Merlijn Sevenster PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Paul J. Chang MD, Presenter: Co-founder, Stentor/Koninklijke Philips Electronics NV Technical Advisory Board, Amirsys, Inc Medical Advisory Board, Koninklijke Philips Electronics NV Medical Advisory Board, MModal Inc Medical Advisory Board, lifeIMAGE Medical Advisory Board, Merge Healthcare Incorporated

Jeffrey Bozeman BA, Abstract Co-Author: Nothing to Disclose

Andrea Cowhy BS, Abstract Co-Author: Nothing to Disclose

Joost Peters, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Manish Sharma MD, Abstract Co-Author: Nothing to Disclose

Adam Randolph Travis MD, Abstract Co-Author: Nothing to Disclose

Will Trost BA, Abstract Co-Author: Nothing to Disclose

Lauren Wall MS, Abstract Co-Author: Nothing to Disclose

Image-based tumor measurements are generally performed by radiologists and reported using dictation software into a narrative report. At many institutions, lesion measurements are then manually transcribed by oncology personnel into worksheets that are used to compute treatment response. We aim to quantify measurement dictation and transcription error rates and the extent to which such errors impact treatment response computation.

RECIST worksheets for over 100 patients were obtained. For every worksheet, and for each index lesion in each study recorded in the worksheet, we inspected the original measurement on the source image exam and then compared it to the radiologist-reported measurement and to the worksheet measurement. A discrepancy between the source image lesion measurement and the reported measurement was counted as a radiologist dictation error, while a discrepancy between the reported measurement (from the radiology report) and the oncology worksheet measurement was counted as an oncology transcription error. 

A preliminary study of 12 RECIST worksheets comprising 58 exams and 155 measurements found 7 dictation errors (4.5%, CI: 1.8-9.1%), 4 of which were in the critical dimension (2.6%, CI: 0.7-6.5%) (long axis for tumors; short axis for lymph nodes). 3 out of these 4 dictation errors were propagated in transcription; 1 dictation error was corrected. 7 correctly dictated measurements were incorrectly transcribed (4.5%, CI: 1.8-9.1%]). In total, 10 measurements were incorrectly dictated and/or transcribed in the critical dimension (6.5%, CI: 3.1-11.5%). No error affected response computation; cumulative lesion measurement dictation-transcription error for affecting computed response ranged from 5mm to 41mm (avg: 18mm). 

Communication of lesion measurements by manually consuming the radiology report narrative can propagate errors. While preliminary analysis showed no errors affected treatment response computation, the potential for such cannot be excluded. PACS-integrated tools for semi-automated lesion measurement management and electronic transmission to the oncology patient management system should be considered as an adjunct to the narrative report.

PACS-integrated tools for semi-automated lesion measurement management and electronic transmission to oncology patient management systems should be considered as an adjunct to the narrative report.

Sevenster, M, Chang, P, Bozeman, J, Cowhy, A, Peters, J, Sharma, M, Travis, A, Trost, W, Wall, L, Radiologic Measurement Dictation and Transcription Error Rates in RECIST (Response Evaluation Criteria In Solid Tumors) Clinical Trials: A Limitation of the Radiology Narrative Report to Accurately Communicate Quantitative Data.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13023898.html