Wagner Steven C, Morrison William B, Carrino John A, Schweitzer Mark E, Nothnagel Henry
Department of Radiology, Thomas Jefferson University Hospital, 3390 Gibbon Bldg, 111 S 11th St, Philadelphia, PA 19107, USA.
Radiology. 2002 Nov;225(2):500-5. doi: 10.1148/radiol.2252011731.
To determine the effect of a picture archiving and communication system (PACS) on reporting of incidental findings outside the area of interest, with a focus on lumbar spinal magnetic resonance (MR) imaging.
Results of 2,500 lumbar spinal 1.5-T MR examinations were reviewed. These included 500 consecutive lumbar spinal MR reports for each of 5 years: 1 year prior to PACS introduction, 1 year during transition to PACS, and 3 consecutive years thereafter. Incidental findings cited in the reports were tabulated, and the frequency, organ system involved, and radiologist recommendations in each case were noted and compared, as were projected expenses based on the Medicare payment scale for recommended follow-up studies. Results of available follow-up studies were also reviewed.
The number of incidental findings increased from 19 before PACS to 31 during transition and 53, 49, and 50 after PACS implementation, which resulted in a maximum increase of 179%. The increase was statistically significant during each post-PACS year. The most common incidental findings involved potential renal, pelvic, hepatic, pulmonary, and lymph node abnormalities. The total number of recommended follow-up studies increased from five before PACS to 15 during transition and 32, 22, and 18 after PACS implementation, with a maximum increase of as much as 540%. Recommended ultrasonographic studies increased the most from two in the pre-PACS year to 11 during transition and 27, 17, and 14 in the 3 post-PACS years. Follow-up expense increased by a mean of 146% after PACS implementation from 4,221 dollars per 1,000 studies in the pre-PACS year to 9,307 dollars, 13,426 dollars, 10,558 dollars, and 8,252 dollars thereafter. Of the 202 incidental findings, four represented occult malignancy, which is an expense of 5,721 dollars per diagnosis.
The introduction of PACS into radiology practice for lumbar spinal MR imaging appears to be associated with an increased number of reported incidental findings and recommended follow-up studies.
确定图像存档与通信系统（PACS）对感兴趣区域以外偶然发现的报告的影响，重点关注腰椎磁共振（MR）成像。
回顾了2500例腰椎1.5-T MR检查的结果。这些检查包括连续5年中每年500例腰椎MR报告：引入PACS前1年、向PACS过渡期间1年以及此后连续3年。将报告中提及的偶然发现制成表格，并记录和比较每种情况下的频率、涉及的器官系统、放射科医生的建议，以及根据医疗保险支付标准对推荐的后续研究预计的费用。还回顾了可用的后续研究结果。
偶然发现的数量从PACS引入前的19例增加到过渡期间的31例，PACS实施后分别为53例、49例和50例，最大增幅为179%。在PACS实施后的每一年，这种增加都具有统计学意义。最常见的偶然发现涉及潜在的肾脏、盆腔、肝脏、肺部和淋巴结异常。推荐的后续研究总数从PACS引入前的5项增加到过渡期间的15项，PACS实施后分别为32项、22项和18项，最大增幅高达540%。推荐的超声检查增加最多，从PACS引入前一年的2项增加到过渡期间的11项，PACS实施后的3年分别为27项、17项和14项。PACS实施后，后续费用平均增加了146%，从PACS引入前每1000项研究4221美元增加到此后的9307美元、13426美元、10558美元和8252美元。在202例偶然发现中，4例为隐匿性恶性肿瘤，每项诊断费用为5721美元。
将PACS引入腰椎MR成像的放射学实践似乎与报告的偶然发现数量增加以及推荐的后续研究增加有关。
