Skip to main content

Advertisement

SpringerLink
Log in

Comparing thoracic and abdominal subspecialists’ follow-up recommendations for abdominal findings identified on chest CT

  • Practice
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

  • 6 Altmetric

Abstract

Purpose

To compare thoracic and abdominal radiologists’ follow-up recommendations for abdominal findings identified on chest CT.

Methods

This Institutional Review Board-exempt, retrospective study was performed at a large academic medical center with subspecialty radiology divisions. We used a combination of natural language processing and manual reviews to identify chest CT reports with and without abdominal findings that were interpreted by thoracic radiologists in 2019. Three random samples of reports were reviewed by two subspecialty trained abdominal radiologists for their agreement with thoracic radiologists’ reporting: abdominal findings with follow-up recommendation (Group 1), abdominal findings without follow-up recommendation (Group 2), and no abdominal findings reported (Group 3). Primary outcome was agreement between thoracic and abdominal radiologists for the need for follow-up of abdominal findings. Secondary outcomes were agreement between subspecialists for the presence of abdominal findings and referring clinician adherence to recommendations. Fischer’s exact test was used to compare proportions.

Results

Abdominal radiologists agreed with need for follow-up in 48.5% (16/33) of Group 1 cases and agreed follow-up was not necessary for 100% (34/34) of Group 2 cases (p < 0.001). Abdominal radiologists identified abdominal findings in 31.4% (11/35) of Group 3 cases, none of which required follow-up. Referring clinician adherence to thoracic radiologist follow-up recommendations for abdominal findings was 13/33 (39.4%).

Conclusion

Abdominal radiologists frequently disagreed with thoracic radiologist recommendations for follow-up of abdominal findings on chest CT. Chest radiologists may consider abdominal subspecialty consultation or clinical decision support to reduce unnecessary imaging.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rosenkrantz AB, Hughes DR, Duszak R (2020) Increasing Subspecialization of the National Radiologist Workforce. J Am Coll Radiol 17(6):812–8. https://doi.org/10.1016/j.jacr.2019.11.027

    Article  PubMed  Google Scholar 

  2. Gore RM, Pickhardt PJ, Mortele KJ, et al. (2017) Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 14(11):1429–37. https://doi.org/10.1016/j.jacr.2017.07.018

    Article  PubMed  Google Scholar 

  3. Mayo-Smith WW, Song JH, Boland GL, et al. (2017) Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 14(8):1038–44. https://doi.org/10.1016/j.jacr.2017.05.001

    Article  PubMed  Google Scholar 

  4. Megibow AJ, Baker ME, Morgan DE, et al. (2017) Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 14(7):911–23. https://doi.org/10.1016/j.jacr.2017.03.010

    Article  PubMed  Google Scholar 

  5. Herts BR, Silverman SG, Hindman NM, et al. (2018) Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15(2):264–73. https://doi.org/10.1016/j.jacr.2017.04.028

    Article  PubMed  Google Scholar 

  6. Berland LL, Silverman SG, Gore RM, et al. (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7(10):754–73. https://doi.org/10.1016/j.jacr.2010.06.013

    Article  PubMed  Google Scholar 

  7. Kapoor N, Lacson R, Eskian M, Cochon L, Glazer D, Ip I, Khorasani R (2021) Variation in Radiologists' Follow-Up Imaging Recommendations for Small Cystic Pancreatic Lesions. J Am Coll Radiol. 18(10):1405-1414. https://doi.org/10.1016/j.jacr.2021.06.007

    Article  PubMed  Google Scholar 

  8. Devine AS, Jackson CS, Lyons L, Mason JD (2010) Frequency of incidental findings on computed tomography of trauma patients. West J Emerg Med 11(1):24–7

    PubMed  PubMed Central  Google Scholar 

  9. Thompson RJ, Wojcik SM, Grant WD, Ko PY (2011) Incidental Findings on CT Scans in the Emergency Department. Emerg Med Int 2011:1–4. https://doi.org/10.1155/2011/624847

    Article  Google Scholar 

  10. Munk MD, Peitzman AB, Hostler DP, Wolfson AB (2010) Frequency and Follow-up of Incidental Findings on Trauma Computed Tomography Scans: Experience at a Level One Trauma Center. J Emerg Med 38(3):346–50. https://doi.org/10.1016/j.jemermed.2008.01.021

    Article  PubMed  Google Scholar 

  11. DiPiro PJ, Alper DP, Giess CS, et al. (2020) Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI. J Am Coll Radiol. 17(6):773-778. https://doi.org/10.1016/j.jacr.2019.12.024

    Article  PubMed  PubMed Central  Google Scholar 

  12. CEBI-Miner. Available at: https://github.com/Center-for-Evidence-Based-Imaging/CEBI-Miner. Accessed June 23, 2020.

  13. Cochran, WG (1977) Sampling Techniques, 3rd Ed. John Wiley and Sons, Inc., New York

    Google Scholar 

  14. Rosenkrantz AB, Matza BW, Foran MP, McMenamy JM (2013) Recommendations for additional imaging on emergency department CT examinations: comparison of emergency- and organ-based subspecialty radiologists. Emerg Radiol 20(2):149–53. https://doi.org/10.1007/s10140-012-1079-3

    Article  PubMed  Google Scholar 

  15. Pavan H, Garcia TS, Torres FS, Gazzoni FF, Folador L, Ghezzi CLA (2022) Focal incidental upper abdominal findings on unenhanced chest computed tomography that do not require further imaging: a roadmap for the thoracic radiologist. Radiol Bras. 55(3):173-180. https://doi.org/10.1590/0100-3984.2021.0106

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cochon LR, Kapoor N, Carrodeguas E, et al. (2019) Variation in Follow-up Imaging Recommendations in Radiology Reports: Patient, Modality, and Radiologist Predictors. Radiology. 291(3):700-707. https://doi.org/10.1148/radiol.2019182826

    Article  PubMed  Google Scholar 

  17. Bates R, Plooster C, Croghan I, Schroeder D, McCoy C (2017) Incidental Pulmonary Nodules Reported on CT Abdominal Imaging: Frequency and Factors Affecting Inclusion in the Hospital Discharge Summary. J Hosp Med. 12(6):454–457. https://doi.org/10.12788/jhm.2757

  18. Hammer MM, Kapoor N, Desai SP, et al. (2019) Adoption of a Closed-Loop Communication Tool to Establish and Execute a Collaborative Follow-Up Plan for Incidental Pulmonary Nodules. AJR 2019:1-5. https://doi.org/10.2214/AJR.18.20692

    Article  Google Scholar 

  19. Bizzo BC, Almeida RR, Michalski MH, Alkasab TK (2019) Artificial Intelligence and Clinical Decision Support for Radiologists and Referring Providers. J Am Coll Radiol. 16(9 Pt B):1351–1356. https://doi.org/10.1016/j.jacr.2019.06.010

  20. Bates DW, Levine D, Syrowatka A, Kuznetsova M, Craig KJT, Rui A, Jackson GP, Rhee K (2021) The potential of artificial intelligence to improve patient safety: a scoping review. NPJ Digit Med. 4(1):54. https://doi.org/10.1038/s41746-021-00423-6

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nallamshetty K, Stukins E, Nielsen P, Rawal U, City R (2022) Impact of AI Enabled Workflows in Promoting Adherence to Evidence Based Guidelines. In: Washington DC, Scientific Program of American College of Radiology Annual Meeting. May 6–10 2022.

  22. Park EM, Yoneoka GM, Yoon HC (2022) Harnessing the Electronic Medical Record to Improve the Utilization of Ultrasound Screening for Abdominal Aortic Aneurysms. J Am Coll Radiol. 19(12):1338-1342. https://doi.org/10.1016/j.jacr.2022.09.031

    Article  PubMed  Google Scholar 

  23. Shinagare AB, Alper E, Wang A, Ip IK, Khorasani R (2019) Impact of a Multifaceted Information Technology-Enabled Intervention on the Adoption of ACR White Paper Follow-Up Recommendations for Incidental Adnexal Lesions Detected on CT. AJR Am J Roentgenol. 2019:1-7. https://doi.org/10.2214/AJR.18.20468

    Article  Google Scholar 

  24. McDonald JS, Koo CW, White D, Hartman TE, Bender CE, Sykes AG (2017) Addition of the Fleischner Society Guidelines to Chest CT Examination Interpretive Reports Improves Adherence to Recommended Follow-up Care for Incidental Pulmonary Nodules. Acad Radiol. 24(3):337-344. https://doi.org/10.1016/j.acra.2016.08.026

    Article  PubMed  Google Scholar 

  25. Trinh TW, Boland GW, Khorasani R (2019) Improving Radiology Peer Learning: Comparing a Novel Electronic Peer Learning Tool and a Traditional Score-Based Peer Review System. AJR Am J Roentgenol. 212(1):135-141. https://doi.org/10.2214/AJR.18.19958

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Laura E. Peterson for editorial assistance.

Author information

Authors and Affiliations

  1. Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, One Brigham Circle, 1620 Tremont Street, Third Floor, Suite 3010, Boston, MA, 02120, USA

    Anna H. Zhao, Daniel I. Glazer, Mark M. Hammer, Kristine S. Burk, Pamela J. DiPiro & Ramin Khorasani

  2. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Anna H. Zhao, Daniel I. Glazer, Mark M. Hammer, Kristine S. Burk, Pamela J. DiPiro & Ramin Khorasani

Authors
  1. Anna H. Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel I. Glazer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark M. Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristine S. Burk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pamela J. DiPiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ramin Khorasani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel I. Glazer.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, A.H., Glazer, D.I., Hammer, M.M. et al. Comparing thoracic and abdominal subspecialists’ follow-up recommendations for abdominal findings identified on chest CT. Abdom Radiol 48, 1468–1478 (2023). https://doi.org/10.1007/s00261-023-03821-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03821-4

Keywords

Search

Navigation