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Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: Implications for natural language processing tools

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Reporting standards promote clarity and consistency of stress myocardial perfusion imaging (MPI) reports, but do not require an assessment of post-test risk. Natural Language Processing (NLP) tools could potentially help estimate this risk, yet it is unknown whether reports contain adequate descriptive data to use NLP.

Methods

Among VA patients who underwent stress MPI and coronary angiography between January 1, 2009 and December 31, 2011, 99 stress test reports were randomly selected for analysis. Two reviewers independently categorized each report for the presence of critical data elements essential to describing post-test ischemic risk.

Results

Few stress MPI reports provided a formal assessment of post-test risk within the impression section (3%) or the entire document (4%). In most cases, risk was determinable by combining critical data elements (74% impression, 98% whole). If ischemic risk was not determinable (25% impression, 2% whole), inadequate description of systolic function (9% impression, 1% whole) and inadequate description of ischemia (5% impression, 1% whole) were most commonly implicated.

Conclusions

Post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. This supports the potential use of NLP to help clarify risk. Further study of NLP in this context is needed.

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Abbreviations

ASNC:

American Society of Nuclear Cardiology

CART:

VA clinical assessment reporting and tracking program

CDW:

VA corporate data warehouse

CPT:

Current procedural terminology

IAC:

Intersocietal accreditation commission

ICD-9:

International classification of diseases, ninth revision codes

MPI:

Myocardial perfusion imaging

NLP:

Natural language processing

PCI:

Percutaneous coronary intervention

SPECT:

Single photon electron computed tomography

SDS:

Summed difference score

SRS:

Summed rest score

SSS:

Summed stress score

TID:

Transient ischemic dilation

VA:

Veterans health administration

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Disclosures

AEL, NRS, MEM, RMR, GTG and SMB have no relevant disclosures.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Andrew E. Levy MD

  2. Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA

    Nishant R. Shah MD, MPH, MSc

  3. Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA

    Nishant R. Shah MD, MPH, MSc

  4. Health Services Research & Development, VA Tennessee Valley Healthcare System, Nashville, TN, USA

    Michael E. Matheny MD, MS, MPH, Ruth M. Reeves PhD & Glenn T. Gobbel DVM, PhD, MS

  5. Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Michael E. Matheny MD, MS, MPH, Ruth M. Reeves PhD & Glenn T. Gobbel DVM, PhD, MS

  6. Cardiovascular Medicine, VA Eastern Colorado Healthcare System, Denver, CO, USA

    Steven M. Bradley MD

  7. Center for Healthcare Delivery Innovation, Minneapolis Heart Institute, Minneapolis, MN, USA

    Steven M. Bradley MD

  8. 1055 Clermont Street (111B), Denver, CO, 80220, USA

    Andrew E. Levy MD

Authors
  1. Andrew E. Levy MD
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  2. Nishant R. Shah MD, MPH, MSc
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  3. Michael E. Matheny MD, MS, MPH
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  4. Ruth M. Reeves PhD
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  5. Glenn T. Gobbel DVM, PhD, MS
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  6. Steven M. Bradley MD
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Corresponding author

Correspondence to Andrew E. Levy MD.

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Funding

This project was supported by funding from VA Health Services Research & Development (HSR&D-QUERI RRP 12-448). Dr. Levy receives funding from the National Institutes of Health (NIH) T32 Training Grant 5T32-HL-007822-19. Dr. Shah is supported by an Agency for Healthcare Research and Quality award (5K12HS022998).

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Levy, A.E., Shah, N.R., Matheny, M.E. et al. Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: Implications for natural language processing tools. J. Nucl. Cardiol. 26, 1878–1885 (2019). https://doi.org/10.1007/s12350-018-1275-y

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  • DOI: https://doi.org/10.1007/s12350-018-1275-y

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