Clinicians and surgeon survey regarding current and future versions of CT/MRI LI-RADS

Abstract

Purpose

To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC).

Methods

Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements.

Results

A total of 152 physicians responded, 66.4% (101/152) from North America, including 42 surgeons, 81 physicians and 29 interventional radiologists. Participants were predominantly from academic centers 83% (126/152), while 13.8% (21/152) worked in private/community centers and 3.2% (5/152) worked in a hybrid practice. Almost 90% (136/152) of participants preferred the use of LI-RADS (compared to nothing or other standardized reporting systems; OPTN and AASLD) to communicate liver-related observations. However, only 28.5% (43/152) of participants input was sought at the time of implementing LI-RADS in their institutions. Fifty-eight percent (88/152) of all participants found standardized LI-RADS management recommendations in radiology reports to be clinically helpful. However, a subgroup analysis of surgeons in academic centers showed that 61.8% (21/34) prefer not to receive standardized LI-RADS recommendations.

Conclusions

Most participants preferred the use LI-RADS in reporting CT and MRI examination. When considering inclusion of management recommendations, radiologists should consult with their referring physicians, as preference may differ.

Appendices

Appendix 1: Introductory statement

Dear Colleagues: As radiologists we are interested in adding value to our reports which we hope will be of help to you in your practice. This survey has been created by the LI-RADS team and you are being asked to answer these 18 questions so that future LI-RADS versions may be of optimal use to you. Thank you in advance for your time in answering this short survey.

Appendix 2

List of all questions involved in the survey.

Q1: What is your specialty?

• Family practice

• Internal medicine

• Gastroenterology

• General Surgery

• Hepatobiliary Surgery

• Transplant Surgery

• Pathology

• Interventional Radiology

• Other (please specific)

Q2: What is your work environment?

• Academic liver transplant center

• Academic non- liver transplant center

• Community hospital/private practice

• Independent health facility

• Mixed practice

• Government

• Other (please specify)

Q3: What country and state (or province) do you work in? (free text answer)

Q4: Does your department currently use LI-RADS?

• Yes

• No

Q5: Which is your preferred system to use for the diagnosis/categorization of any liver lesion? (check all that apply)?

• LI-RADS

• OPTN

• AASLD

• I do not use any system

• I use a different system (specify)

Q6: Was your input/opinion sought prior to having the radiology department start using LI-RADS?

• Yes

• No

Q7: With regard to multiphase CT or MRI done for HCC imaging at your institution, what percentage of the radiology reports use LI-RADS?

• 0%

• 1–10%

• 11–40%

• 41–60%

• 61–90%

• > 90%

• Don’t know

Q8: Do you find the presence of a diagnostic radiologist at your multidisciplinary discussion/case conference valuable? Why?

Q9: With regard to multiphase CT or MRI done for HCC imaging at your institution, do you prefer radiology reports with LI-RADS compared to those without? (free-text also available)

• Yes

• No

• Not sure

Q10: Rate how LI-RADS use affects radiology reports in the following areas (scale of 1–5; 1 = not helpful; 5 = extremely helpful). Can use same number more than once.

• Communication of whether your patient has HCC

• Communication of how many HCC lesions your patient has

• Communication of whether your patient has a malignant neoplasm invading a vein

• Communication of whether your patient may have a malignant neoplasm other than HCC

• Other

Q11: Rate how LI-RADS affects various aspects of patient care (scale 1–5; 1 = negatively affects patient care; 3 = neither positive nor negative effect on patient care; 5 = positively affects patient care). Can use same number more than once.

Determining liver transplant eligibility and prioritization

• Making treatment decisions

• Communicating results with patient

• Communication with different service lines involved with patient care (hepatology, oncology, transplant surgery, interventional radiology)

• Communication with different hospitals (e.g., transplant centers)

• Other

Q12: Do you manage LR-4 observations the same way you would manage LR-5?

• Always or almost always

• Sometimes (specify when)

• Never or almost never. Instead, I follow LI-RADS guidelines when something is categorized as LI-RADS-4 (short term surveillance, biopsy, and/or multidisciplinary discussion)

Q13: The latest versions of LI-RADS include standardized management recommendations for each category. What is your opinion regarding the provision of management recommendations in radiology reports?

• I appreciate radiology reports providing standardized recommendations

• I do not want radiology reports providing management recommendations

Q14: What are some of the barriers to implementing LI-RADS across the world (check all that apply):

• Radiologists not using LI-RADS

• Personal unfamiliarity with LI-RADS

• Other service lines involved with patient care not using LI-RADS (hepatology, oncology, transplant surgery, interventional radiology)

• Presence or preference of other guidelines (AASLD, OPTN, other country’s guidelines)

• Radiology reporting of LI-RADS is inconsistent

• LI-RADS terminology is too complex

• There are too many LI-RADS categories

Q15: The new tumor response algorithm was designed as a first iteration to include imaging appearance of viable tumor, non-viable tumor or equivocal findings: this currently applies to ALL locoregional therapies (though not systemic therapies such as chemotherapy, immunotherapy or most surgical interventions). With regards to the Tumor Response Algorithm, please choose the option that you feel best applies.

• This algorithm satisfies my needs as a clinician/surgeon

• I do not need a tumor response algorithm for assessing my patients post locoregional therapy

• This algorithm is only helpful for certain therapies and does not represent appearance of HCC post other types of locoregional therapies. Future iteration of tumor response should have specific algorithms for specific therapies

• Other (please specify)

Q16: What are aspects of LI-RADS you would like changed/improved? (check all that apply)

• Would like to see standardization of technique and lesion reporting from outside hospitals

• I feel sometimes lesions are categorized as LI-RADS 4, but clinical suspicion is high, and this sometimes prevents moving forward with treatment

• It would be easier to use if it were simplified

• I wish there were a way to better incorporate clinical suspicion for management of LI-RADS observations

• It would be helpful to have an App on a smart phone that could help radiologists characterize lesions and for clinicians/surgeons to understand the management implications more easily

• Other (please specify)

Q17: About how often do you think LI-RADS updates should take place (choose your preferred answer)

• Yearly

• Every 2 years

• Every 3 years

• Every 5 years

• Other (please specify)

Q18: Do you have any additional needs, related to patients at risk for HCC, which are not addressed by LI-RADS? (please write in comments section).