultrasound interpretations often include a disclaimer, which leads to a 150% increase in follow-up CT imaging. We suggest that radiologists consider the impact of including such a disclaimer, knowing that this may contribute to possible unnecessary imaging.
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Lee B, Whitehead MT. Radiology Reports: What YOU Think You’re Saying and What THEY Think You’re Saying. Curr Probl Diagn Radiol 2017; 46:186-195. [DOI: 10.1067/j.cpradiol.2016.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/06/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
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Strategies for Improving the Value of the Radiology Report: A Retrospective Analysis of Errors in Formally Over-read Studies. J Am Coll Radiol 2017; 14:459-466. [DOI: 10.1016/j.jacr.2016.08.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/20/2022]
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Gunn AJ, Tuttle MC, Flores EJ, Mangano MD, Bennett SE, Sahani DV, Choy G, Boland GW. Differing Interpretations of Report Terminology Between Primary Care Physicians and Radiologists. J Am Coll Radiol 2016; 13:1525-1529.e1. [DOI: 10.1016/j.jacr.2016.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 12/01/2022]
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Little D, McCoubrie P. Learning whilst on-call: a vital part of radiology training? Clin Radiol 2016; 71:921-4. [DOI: 10.1016/j.crad.2016.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
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Zafar HM, Bugos EK, Langlotz CP, Frasso R. "Chasing a Ghost": Factors that Influence Primary Care Physicians to Follow Up on Incidental Imaging Findings. Radiology 2016; 281:567-573. [PMID: 27192458 DOI: 10.1148/radiol.2016152188] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To explore provider and patient characteristics that influence how primary care providers (PCPs) communicate and manage incidental imaging findings. Materials and Methods This HIPAA-compliant study was approved by the institutional review board. Through semistructured interviews, researchers explored concerns and perspectives of 30 PCPs on receiving and acting on incidental imaging findings. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. Thematic codes were developed and explicitly defined. Three research assistants independently coded all 30 deidentified transcripts and resolved discrepancies (κ = 0.85). Codes pertaining to PCP and patient characteristics were organized into an explanatory model. Results Some PCPs felt compelled but frustrated to pursue costly follow-up for incidental imaging findings of limited clinical importance. Other PCPs did not act on findings that were unfamiliar or occurred in an unusual clinical context when follow-up recommendations were not given; the challenges of researching the clinical importance of these findings or seeking specialist consultation led to inaction. Some PCPs reported using a uniform approach to communicate and manage incidental findings, while others adapted their approach to the patient and the finding. Sometimes PCP characteristics such as follow-up style superseded patient characteristics. At other times patient characteristics such as health literacy superseded PCP characteristics. Conclusion PCPs cited a variety of objective and subjective factors that influence how they communicate and manage incidental imaging findings. These results suggest that some patients may receive inappropriate follow-up of incidental imaging findings and present an opportunity for radiologists to help PCPs and patients to best use the information conveyed in imaging reports. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Hanna M Zafar
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.)
| | - Eva K Bugos
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.)
| | - Curtis P Langlotz
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.)
| | - Rosemary Frasso
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (H.M.Z.); Leonard Davis Institute of Health Economics (H.M.Z.) and Center for Public Health Initiatives, School of Social Policy and Practice (R.F.), University of Pennsylvania, Philadelphia, Pa; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.K.B.); and Departments of Radiology and Medicine, Stanford University School of Medicine, Stanford, Calif (C.P.L.)
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Association Between Confidence Level of Acute Pulmonary Embolism Diagnosis on CTPA images and Clinical Outcomes. Acad Radiol 2015; 22:1555-61. [PMID: 26391859 DOI: 10.1016/j.acra.2015.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/22/2015] [Accepted: 08/23/2015] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose was to evaluate clinical characteristics associated with low confidence in diagnosis of acute pulmonary embolism (PE) as expressed in computed tomography pulmonary angiography (CTPA) reports and to evaluate the effect of confidence level in PE diagnosis on patient clinical outcomes. MATERIALS AND METHODS This study included radiology reports from 1664 consecutive CTPA considered positive for acute PE (8/2003-5/2010). All reports were retrospectively assessed for the level of confidence in diagnosis. Baseline characteristics and outcomes (therapies related to PE and short-term mortality) were compared between high and low confidence groups. Multivariable logistic and Cox regression analyses were used to analyze the relationship between the confidence level and outcomes. RESULTS One-hundred sixty of 1664 (9.6%) reports had language that reflected a low confidence in PE diagnosis. The low confidence group had smaller (segmental and subsegmental) suspected emboli (prevalence, 72.5% vs. 50.7%; P < .001) and more comorbidities. The low confidence group had a lower likelihood of receiving PE-related therapies (adjusted odds ratio [OR], 0.18; 95% confidence interval, 0.10-031, P < .001), but there was no change in the all-cause and PE-related 30-day and/or 90-day mortality (OR of death for low confidence, 0.81-1.13, P values > .5). CONCLUSIONS Roughly 10% of positive CTPA reports had uncertainty in PE findings, and patients with reports categorized as low confidence had smaller emboli and more comorbidities. Although the low confidence group was less likely to receive PE-related therapies, patients in this group were not associated with higher probability of short-term mortality.
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Kuzminski SJ. Recommend Clinical Correlation: A Common but Meaningless Phrase in Radiology Reporting. J Am Coll Radiol 2015; 12:775. [DOI: 10.1016/j.jacr.2015.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/07/2015] [Indexed: 11/25/2022]
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Imaging-histologic discordance at percutaneous biopsy of the lung. Acad Radiol 2015; 22:481-7. [PMID: 25601302 DOI: 10.1016/j.acra.2014.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease. MATERIALS AND METHODS A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects. RESULTS Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis. CONCLUSIONS Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.
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Al-Mutairi A, Meyer AND, Chang P, Singh H. Lack of timely follow-up of abnormal imaging results and radiologists' recommendations. J Am Coll Radiol 2015; 12:385-9. [PMID: 25582812 DOI: 10.1016/j.jacr.2014.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Abnormal imaging results may not always lead to timely follow-up. We tested whether certain aspects of communication in radiology reports influence the response of the referring providers, and hence follow-up on abnormal findings. METHODS We focused on 2 communication-related items that we hypothesized could affect follow-up: expressions of doubt in the radiology report, and recommendations for further imaging. After institutional review board approval, we conducted a retrospective review of 250 outpatient radiology reports from a multispecialty ambulatory clinic of a tertiary-care Veterans Affairs facility. The selected studies included 92 cases confirmed to lack timely follow-up (ie, further tests or consultations, treatment, and/or communication to the patient within 4 weeks), as determined in a previous study. An additional 158 cases with documented timely follow-up served as controls. Doubt in the narrative was measured by the presence of key phrases (eg, "unable to exclude," "cannot exclude," "cannot rule out," "possibly," and "unlikely"), in the absence of which we used reviewer interpretation. A physician blinded to follow-up outcomes collected the data. RESULTS Patients whose reports contained recommendations for further imaging were more likely to have been lost to follow-up at 4 weeks compared with patients without such recommendations (P = .01). Language in the report suggestive of doubt did not affect the timeliness of follow-up (P = .59). CONCLUSIONS Abnormal imaging results with recommendations for additional imaging may be more vulnerable to lack of timely follow-up. Additional safeguards, such as tracking systems, should be developed to prevent failure to follow up on such results.
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Affiliation(s)
- Aymer Al-Mutairi
- Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Ashley N D Meyer
- Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Paul Chang
- Division of Radiology Informatics, Department of Radiology, University of Chicago Medical Center, Chicago, IL
| | - Hardeep Singh
- Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Currie S, Igra M, Warren D, Macmullen-Price J, Craven I. New General Medical Council language checks to be introduced in the summer. How will radiology reports fare? Clin Radiol 2014; 69:989-90. [DOI: 10.1016/j.crad.2014.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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How “consistent” is “consistent”? A clinician-based assessment of the reliability of expressions used by radiologists to communicate diagnostic confidence. Clin Radiol 2014; 69:745-9. [DOI: 10.1016/j.crad.2014.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/16/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
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Collard MD, Tellier J, Chowdhury ASMI, Lowe LH. Improvement in reporting skills of radiology residents with a structured reporting curriculum. Acad Radiol 2014; 21:126-33. [PMID: 24331275 DOI: 10.1016/j.acra.2013.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/04/2013] [Accepted: 10/12/2013] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology residents must acquire dictation and reporting skills to meet Accreditation Council for Graduate Medical Examination requirements and provide optimal patient care. Historically, these skills have been taught informally and vary between institutions and among radiologists. A structured curriculum improves resident report quality when using a quantitative grading scheme. This study describes the implementation of such a curriculum and evaluates its utility in tracking resident progress. MATERIALS AND METHODS We implemented a three-stage reporting curriculum in our diagnostic radiology residency program in 2009. Stages 1 and 2 involve instruction and formative feedback composed of suggestions for improvement in a 360° format from faculty, peers, and others within the resident's sphere of influence. The third stage involves individual, biannual, written feedback with scored reports specifically assessing four categories: succinctness, spelling/grammar, clarity, and responsible referral. Biannual scores were collected from 2009 to 2013, sorted by year of residency training (R1 to R4), and average training level scores were statistically compared. RESULTS Review of 1500 reports over a 4-year period yielded a total of 153 scores: 54, 36, 29, and 34 from R1, R2, R3, and R4 residents, respectively. The mean (standard deviation) scores for R1, R2, R3, and R4 residents were 10.20 (1.06), 10.25 (0.81), 10.5 (0.74), and 10.75 (0.69), respectively. Post hoc analysis identified significant differences between R1 and R4 residents (P = .012) and R2 and R4 residents (P = .009). CONCLUSIONS Residents' reporting scores showed significant improvement over the course of their residency training. This indicates that there may be a benefit in using an organized reporting curriculum to track resident progress in producing reports that may improve patient care.
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Affiliation(s)
- Michael D Collard
- Department of Radiology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO; Department of Radiology, Saint Luke's Hospital, Kansas City, MO; Department of Radiology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108.
| | - Jacob Tellier
- Department of Radiology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO; Department of Radiology, Saint Luke's Hospital, Kansas City, MO
| | - A S M Iftiar Chowdhury
- Department of Radiology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO; Department of Radiology, Saint Luke's Hospital, Kansas City, MO
| | - Lisa H Lowe
- Department of Radiology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO; Department of Radiology, Saint Luke's Hospital, Kansas City, MO; Department of Radiology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108
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Baker SR. The dictated report and the radiologist's ethos. An inextricable relationship: pitfalls to avoid. Eur J Radiol 2013; 83:236-8. [PMID: 24262977 DOI: 10.1016/j.ejrad.2013.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
Radiologists' reputation as expert image interpreters are in large measured defined by the content of their written reports. Habitually use of terms that reveal a lack of decisiveness will serve to diminish their esteem in the minds of their referrers. Recurrent resort expression to such as questionable, suspicious, cannot rule out, and clinical correlation requested when frequently deployed are examples of phrases that can have a negative effect on the radiologist's ethos.
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Affiliation(s)
- Stephen R Baker
- Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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Harvey J, West A. The right scan, for the right patient, at the right time: The reorganization of major trauma service provision in England and its implications for radiologists. Clin Radiol 2013; 68:871-86. [DOI: 10.1016/j.crad.2013.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 01/02/2013] [Accepted: 01/08/2013] [Indexed: 12/30/2022]
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Wallis A, Edey A, Prothero D, McCoubrie P. The Bristol Radiology Report Assessment Tool (BRRAT): developing a workplace-based assessment tool for radiology reporting skills. Clin Radiol 2013; 68:1146-54. [PMID: 23948663 DOI: 10.1016/j.crad.2013.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/18/2013] [Accepted: 06/26/2013] [Indexed: 11/16/2022]
Abstract
AIM To review the development of a workplace-based assessment tool to assess the quality of written radiology reports and assess its reliability, feasibility, and validity. MATERIALS AND METHODS A comprehensive literature review and rigorous Delphi study enabled the development of the Bristol Radiology Report Assessment Tool (BRRAT), which consists of 19 questions and a global assessment score. Three assessors applied the assessment tool to 240 radiology reports provided by 24 radiology trainees. RESULTS The reliability coefficient for the 19 questions was 0.79 and the equivalent coefficient for the global assessment scores was 0.67. Generalizability coefficients demonstrate that higher numbers of assessors and assessments are needed to reach acceptable levels of reliability for summative assessments due to assessor subjectivity. CONCLUSION The study methodology gives good validity and strong foundation in best-practice. The assessment tool developed for radiology reporting is reliable and most suited to formative assessments.
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Affiliation(s)
- A Wallis
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK.
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Del Grande FF, Carrino JA, Nagy P. Performance quality improvement projects in musculoskeletal radiology. J Am Coll Radiol 2013; 10:475-6. [PMID: 23735274 DOI: 10.1016/j.jacr.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Filippo F Del Grande
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Niederkohr RD, Greenspan BS, Prior JO, Schöder H, Seltzer MA, Zukotynski KA, Rohren EM. Reporting guidance for oncologic 18F-FDG PET/CT imaging. J Nucl Med 2013; 54:756-61. [PMID: 23575994 DOI: 10.2967/jnumed.112.112177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The written report (or its electronic counterpart) is the primary mode of communication between the physician interpreting an imaging study and the referring physician. The content of this report not only influences patient management and clinical outcomes but also serves as legal documentation of services provided and can be used to justify medical necessity, billing accuracy, and regulatory compliance. Generating a high-quality PET/CT report is perhaps more challenging than generating a report for other imaging studies because of the complexity of this hybrid imaging modality. This article discusses the essential elements of a concise and complete oncologic (18)F-FDG PET/CT report and illustrates these elements through examples taken from routine clinical practice.
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Affiliation(s)
- Ryan D Niederkohr
- Department of Nuclear Medicine, Kaiser Permanente Medical Center, Santa Clara, CA, USA.
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Mamlouk MD. Becoming a Clinical Diagnostic Radiologist: The Answer Is Not “Clinically Correlate”. J Am Coll Radiol 2012; 9:611-2. [DOI: 10.1016/j.jacr.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 01/04/2012] [Indexed: 10/27/2022]
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Wallis A, McCoubrie P. The radiology report--are we getting the message across? Clin Radiol 2011; 66:1015-22. [PMID: 21788016 DOI: 10.1016/j.crad.2011.05.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/09/2011] [Accepted: 05/31/2011] [Indexed: 01/18/2023]
Abstract
The radiology report is the primary method of communication between radiologist and referrer. Despite this, radiologists receive very little formal training regarding the structure of the radiology report and also its importance as a medico-legal document. We present a review of radiology reporting, highlighting the importance of report structure and language with the purpose of helping radiologists improve the clarity, brevity, pertinence, and readability of reports. We encourage radiologists to avoid hedging and strive to improve communication with referring clinicians.
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Affiliation(s)
- A Wallis
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Chapman BE, Lee S, Kang HP, Chapman WW. Document-level classification of CT pulmonary angiography reports based on an extension of the ConText algorithm. J Biomed Inform 2011; 44:728-37. [PMID: 21459155 DOI: 10.1016/j.jbi.2011.03.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 03/08/2011] [Accepted: 03/27/2011] [Indexed: 11/28/2022]
Abstract
In this paper we describe an application called peFinder for document-level classification of CT pulmonary angiography reports. peFinder is based on a generalized version of the ConText algorithm, a simple text processing algorithm for identifying features in clinical report documents. peFinder was used to answer questions about the disease state (pulmonary emboli present or absent), the certainty state of the diagnosis (uncertainty present or absent), the temporal state of an identified pulmonary embolus (acute or chronic), and the technical quality state of the exam (diagnostic or not diagnostic). Gold standard answers for each question were determined from the consensus classifications of three human annotators. peFinder results were compared to naive Bayes' classifiers using unigrams and bigrams. The sensitivities (and positive predictive values) for peFinder were 0.98(0.83), 0.86(0.96), 0.94(0.93), and 0.60(0.90) for disease state, quality state, certainty state, and temporal state respectively, compared to 0.68(0.77), 0.67(0.87), 0.62(0.82), and 0.04(0.25) for the naive Bayes' classifier using unigrams, and 0.75(0.79), 0.52(0.69), 0.59(0.84), and 0.04(0.25) for the naive Bayes' classifier using bigrams.
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Affiliation(s)
- Brian E Chapman
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0728, USA.
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