Adequacy of ultrasound reports in patients presenting with obstructive jaundice at a tertiary hospital radiology department

Nondumiso Dlamini,Matthew Goodier

doi:10.4102/sajr.v20i1.1034

Abstract

Background: Patients with obstructive jaundice require a stepwise approach to investigation and management. Ultrasound (US) is the initial screening modality of choice and has been shown to be accurate in demonstrating the presence of dilated bile ducts, as well as the level and cause of obstruction. For adequate radiological communication to the clinician, degree of bile duct dilatation, level of obstruction, appearance of the transition zone and cause of obstruction must be reported. However, without a structured reporting method, much of this information may be omitted.Objectives: The aim of the study was to investigate the adequacy of US findings in patients with obstructive jaundice, as documented, without standardised reporting.Methods: A retrospective chart review of 130 US reports of adult patients presenting at Grey’s Hospital US Department with a clinical assessment of obstructive jaundice was conducted. Data for the period January to December 2013, were analysed. US reports of patients with dilated bile ducts were assessed for report adequacy by looking at four important clinical factors, that is, the degree of bile duct dilatation, the level of obstruction, the appearance of the transition zone and the cause of the obstruction.Results: A report adequacy score was assessed in 79 patients with dilated bile ducts; however, two reports were excluded because of obscuration by gas. There was a high level of report inadequacy (38%) without the use of a structured reporting template. The level of obstruction was the most common component missing from the reports (25%), followed by the appearance of the transition zone (18%) and cause of obstruction (12%).Conclusion: We propose the use of an US report template for obstructive jaundice patients in order to ensure comprehensive reporting. Structured radiological reporting will improve the method of communication between clinicians and radiologists, thus improving the quality of patient care.

Highlights

These reports can be integrated with the picture archiving and communication system (PACS), improving the service provided by the radiology department and improving the efficiency of communication between the radiologist and the referring clinician.[10,11,12,13]
The bile ducts were considered dilated if the internal diameter of the common bile duct (CBD) was > 7 mm or if the intrahepatic bile ducts were > 2 mm in diameter
The degree of bile duct dilatation was the most often reported component with 96% of reports commenting on this finding

Summary

Introduction

Jaundice is a commonly encountered condition in clinical practice.[1,2] Differentiating between obstructive (surgical) and non-obstructive (medical) jaundice can be achieved clinically by using a combination of clinical signs, symptoms and biochemical markers.[2,3,4,5,6,7] It is important to differentiate between the two conditions because patients with obstructive jaundice usually require surgical or radiological intervention.[3,8] Ultrasound (US) is the initial screening modality of choice for patients with obstructive jaundice as it assists in the cost-effective management of these patients by determining the need for further imaging.[2,3,4,5,8,9] In order to achieve these goals, US reports of these patients should include the presence and degree of bile duct dilatation and the level and cause of obstruction.[3,8]Radiology reports are an important method of communication between the radiologist and the referring clinician.[10]. Jaundice is a commonly encountered condition in clinical practice.[1,2] Differentiating between obstructive (surgical) and non-obstructive (medical) jaundice can be achieved clinically by using a combination of clinical signs, symptoms and biochemical markers.[2,3,4,5,6,7] It is important to differentiate between the two conditions because patients with obstructive jaundice usually require surgical or radiological intervention.[3,8] Ultrasound (US) is the initial screening modality of choice for patients with obstructive jaundice as it assists in the cost-effective management of these patients by determining the need for further imaging.[2,3,4,5,8,9] In order to achieve these goals, US reports of these patients should include the presence and degree of bile duct dilatation and the level and cause of obstruction.[3,8]. Without a structured reporting method, much of this information may be omitted

Objectives

Methods

Results

Discussion

Conclusion