Variation in Radiologists’ Follow-Up Imaging Recommendations for Small Cystic Pancreatic Lesions |
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| Institution: | 1. Director of Diversity, Equity, and Inclusion, Quality and Patient Safety Officer, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;2. Director of Education, Center for Evidence-Based Imaging, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;3. Director of Clinical Informatics, Harvard Medical School Library of Evidence, Boston, Massachusetts;4. Research Fellow, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;5. Medical Director of CT, and Director, Cross-Sectional Interventional Radiology (CSIR), Department or Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;6. Faculty, Center for Evidence-Based Imaging, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;7. Director, Center for Evidence-Based Imaging, and Vice Chair of Quality/Safety, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;1. Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida;2. Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri;3. Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland;4. Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota;1. Former President, Johns Hopkins University, Baltimore, Maryland; and Former President, Salk Institute for Biological Studies, San Diego, California;2. Professor, Johns Hopkins Medicine, Department of Radiology and Radiological Science, Department of Oncology and Department of Surgery. He serves as Director of Diagnostic Imaging and Body CT at Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Associate Professors from The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Chief, Ultrasound Section, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut;2. Executive Vice President for Quality and Safety, American College of Radiology, Reston, Virginia;3. Yale University School of Medicine, New Haven, Connecticut;4. Boston Medical Center, Boston, Massachusetts;5. Massachusetts General Hospital, Boston, Massachusetts;1. Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency in the Department of Radiology, Boston University Medical Center, Boston, Massachusetts;2. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Chair of Radiology, Department of Radiology, Boston University Medical Center, Boston, Massachusetts;4. Director of Academic Innovation for the Department of Medical Imaging Department, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;5. Director of Radiology, Denver Health, Denver, Colorado;6. Professor and Vice Chair, Department of Radiology, University of Colorado School of Medicine, Denver, Colorado;1. Vice Chair of Communications, Division Chief of Neuroradiology;2. Vice Chair of Education, Neuroradiology Fellowship Director, Department of Radiology, Division of Neuroradiology;3. Radiology Vice Chair for Academic Affairs, Interim Chief of Neuroradiology, Department of Radiology, Division of Neuroradiology;1. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Residency director of the Integrated IR/DR residency, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Co-directors of the Penn Image-Guided Interventions Laboratory, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania |
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| Abstract: | ObjectiveThis study aimed to determine the incidence, identify imaging and patient factors, and measure individual radiologist variation associated with follow-up recommendations for small focal cystic pancreatic lesions (FCPLs), a common incidental imaging finding.MethodsThis institutional review board–approved retrospective study analyzed 146,709 reports from abdominal CTs and MRIs performed in a large academic hospital from July 1, 2016, to June 30, 2018. A trained natural language processing tool identified 4,345 reports with FCPLs, which were manually reviewed to identify those containing one or more <1.5-cm pancreatic cysts. For these patients, patient, lesion, and radiologist features and follow-up recommendations for FCPL were extracted. A nonlinear random-effects model estimated degree of variation in follow-up recommendations across radiologists at department and division levels.ResultsOf 2,872 reports with FCPLs < 1.5 cm, 708 (24.7%) had FCPL-related follow-up recommendations. Average patient age was 67 years (SD ± 11). In all, 1,721 (60.0%) reports were for female patients; 59.3% of patients had only one cyst. In multivariable analysis, older patients had slightly lower follow-up recommendation rates (odds ratio OR]: 0.98 0.98-1.00] per additional year), and lesions associated with main duct dilatation and septation were more likely to have a follow-up recommendation (ORs: 1.93 1.11-3.36] and 2.88 1.89-4.38], respectively). Radiologist years in practice (P = .51), trainee presence (P = .21), and radiologist gender (P = .52) were not associated with increased follow-up recommendations. There was significant interradiologist variation in the Abdominal Imaging Division (P = .04), but not in Emergency Radiology (P = .31) or Cancer Imaging Divisions (P = .29).DiscussionInterradiologist variation significantly contributes to variability in follow-up imaging recommendations for FCPLs. |
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| Keywords: | Follow-up imaging natural language processing pancreatic cyst |
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