Abstract

PurposeThe American College of Radiology (ACR) Actionable Reporting Work Group defined three categories of imaging findings that require additional, nonroutine communication with the referring physician because of their urgency or unexpectedness. The objective of this study was to determine the prevalence of actionable findings in radiology reports, and to assess how well radiologists agree on the categorisation of actionable findings. MethodFrom 124,909 consecutive radiology reports stored in the electronic health record system of a large university hospital, 1000 reports were randomly selected. Two radiologists independently annotated all actionable findings according to the three categories of urgency defined by the ACR Work Group. Annotation differences were resolved in a consensus meeting and a final category was established for each report. Interannotator agreement was measured by accuracy and the kappa coefficient. ResultsThe prevalence of the three categories of actionable findings together was 32.5 %. Of all reports, 10.9 % were from patients seen in the emergency department. Prevalence of actionable findings for these patients (45.9 %) was considerably higher than for patients in routine clinical care (30.9 %). Interannotator agreement scores on the categorisation of actionable findings were 0.812 for accuracy and 0.616 for kappa coefficient. ConclusionsThe prevalence of actionable findings in radiology reports is high. The interannotator agreement scores are moderate, indicating that categorisation of actionable findings is a difficult task. To avoid unneeded increase in the workload of radiologists, in particular in routine practice, clinical context may need to be considered in deciding whether a finding is actionable.

Highlights

  • The radiologist’s interpretation of an imaging examination can only impact and improve patient care if the referring physician is notified of the results of the requested examination

  • Of the 1000 reports that were annotated by the two radiologists, 297 reports contained actionable findings according to one radiologist, and 339 according to the other

  • We found a prevalence of actionable findings in our population of 32.5 %

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Summary

Introduction

The radiologist’s interpretation of an imaging examination can only impact and improve patient care if the referring physician is notified of the results of the requested examination. Larson et al [3], representing the American College of Radiology (ACR) Actionable Reporting Work Group (hereafter called the ACR Work Group), proposed a classification in three categories based on the timing of communication: findings that require communication within minutes (category 1), within hours (category 2), or within days (category 3). They provided an extensive list of actionable findings for each category. A stable finding that was previously known and appropriately communicated may not require additional nonroutine communication despite the severity of the disease process

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