Vartan Vartanians MD, Presenter: Nothing to Disclose

Tarik K. Alkasab MD, PhD, Abstract Co-Author: Nothing to Disclose

Matthew Stewart Cushing MD, Abstract Co-Author: Nothing to Disclose

Matthew David Gilman MD, Abstract Co-Author: Nothing to Disclose

Hani H. Abujudeh MD, MBA, Abstract Co-Author: Research grant, Bracco Group Consultant, RCG HealthCare Consulting

Jo-Anne O. Shepard MD, Abstract Co-Author: Nothing to Disclose

Daniel Ira Rosenthal MD, Abstract Co-Author: Nothing to Disclose

Radiologists phrase recommendations for follow-up imaging in a variety of non-standard ways. We sought to assess effect of differences in phrasing on the compliance and positive predictive value of radiologist recommendations for follow-up CT in the clinical setting of outpatient chest radiographs (CXRs).

We queried for all outpatient CXRs during 2008. Each matching CXR was scanned for recommendations for chest CT, which were then classified according to phrasing as “direct” or “conditional” recommendations. We then queried for subsequent CTs within one year of index exam and excluded patients with prior chest CT. Reports of CXR and CT were reviewed in tandem. When a CT finding corresponding to the CXR finding was identified, it was categorized as “significant” if it required further imaging or treatment or “incidental” if no further workup was required. Differences in recommendation compliance rate and positive predictive value (PPV) were then assayed using Χ2 tests.

Of 29138 outpatient CXRs, 1317 (4.5%) led to recommendations for chest CT: 798 “direct” and 519 “conditional”. CT was obtained after 583 (73.1%) direct and 277 (53.6%)conditional recommendations. Among a group of 1671 exams without CT recommendations, 535 (32.0%) had a CT within a year. Compliance rate differences between all groups were significant (p<0.00001) After excluding patients with a prior CT exam,of the 476 chest CTs after direct recommendations,176 had a significant finding and 129 had an incidental finding for a PPV of 37% for significant and 64% for any corresponding finding. Of the 233 chest CTs after conditional recommendations, 77 had a significant finding and 67 had an incidental finding for a PPV of 32% for significant and 62% for any corresponding finding. Differences in PPV between the groups for both significant findings (p=0.30) and any corresponding finding (p=0.55)were not significant.  

The phrasing of a radiologist recommendation for follow-up imaging affects the rate at which the recommended imaging is obtained. However, in the clinical context we studied, the diagnostic yield of the obtained exams is nearly identical for direct and conditionally recommended exams.

Radiologists should think carefully about the phrasing of their recommendations, since decreased compliance is likely to result in delay of potentially significant diagnoses.

Vartanians, V, Alkasab, T, Cushing, M, Gilman, M, Abujudeh, H, Shepard, J, Rosenthal, D, Effect of Recommendation Phrasing on Yield and Compliance of Radiologist-recommended Chest CT.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011987.html