Consistent tumor measurement reporting in serial CT scans: A pilot study.

Abstract

99 Background: Oncologists in community cancer centers affiliated with the UC Davis Cancer Care Network reported quality concerns with inconsistently measured lesions on serial Computed Tomography (CT) scan reports. Radiologic imaging is an important tool in diagnosis, staging, and assessment of response to therapy in cancer treatment cancer. Accurate assessment of oncologic therapeutic efficacy is dependent on reliable radiology and report quality. The primary objective of this pilot study was to validate oncologist concerns about tumor measurement consistency in radiology reports through an audit. The secondary objective was to identify areas for quality improvement and establish process and time requirements for auditing. Two of four affiliated cancer centers (CC1 and CC2) were selected for a pilot assessment. Methods: CC1 and CC2 identified charts with CT scans in the audit timeframes. Auditors reviewed charts for serial CT scans and measureable disease in the audit date range and created a list of eligible charts. Auditors randomized the list and a sample of 61 (CC1) and 66 (CC2) charts were audited. Auditors reviewed CT orders, radiology reports for consistent lesion measurement, comparison to previous scan, addenda, service dates, radiology facilities, reading radiologist, and medical provider placing order. Results: This audit demonstrated deficiencies with lesion measurement consistency at both CC1 and CC2. At CC1 64% of radiology reports were consistently measured and at CC2 57% were consistently measured. Both CC1 and CC2 had identifiable areas for process and quality improvement. The audit required 86 hours at CC1 and 83 hours at CC2. The audit identified deficiencies in order clarity and information flow from the cancer center to the reading radiologist. At CC1 a radiologist reviewed the audited charts and reported an 85% concurrence with the auditors. A literature search did not provide benchmarks for measurement consistency in radiology reports. Conclusions: Oncologists complaints were verified regarding lesion measurement inconsistencies. This pilot demonstrated the need for quality oversight and implementation of standardized measurement (RECIST) criteria and tumor logs in the non-clinical trial environment.