Karl James MBBCh, MRCS, Abstract Co-Author: Nothing to Disclose

Jennifer Murphy MBBCh, MRCPI, Abstract Co-Author: Nothing to Disclose

Patrick Nicholson MBBCh, Presenter: Nothing to Disclose

Max Frederick Ryan MBBCh, Abstract Co-Author: Nothing to Disclose

Efficient diagnosis is seen to be possible with a well established electronic communication system. The fact that new cancer was confirmed in almost one third of the CXR alerts indicates the importance of clinicians receiving and acting on these alerts. The study also highlights that 20% of potential cancer alerts were not officially acknowledged by the clinician. Although the majority of patients had timely follow-up, there were causes for concern with delayed diagnosis and follow-up failures that must be addressed.

Failure to communicate important radiological findings is a major patient safety issue and is now the third largest cause of litigation against radiologists in the USA. In our institution, an alert system exists whereby the radiologist can directly alert the referring clinician of a significant radiological finding by selecting an icon on the iPACS workstation. The clinician is then obliged to acknowledge the alert. A RIS manager follows up any unacknowledged alerts and escalates alerts as necessary.

Data on all PACS alerts issued in our institution over a 1 year period was collected and analysed for the source of referral, modalities used,  report turn around time, time to clinician acknowledgment of the alert and duration/outcome of follow-up. Any failures to acknowledge alerts or to follow-up were also noted.

372 alerts were issued over the 1 year study period. 49% (181) of alerts were issued due to a suspected cancer diagnosis and of those 67% (121) arose from a chest X-ray report. 57% of the "cancer" alerts were acknowledged by clinicians within 3 days, however, 19% (35) of the "cancer" alerts were never acknowledged and 5 of these patients did not receive the recommended follow-up. CT follow-up was recommended in 103 CXR reports and was performed in less than 1 month in 50% (53). 5 patients had to wait more than 90 days for the CT scan and of those patients, 3 patients subsequently had a CT diagnosis of lung cancer. 20% (21)of patients never had a CT thorax for reasons including loss to follow-up, resolution on subsequent plain imaging, etc. Analysis of subsequent CT thorax results found that previously undiagnosed cancer was detected in 31% (26) patients.

James, K, Murphy, J, Nicholson, P, Ryan, M, Communication of Significant Unexpected Radiological Findings Using an Automated iPACS Radiology Alert System.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045487.html