The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach

The goal of this project was to create a system that was easy for radiologists to use and that could reliably identify, communicate, and track communication of important but non-urgent radiology findings to providers and patients. Prior to 2012, our workflow for communicating important non-urgent diagnostic imaging results was cumbersome, rarely used by our radiologists, and resulted in delays in report turnaround time. In 2012, we developed a new system to communicate important non-urgent findings (the RADiology CATegorization 3 (RADCAT-3) system) that was easy for radiologists to use and documented communication of results in the electronic medical record. To evaluate the performance of the new system, we reviewed our radiology reports before (June 2011–June 2012) and after (June 2012–June 2014) the implementation of the new system to compare utilization by the radiologists and success in communicating these findings. During the 12 months prior to implementation, 250 radiology reports (0.06 % of all reports) entered our workflow for communicating important non-urgent findings. One-hundred percent were successfully communicated. During the 24 months after implementation, 13,158 radiology reports (1.4 % of all reports) entered our new RADCAT-3 workflow (3995 (0.8 % of all reports) during year 1 and 9163 (1.9 % of all reports) during year 2). 99.7 % of those reports were successfully communicated. We created a reliable system to ensure communication of important but non-urgent findings with providers and/or patients and to document that communication in the electronic medical record. The rapid adoption of the new system by radiologists suggests that they found it easy to use and had confidence in its integrity. This system has the potential to improve patient care by improving the likelihood of appropriate follow-up for important non-urgent findings that could become life threatening.     

Feasibility of Natural Language Processing–Assisted Auditing of Critical Findings in Chest Radiology

ObjectiveTime-sensitive communication of critical imaging findings like pneumothorax or pulmonary embolism to referring physicians is essential for patient safety. The definitive communication is the radiology free-text report. Quality assurance initiatives require that institutions audit these communications, a time-intensive manual task. We propose using a rule-based natural language processing system to improve the process for auditing critical findings communications.MethodsWe present a pilot assessment of the feasibility of using an automated critical finding identification system to assist quality assurance teams’ evaluation of critical findings communication compliance. Our assessment is based on chest imaging reports. Critical findings are identified in radiology reports using pyConTextNLP, an open source Python implementation of the ConText algorithm.ResultsIn our test set, there were 75 reports with critical findings and 591 reports without critical findings. pyConTextNLP correctly identified 69 of the positive cases with 8 false-positives for a sensitivity of 0.92 and a specificity of 0.99.DiscussionNatural language processing can provide valuable assistance to auditing critical findings communications.     

Critical Findings: Timing of Notification in Neuroradiology

BACKGROUND AND PURPOSE:Timely reporting of critical findings in radiology has been identified by The Joint Commission as one of the National Patient Safety Goals. Our aim was to determine the magnitude of delays between identifying a neuroradiologic critical finding and verbally notifying the caregiver in an effort to improve clinical outcomes.MATERIALS AND METHODS:We surveyed the time of critical finding discovery, attempted notification, and direct communication between neuroradiologists and caregivers for weekday, evening, overnight, and weekend shifts during an 8-week period. The data were collected by trained observers and/or trainees and included 13 neuroradiology attendings plus fellows and residents. Critical findings were based on a previously approved 17-item list. Summary and comparative t test statistics were calculated, and sources of delays were identified.RESULTS:Ninety-one critical findings were recorded. The mean time from study acquisition to critical finding discovery was 62.2 minutes, from critical finding discovery to call made 3.7 minutes, and from call made to direct communication, 5.2 minutes. The overall time from critical finding discovery to caregiver notification was within 10 minutes in 72.5% (66/91) and 15 minutes in 93.4% (85/91) of cases. There were no significant differences across shifts except for daytime versus overnight and weekend shifts, when means were 2.4, 5.6, and 8.7 minutes, respectively (P < .01). If >1 physician was called, the mean notification time increased from 3.5 to 10.1 minutes (P < .01). Sources of delays included inaccurate contact information, physician unavailability (shift change/office closed), patient transfer to a different service, or lack of responsiveness from caregivers.CONCLUSIONS:Direct communication with the responsible referring physician occurred consistently within 10–15 minutes after observation of a critical finding. These delays are less than the average interval from study acquisition to critical finding discovery (mean, 62.2 minutes).

The eradication of preventable medical errors is of paramount importance in the field of health care. In July 2011, The Joint Commission (TJC) released a National Patient Safety Goal that mandated that healthcare providers “report critical results of tests and diagnostic procedures on a timely basis.”¹ There have subsequently been protocols created to reach this goal, including those for the following: 1) defining a critical finding (CF), 2) communicating the critical finding to the physician, and 3) indicating what makes a report “timely.”^2–6TJC has never defined a CF, stating only “each organization can define for itself the circumstances under which a test result is considered ‘critical.’”¹ The American College of Radiology identifies findings that require nonroutine communication as those “that suggest a need for immediate or urgent intervention.”² Likewise, TJC has never defined what “timely” means. Once again it has suggested that institutions define for themselves what is timely for a given laboratory or imaging finding. However TJC demands that institutions monitor compliance with the communication of CFs (Appendix).At our institution, we have created, in neuroradiology, a list of critical findings that neuroradiology, neurosurgery, neurology, and otorhinolaryngology departments have agreed is acceptable to all services. It has been reviewed at 5-year intervals. As to CF notification times, the only mandate has come from our Brain Attack team for being a Stroke Center of Excellence, which requires 20 minute Team turnaround times for reports after scans. There have been no guidelines set for other CFs.Recent studies involving the determination and communication of critical findings in neuroradiology have analyzed such compliance with the National Patient Safety Goals of the TJC by conducting surveys of academic radiology departments for the presence of a critical finding list and the method of disseminating and implementing the information.^3,7 Another publication studied the existing list of critical findings in neuroradiology and revised that list to include frequent findings that were not previously identified in an effort to be more inclusive of lesions that warrant immediate communication.⁴ Others have suggested that careful review of performance on an ongoing basis with regard to communication of radiologic critical findings can result in significant improvement in adherence to institutional guidelines.⁵Because TJC has been ambiguous about what constitutes appropriate timing for communicating CFs in radiology and no one has established baseline data with which to assess interval improvements, we sought to address this knowledge gap. The purpose of this study was to assess the extent of delays occurring between identification of a critical finding and communication to the referring physician. We focused only on this communication process (rather than delays from study ordered to study completion) to address TJC concerns about physician-physician communication delays. A broad interpretation of the mandate of TJC might suggest that radiologists must record when they see a CF, when they attempt to notify a caregiver, and when they actually communicate with the caregiver about that CF, as part of the monitoring function for critical results. For that reason, we investigated each of these intervals to assess their magnitude. We hypothesized that the time between the discovery of a critical finding and the attempt to contact the referring physician would be short and consistent across all timeframes of daily practice. However, the time between attempted notification of the referring physician and communication with the clinician would vary widely depending on the time of day the CF was discovered, the service being notified, and weekday or weekend shift. We also sought to determine the nature of such communication delays. This is the first step in improving patient care. By identifying sources of delays, addressing the sources of these delays, remediating them, and then reassessing notification times after corrections are made, we believe that patient care can be enhanced. Patients with critical health care needs can be treated earlier; hopefully, this change will positively impact outcomes.     

Trainee reporting of computed tomography examinations: do they make mistakes and does it matter?

AIM: To determine the accuracy of trainees reporting computed tomography (CT) examinations. MATERIAL AND METHODS: Over a 6-month period a single consultant reviewed all the CT examinations reported by registrars in one radiology department. After recording a provisional registrar report each examination was jointly reviewed by the consultant and registrar. The consultant's opinion was regarded as the gold standard. Data collected included: the error rate, whether an error was significant, leading to a change in patient management, and whether the mistake was a false-negative or positive. RESULTS: Three hundred and thirty-one patients were included in the study. There was an overall error rate of 21.5%. A significant error leading to a change in management was made in 10% of reports, and a significant error that did not lead to a change in management was made in 9.3%; 2.1% of reports had insignificant errors; and 69% of errors were false-negatives. CONCLUSION: Registrars make a significant number of errors affecting patient management when reporting CT and ideally all examinations should be reviewed by a consultant.     

Implementation and Impact of a Comprehensive Radiology Report Categorization System on Communication of Important Results

PurposeEffective communication of important imaging results is critical to patient care but difficult to accomplish efficiently. To improve communication at their institution, the authors introduced a radiology report categorization system (RADCAT) that organizes diagnostic imaging reports and uses automated communication systems. The study objectives were to (1) describe RADCAT’s design, (2) evaluate its implementation for appropriate imaging, and (3) evaluate the communication of important, nonurgent results with recommended follow-up.MethodsThis retrospective study was performed in a multihospital adult and pediatric tertiary referral academic health system. The intervention, a radiology report categorization system with five levels of acuity and IT-supported communication workflows, was globally implemented in November 2017. The primary outcomes were the successful implementation of RADCAT to appropriate diagnostic imaging reports and the successful communication of important, nonurgent results with recommended follow-up to ordering providers and patients by the radiology quality assurance team.ResultsOver 18 months after implementation, 740,625 radiology reports were categorized under the RADCAT system, with 42%, 28%, and 30% from the emergency department, inpatient, and outpatient settings, respectively. A random selection of 100 studies from the 23,718 total reports without RADCAT categorization identified 4 diagnostic radiology reports that erroneously lacked RADCAT grading. In 2019, of the 38,701 studies with nonurgent imaging follow-up recommendations, 38,692 (nearly 100.0%) were successfully communicated to providers or patients on the basis of quality assurance data.ConclusionsA comprehensive radiology report categorization system was successfully implemented across a multihospital adult and pediatric health system, demonstrating reliable communication of imaging results with recommendations for nonacute imaging follow-up.     

Implementation of online radiology quality assurance reporting system for performance improvement: initial evaluation

PURPOSE: To evaluate an online system developed and implemented for reporting and managing quality assurance (QA) events occurring in a radiology department. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was not required. Using repeated plan-do-study-act cycles, a radiology quality management team applied a 10-step process to implement an online reporting system. The system permits remote submission of cases by staff members. The number of weekly submissions to the system over a 9-month period was evaluated and compared with that for the preceding 6 months by using the Mann-Whitney test. Sources and nature of data, actions initiated, and final outcomes were also analyzed. Recorded data included forum of discussion, dimension of care, action items, monitoring of follow-up and compliance, and notification status. RESULTS: During the first 9 months of implementation, 605 cases were submitted (mean, 21.4 cases per week), a significant increase (P < .005) compared with the preceding 6 months (mean, 3.2 cases per week). Cases, which were submitted by residents (121 cases [20.0%]), fellows (94 cases [15.5%]), faculty members (319 cases [52.7%]), or technologists (54 cases [8.9%]), reported technical (33.1%) or administrative (8.0%) issues. The 329 clinical cases (54.4%) included 60 errors in communication (18.2%), 67 errors in interpretation (20.4%), 78 diagnostic delays (23.7%), 99 missed diagnoses (30.1%), and 54 procedural complications (16.4%); some cases were in more than one category. Twenty-three cases (3.8%) resulted in submission-related QA projects, and 69 cases (11.4%) resulted in individuals or sections of the hospital undergoing additional training. CONCLUSION: A secure online QA reporting system promotes reporting of QA events and serves as a database for identifying and managing trends, initiating performance improvement projects, and providing feedback to staff members who submit cases.     

Inappropriateness of breast imaging: cost analysis

Purpose

The aim of this study was to assess how an incorrect indication for an examination may affect the diagnostic workup and diagnosis as well as healthcare expenditure.

Materials and methods

We considered all the requests for breast imaging (mammography, ultrasound and magnetic resonance imaging) received by our radiology department between October 2010 and December 2010, and assessed their appropriateness based on the patient’s age and the clinical question, if present. We then analysed the unnecessary costs resulting from inappropriate requests.

Results

Out of a total of 1500 requests for ultrasound examination, the request was appropriate in 855 (57%) cases; out of a total of 2350 requests for mammography, the request was appropriate in 493 (21%) cases; out of a total of 100 requests for magnetic resonance imaging, the request was appropriate in 83 (83%) cases. The cost deriving from inappropriate requests was 51,235.04 Euros.

Conclusions

Improving the timeliness of diagnosis is an important goal to be pursued by enhancing the available health services, improving communication and coordination of the different professionals involved and optimising diagnostic pathways in order to reduce healthcare spending.     

The current position of cardiac radiology in the United Kingdom

A questionnaire was sent to 39 hospitals, in the United Kingdom, 38 with a cardiosurgical unit and one with a cardiac radiology department. The object was to ascertain the commitment of consultant radiologists to cardiovascular radiology and cardiac radiology in particular and to evaluate training given to non-consultant radiologists in this subspecialty. Thirty-five (90%) departments responded, 33 of which had a cardiac radiology consultant. All but three of the 63 consultant cardiac radiologists report cine angiography. Of the 63, 26 perform one additional imaging technique and 21 perform two or more additional imaging techniques. The remaining 16 consultants only report on cine angiography. Only nine of 21 departments in which some form of cardiac radiology training was given, had a rotation through the subspecialty at registrar or senior registrar level. Twenty-one departments thought that an additional post in cardiac radiology would be sought if trained people were available.     

Dosimetry in diagnostic radiology

Dosimetry is an area of increasing importance in diagnostic radiology. There is a realisation amongst health professionals that the radiation dose received by patients from modern X-ray examinations and procedures can be at a level of significance for the induction of cancer across a population, and in some unfortunate instances, in the acute damage to particular body organs such as skin and eyes.The formulation and measurement procedures for diagnostic radiology dosimetry have recently been standardised through an international code of practice which describes the methodologies necessary to address the diverging imaging modalities used in diagnostic radiology. Common to all dosimetry methodologies is the measurement of the air kerma from the X-ray device under defined conditions. To ensure the accuracy of the dosimetric determination, such measurements need to be made with appropriate instrumentation that has a calibration that is traceable to a standards laboratory.Dosimetric methods are used in radiology departments for a variety of purposes including the determination of patient dose levels to allow examinations to be optimized and to assist in decisions on the justification of examination choices. Patient dosimetry is important for special cases such as for X-ray examinations of children and pregnant patients. It is also a key component of the quality control of X-ray equipment and procedures.     

Patient satisfaction with the communication of mammographic results before and after the Mammography Quality Standards Reauthorization Act of 1998.

OBJECTIVE: The goal of this study was to evaluate the difference in patient satisfaction, timeliness of reporting, patient recollection of recommendations, and patient anxiety before and after passage of the Mammography Quality Standards Reauthorization Act of 1998, which requires written notification of all mammographic results. MATERIALS AND METHODS: We used a telephone survey with sampling that was stratified to reflect patients with normal and abnormal findings who had screening and diagnostic mammograms. Patients with visits before the mandate became effective (April 1999, n = 298) and after (January 2000, n = 316) were interviewed about the average time to receive results, satisfaction with communication about results, anxiety, and perceived follow-up recommendations. Multiple logistic regression was used to test the association of time period with patient dissatisfaction, controlling for age, anxiety level (considerable or extreme vs none or moderate), examination type (screening vs diagnostic), and examination result (normal vs abnormal findings). RESULTS: No significant difference was found between periods in anxiety about results or agreement with documented radiology recommendations, but we found a substantial increase in the number of screening patients who reported timely receipt of results. Significantly fewer patients were dissatisfied with mammographic results communication after the mandate (multivariable odds ratio = 0.46, p = 0.006). Screening examination patients and patients who reported considerable or extreme anxiety about test results were more likely to be dissatisfied in both periods. CONCLUSION: By standardizing results notification, the Mammography Quality Standards Reauthorization Act improved patient satisfaction and reporting timeliness among screening examination patients, but did little to improve anxiety or recollection of recommendations. Future quality improvement efforts should focus on improving patients' understanding of follow-up recommendations.     

Impact of PTRIA (Patient Test Result Information Act) on patient follow up management

ObjectiveWe aim to study if direct patient notification in accordance with the Patient Test Results Information Act (Act 112) in Pennsylvania leads to decreased loss to follow up and prompt management of actionable imaging findings.MethodsFor this IRB-approved study, radiology reports were randomly identified using the Nuance mPower™ search engine. The actionable finding group (prior to Act-112) contained 300 patients for which a voice notification was sent by radiologists to alert ordering physicians about significant imaging findings. The PTRIA group (after Act-112) contained 300 patients who were mailed a standardized letter one day after the final report was issued. The electronic medical records were reviewed to evaluate how patients were managed.ResultsThere was no difference in loss to follow up rates and time to follow up completion between the two groups. In both groups, 34% of patients were lost to follow up in transition of care from generalists to specialists; 24% cases were lost to follow up when imaging findings were not in the area of the initial ordering provider expertise.ConclusionThe goal of Act 112 is to increase patients' role in the timely management of their significant medical conditions and prevent medical errors, specifically loss to follow up. Our study suggests that presumed patients' awareness does not contribute to improved follow up rates or decreased time to a follow up visit. 13% of patients are lost to follow up in both groups. A tracking system is required to prevent delayed management of the significant findings.     

Asymptomatic Abdominal Aortic Aneurysm: Standardizing Reporting Recommendations at a Large Multistate Radiology Practice

ObjectiveAlthough 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.MethodsAfter 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.ResultsDuring 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).DiscussionQuality 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.     

A case of a Dandy-Walker variant: the importance of a multidisciplinary team approach using complementary techniques to obtain accurate diagnostic information

Dandy-Walker malformation is a rare abnormality of the central nervous system (CNS) with a reported incidence of 1 in 25,00-35,00 live births and a slight female predominance. It accounts for 1-4% of cases of antenatally detected hydrocephalus. Dandy Walker variant forms part of the spectrum of Dandy Walker malformation. It is characterized by partial agenesis of the vermis, resulting in communication between the fourth ventricle and the cisterna magna. Dandy Walker malformation demonstrates an enlarged posterior fossa, with high insertion of the torcula herophili, as well as other features. In the diagnostic workup, ultrasound is reliable and accurate for making the diagnosis. In utero, fetal MRI can be used to confirm the diagnosis and also to identify any associated abnormalities. In cases of termination of pregnancy, autopsy will offer the diagnosis and provide additional information to assess the risk for future pregnancies and to help in counselling the parents. Autopsy is considered the gold standard for accurate diagnosis of the fetal abnormality. We report the unexpected finding of complete absence of the cerebellum due to maceration at autopsy, even though it was clearly demonstrated (but abnormal) on the antenatal ultrasound scan and MRI, as well as on post-mortem MRI. To the best of our knowledge, this has not been reported previously. Our case demonstrates the relevance of MRI when approaching a post-mortem examination with CNS malformation, and indicates that the "gold standard" might not always be autopsy.     

Clinical usefulness of imaging performed after CT angiography that was negative for pulmonary embolus in a high-risk oncologic population

OBJECTIVE: The purpose of our study was to determine the prevalence and types of additional imaging examinations that were performed, and whether anticoagulation therapy was started or continued, after CT angiography showed no pulmonary embolus in a high-risk oncologic population. MATERIALS AND METHODS: We reviewed the radiology report for each CT angiogram that was obtained for clinically suspected pulmonary embolism at our institution (a tertiary cancer center) during a 25-month period. The radiology information system was then searched for any additional confirmatory radiologic examinations performed within 2 days after a negative finding on CT angiography. Medical records were reviewed to determine whether anticoagulation therapy was started or continued despite a negative finding on CT angiography. RESULTS: Two hundred seventy-six CT angiograms were obtained in 260 oncology patients who were clinically suspected of having pulmonary embolism. The findings from 203 CT angiograms (74%) were interpreted as negative; 56 (20%), as positive; and 17 (6%), as equivocal for pulmonary embolism. Fifty-eight patients (21%) with negative findings on CT angiography subsequently underwent additional imaging, the results of which were potentially clinically important in 6% of the patients. Six patients began to receive and two continued to undergo anticoagulation therapy despite negative findings on CT angiography; three of the six patients received anticoagulation for new-onset atrial fibrillation. CONCLUSION: Negative results of CT angiography for pulmonary embolism did not deter referring physicians from ordering other confirmatory imaging tests in 21% of patients in a high-risk oncologic population. Those additional tests rarely revealed results that might have been clinically important.     

System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings

The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method. We assembled a multidisciplinary team to address the nature of these incidental findings and designed new workflows and operational pathways for both radiology and ED staff to properly communicate incidental findings. Our results are based on all incidental findings received and acknowledged between November 1, 2016, and May 30, 2017. The total number of incidental findings discovered was 1,409. Our systematic compliance fluctuated between 45% and 95% initially after implementation. However, after overcoming various challenges through optimization, our system reached a compliance rate of 93% to 95%. Through the implementation of our new, standardized communication system, a high degree of compliance with loop closure for ED incidental radiology findings was achieved at our institution.     

Clinical consequences of misinterpretations of neuroradiologic CT scans by on-call radiology residents

BACKGROUND AND PURPOSE: Studies have looked at the accuracy of radiologic interpretations by radiology residents as compared with staff radiologists with regard to emergency room plain films, emergency room body CT scans, and trauma head CT scans; however, to our knowledge, no study has evaluated on-call resident interpretations of all types of neuroradiologic CT scans. Both as a part of our departmental quality control program and to address concerns of clinical services about misinterpretation of neuroradiologic CT scans by on-call radiology residents, we evaluated the frequency of incorrect preliminary interpretations of neuroradiologic CT scans by on-call radiology residents and the effect of such misinterpretations on clinical management and patient outcome. METHODS: As determined by the staff neuroradiologist the next day, all potentially clinically significant changes to preliminary reports of emergency neuroradiologic CT scans rendered by on-call radiology residents were recorded over a 9-month period. A panel of neuroradiologists reviewed and graded all the changed cases by consensus. An emergency department staff physician reviewed medical records of all submitted cases to determine clinical consequences of the misinterpretations. RESULTS: Significant misinterpretations were made in 21 (0.9%) of 2388 cases during the study period. There was a significant change in patient management in 12 of the cases, with a potentially serious change in patient outcome in two cases (0.08%). CONCLUSION: On-call radiology residents have a low rate of significant misinterpretations of neuroradiologic CT scans, and the potential to affect patient outcome is rare.     

Clinical significance of unexplained abnormal focal FDG uptake in the abdomen during whole-body PET

OBJECTIVE: FDG PET is frequently used as part of the diagnostic workup in cancer patients. Visualization of radiotracer-avid foci suggests the presence of malignant disease. Unexplained focal FDG accumulation in the abdomen is sometimes noted, but the clinical significance of this finding is unknown. Therefore, we followed cases with unexplained focal abdominal FDG uptake found incidentally on whole-body scans to define the cause and clinical significance of this finding. CONCLUSION: Unexplained focal abdominal FDG uptake is an unusual finding with causes that include malignant and benign processes. Among the 14 cases with definitive diagnoses, seven were adenomas, which is a premalignant condition, and five (35.7%) were malignant. Therefore, although rare, unexplained focal abdominal FDG uptake should not be ignored and further diagnostic workup is warranted.     

Early Impact of Pennsylvania Act 112 on Follow-up of Abnormal Imaging Findings

ObjectivePennsylvania Act 112 requires diagnostic imaging facilities to directly notify outpatients about significant imaging abnormalities that require follow-up care within 3 months. The effects of Act 112 on patient care are unclear. We sought to characterize follow-up discussions and care received by outpatients with significant imaging abnormalities as defined by Act 112.MethodsWe evaluated findings flagged for patient notification under Act 112 at our institution over a 1-month period. We analyzed findings for radiologic reporting, follow-up discussions between patients and ordering providers, and follow-up medical care provided.ResultsFollow-up discussions were documented for 87% of findings (n = 205 of 235) and occurred on average 6.0 days after imaging examinations were performed. Follow-up discussions directly attributable to the Act 112 letter occurred in 0.4% of findings. Follow-up care was provided for 74% of findings on average 31.3 days after imaging examinations were performed. Provider-initiated follow-up discussions occurred earlier and were associated with shorter time to follow-up care when compared with patient-initiated discussions. Direct contact of ordering provider by interpreting radiologist was a significant predictor of occurrence of follow-up discussions and length of time to follow-up care.DiscussionAct 112 had a small impact at our institution on improving completed follow-up for abnormal imaging findings. Our results also imply that health systems should encourage timeliness of patient-provider discussions of abnormal imaging findings and facilitate direct radiologist communication with ordering providers. Future studies should evaluate the impact of Act 112 in different practice settings to understand its broader impact on follow-up care.     

Optimizing radiologic costs in the DRG environment

Previously developed consensus algorithms expressing a suggested radiologic workup for the diagnostic related groups (DRGs) specified by the prospective reimbursement policy have proven to be useful tools for investigating radiologic decision making and the resulting economic implications. The mathematical equations for determining diagnostic and therapeutic costs for two alternative algorithms for suspected acute cholecystitis are formulated. Illustrative examples and graphic displays are given regarding how such algorithms and equations are useful in finding answers to questions about the appropriate diagnostic workup, time, and cost. Exploration of the effect of different parameter values on the choice of the appropriate algorithm is illustrated.