Variation in Follow-up Imaging Recommendations in Radiology Reports: Patient, Modality, and Radiologist Predictors

Abstract

A critical part of interpreting radiologic images is determining the need for potential follow-up imaging. Reported rates of follow-up recommendations in radiology reports range 8%-37% (1-6) with high rates of interobserver variability (7). Even radiology reports with noncritical findings may contain recommendations for further imaging by using different modalities or recommendations for interval followup by using the same modality (5). Furthermore, there are known differences in radiologists' familiarity and adherence with evidence-based guidelines (8-10). This may lead to unnecessary additional tests in the follow-up of incidental or ambiguous imaging findings (11,12). A better understanding of follow-up recommendations in radiology reports is needed, as are clear identification of factors that might account for variation in rates of follow-up recommendations. Previous studies (5,13) performed at single institutions and in single subspecialty divisions have suggested that radiologist experience may be associated with fewer follow-up recommendations. However, it remains poorly understood how much radiologists vary when recommending additional imaging and what additional radiologists and other factors influence the likelihood of additional imaging. We hypothesized there is a large amount of likely unwarranted variation among radiologists in terms of the probability of making a follow-up recommendation. Therefore, we sought to identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions to better evaluate features associated with a higher number of follow-up recommendations.

Radiologist Variation in the Rates of Follow-up Imaging Recommendations Made for Pulmonary Nodules

“…Additionally, not all imaging examinations that might show a pulmonary nodule were included, such as CT imaging of the spine. However, several radiology subspecialties were represented, and our finding regarding variation in followup recommendations for pulmonary nodules was consistent with prior published work showing significant interradiologist variation in follow-up recommendations for all imaging findings, not just limited to pulmonary nodules [15,17,22]. Second, variation in follow-up recommendations between radiologists could reflect patient-level differences, an issue of confounding.…”

“…Our study is consistent with prior work, which has shown high rates of interradiologist variation using nondisease-specific data [15,17,22]. However, there is limited work analyzing follow-up recommendations at the disease level, which is important because focusing on a specific disease allows for a more uniform comparison of patient and radiologist factors that are associated with follow-up recommendations and that may be confounded by diseasespecific factors that are inadequately adjusted for in nondisease-specific data.…”

“…For these patients, follow-up is determined on case-by-case basis by the radiologist and ordering provider. Further complicating the issue of pulmonary nodule management, radiologists in general have high levels of reported interobserver variability in identifying these nodules [15][16][17]. For instance, one study showed that out of 5,835 lung cancer screening CTs, 13% were false-positive, which was defined as Lung-RADS 3-4X and no history of lung cancer diagnosis within 1 year [18].…”

Laboratory-Generated Urine Toxicology Interpretations: A Mixed Methods Study

“…If laboratory-generated toxicology interpretations become more widespread, guidelines to standardize reporting language will be necessary to ensure that information is conveyed accurately and succinctly while minimizing patient stigma. Substantial variation in interclinician reporting currently exists within radiology and pathology (49,50). These specialties are working to reduce unwarranted variation by synoptic reporting, which is the use of a structured report with coded concepts that support the discrete input and storage of clinical data and enables direct extraction in a machinereadable format (51,52).…”

Clinicians' Behavior Toward Radiology Reports: A Cross-Sectional Study

“…The study showed that the majority of clinicians (70.5%) preferred if a recommendation section was provided at the end of the report, which would have helped them understand the report more [ 5 , 7 ]. This would significantly help clinicians easily reach the definitive diagnosis by combining the data of the radiology report with the clinical presentation and examination of each patient [ 1 , 8 , 9 ]. Based on the aforementioned observations, it is important to form a relevant and convenient conclusion section in the radiology report, given that a representative number of clinicians do not read the report fully, as we found in our research that 6.5% of the physician read only the conclusion.…”