A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative

Kim, Danny; Bennett, Genevieve L.; Somberg, Molly B.; Campbell, Nicole; Gaing, Byron; Recht, Michael P.; Doshi, Ankur M.

doi:10.1016/j.jacr.2016.01.015

Cited by 20 publications

(16 citation statements)

References 9 publications

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“…This document provides a management framework for adnexal cysts, from physiologic follicles to benign and malignant neoplasms. The guidelines are in use at our institutions and others (14,15) and have been used as a basis for practice quality-improvement efforts (16). However, to our knowledge, the performance of these guidelines in appropriately characterizing nonneoplastic and neoplastic cysts has not been formally evaluated.…”

Section: Ultrasonography: Risk Stratification Of Adnexal Cysts and Cymentioning

confidence: 99%

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Maturen¹,

Blaty²,

Wasnik³

et al. 2017

Radiology

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Purpose To evaluate the performance of the 2010 Society of Radiologists in Ultrasound (SRU) consensus guidelines in the risk stratification of symptomatic and asymptomatic adnexal cysts. Materials and Methods An institutional review board-approved retrospective review was performed, including adnexal cysts detected with ultrasonography (US) with surgical diagnosis or at least 2 years of imaging or clinical follow-up, from January to June 2011. SRU management recommendations were scored as 0, no follow-up; 1, US follow-up; 2, magnetic resonance (MR) imaging follow-up; and 3, surgical evaluation. Distribution of outcomes (nonneoplastic cyst, benign neoplasm, malignant neoplasm) was compared in each rating group by using the Cochran-Armitage trend test. Where SRU guidelines allow more than one management option, they were classified as being interpreted in either a "surgically focused" environment, with limited MR imaging availability, or an "MR-capable" center, where MR imaging is selected whenever it is an option. Predictors of neoplasms and malignancy were evaluated by using multivariate logistic regression. Results A total of 570 cysts in 500 women aged 18-90 years (mean, 42 years) were included. There were 475 (83.3%) nonneoplastic cysts, 77 (13.5%) benign neoplasms, and 18 (3.2%) malignant neoplasms. Of the 500 women, 161 (32.2%) were asymptomatic. In the surgically focused interpretation of guidelines, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 48% and 0% in SRU 2, and 48% and 16% in SRU 3 (P < .0001 for both trends). In the interpretation of SRU guidelines with MR imaging when it was an option, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 38% and 5% in SRU 2, and 81% and 52% in SRU 3 (P < .0001, both trends) and 82 (89.1%) fewer benign cysts would have gone directly to surgical evaluation. In multivariate regression, SRU rating predicted both any neoplasm (odds ratio, 2.58; P < .0001) and malignant neoplasm (odds ratio, 4.94; P = .005). Conclusion SRU consensus guidelines effectively stratified the risk of neoplasia and malignancy. Selecting MR imaging when it is an option in the guidelines would have reduced the number of benign cysts sent for surgical evaluation. RSNA, 2017.

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Section: Ultrasonography: Risk Stratification Of Adnexal Cysts and Cymentioning

confidence: 99%

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Maturen¹,

Blaty²,

Wasnik³

et al. 2017

Radiology

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“…Four studies used electronic guideline references embedded within electronic radiology reporting and communication systems to provide radiologists easy access to guidelines and follow-up recommendations (phase 2) [20][21][22][23]. One study also used electronic guideline references to influence clinician behavior (phase 3) when reading radiologists' recommendations [23]. Clark and Coats developed a computer application that stored all published guidelines from the ACR.…”

Section: Qualitative Synthesis Of If Management Strategiesmentioning

confidence: 99%

“…Kim et al used electronic guideline reminders to modify clinical processes for incidental ovarian findings across phases 2 and 3. Radiology and obstetrics and gynecology departments transformed institution-specific recommendations into flowcharts for radiologists to reference during dictation [23]. An educational statement about the guidelines interdisciplinary development and institutional endorsement was added to the radiology report to educate referring clinicians and reinforce confidence in following care recommendations (phase 3) [23].…”

Section: Qualitative Synthesis Of If Management Strategiesmentioning

confidence: 99%

Management Strategies to Promote Follow-Up Care for Incidental Findings: A Scoping Review

Crable

Feeney

Harvey

et al. 2021

Journal of the American College of Radiology

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“…However, studies have shown that a significant proportion of patients with incidental adnexal lesions undergo work-up that is not adherent to the guidelines. In a study by Kim et al (22) the current guidelines were not followed in 50% of patients, perhaps because of barriers to adherence such as lack of awareness, previous practice habits, lack of local practice “buy-in”, shortage of time and difficulty in incorporating the guidelines in practice (23). The same group demonstrated that local adaptation of the existing guidelines and incorporating them into a radiology decision support tool significantly improved the rate of guideline-adherent evaluation of incidental adnexal lesions (22).…”

Section: Incidental Findings and Evidence-based Imagingmentioning

confidence: 99%

“…At our institution, several CDS-enabled interventions have been successfully implemented over the past decade (414445), and a vast potential for oncologic applications exists. Experience at our and other institutions has shown that implementation of CDS leads to an improvement in the quality of care and adherence to guidelines (22414445). …”

Section: Use Of Technology To Choose the Right Testmentioning

confidence: 99%

Evidence-Based Cancer Imaging

Shinagare

Khorasani

2017

Korean J Radiol

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With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.

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A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative

Cited by 20 publications

References 9 publications

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Management Strategies to Promote Follow-Up Care for Incidental Findings: A Scoping Review

Evidence-Based Cancer Imaging

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