Kaan David Erbay, Presenter: Nothing to Disclose

Nazli Erbay MD, Abstract Co-Author: Nothing to Disclose

Sami H. Erbay MD, Abstract Co-Author: Nothing to Disclose

-To identify the incidence of incidental findings on spinal CT and MRI studies. -To specify these incidental findings based on specific sites of involvement and disease processes. -To identify the additional radiologic recommendations for these findings, -To characterize the notification methods, -To review variable response of referring physicians for these findings. -To propose possible solutions to improve the compliance of referring physicians.

1000 CT or MRI total spine studies done consequently for trauma cases between 1/1/2006 and 1/1/2010 were reviewed in this retrospective study to detect unrelated paraspinal findings and additional imaging recommendations for such findings. These were grouped into cervical, thoracic, lumbar by location and different categories by disease processes. Posttraumatic soft tissue changes as well as intraspinal findings were excluded. Notification specifications( notifying person, type, speed of notification and notified person) are recorded. Variable actions of referring physicians are specified as no action, action with partial (if organ specific evaluation is performed but not by recommed test) or full compliance. Prior evaluations of these findings, if available from the medical records, were recorded.

213 incidental findings were; 41 % cervical , 34 % lumbar, 25 % thoracic. 40 % were in the neoplastic category. Email and ancillary services were dominant ways of notification. 72 additional imaging studies were recommended. Action profiles of no action, partial or full compliance were almost evenly divided. The compliance rate of referring physicians increased with reporting of urgent findings and direct reporting by the radiologist. Most common reasons of no or partial compliance were recommendations of expensive tests (such as PET-CT), previously evaluated lesions or referring physician specific.    

As radiologists, we can improve reffering physicians compliance for additional studies we are recommending by; -Directly notifying the referring physicians, -Be aware of cost consciousness of our colleques and patients, -By throughly reviewing patients' older medical records to exclude prior pertinent work up of same finding.

Improved compliance of referring physicians to order additional recommended imaging studies is achievable with direct physician notification and offering low cost alternatives.

Erbay, K, Erbay, N, Erbay, S, What Do We Want the Referring Physicians to Do and How Do We Convince Them? Improving Compliance for Additional Imaging Recommendations of Incidental Paraspinal Findings.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003680.html