Director of Diversity, Inclusion, and Equity, Department of Radiology, Brigham and Women's Hospital, Quality and Patient Safety Officer, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Director of Education, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Director of Clinical Informatics, Harvard Medical School Library of Evidence, Boston, Massachusetts.
J Am Coll Radiol. 2021 Jul;18(7):896-905. doi: 10.1016/j.jacr.2020.12.031. Epub 2021 Feb 7.
Determine whether differences exist in rates of follow-up recommendations made for pulmonary nodules after accounting for multiple patient and radiologist factors.
This Institutional Review Board-approved, retrospective study was performed at an urban academic quaternary care hospital. We analyzed 142,001 chest and abdominal CT reports from January 1, 2016, to December 31, 2018, from abdominal, thoracic, and emergency radiology subspecialty divisions. A previously validated natural language processing (NLP) tool identified 24,512 reports documenting pulmonary nodule(s), excluding reports NLP-positive for lung cancer. A second validated NLP tool identified reports with follow-up recommendations specifically for pulmonary nodules. Multivariable logistic regression was used to determine the likelihood of pulmonary nodule follow-up recommendation. Interradiologist variability was quantified within subspecialty divisions.
NLP classified 4,939 of 24,512 (20.1%) reports as having a follow-up recommendation for pulmonary nodule. Male patients comprised 45.3% (11,097) of the patient cohort; average patient age was 61.4 years (±14.1 years). The majority of reports were from outpatient studies (62.7%, 15,376 of 24,512), were chest CTs (75.9%, 18,615 of 24,512), and were interpreted by thoracic radiologists (63.7%, 15,614 of 24,512). In multivariable analysis, studies for male patients (odds ratio [OR]: 0.9 [0.8-0.9]) and abdominal CTs (OR: 0.6 [0.6-0.7] compared with chest CT) were less likely to have a pulmonary nodule follow-up recommendation. Older patients had higher rates of follow-up recommendation (OR: 1.01 for each additional year). Division-level analysis showed up to 4.3-fold difference between radiologists in the probability of making a follow-up recommendation for a pulmonary nodule.
Significant differences exist in the probability of making a follow-up recommendation for pulmonary nodules among radiologists within the same subspecialty division.
确定在考虑多个患者和放射科医生因素后，对肺结节的随访建议率是否存在差异。
这项经机构审查委员会批准的回顾性研究在一家城市学术四级保健医院进行。我们分析了 2016 年 1 月 1 日至 2018 年 12 月 31 日来自腹部、胸部和急诊放射科专业科室的 142001 份胸部和腹部 CT 报告。一个经过先前验证的自然语言处理 (NLP) 工具识别出 24512 份记录肺结节的报告，不包括 NLP 阳性的肺癌报告。第二个经过验证的 NLP 工具识别出专门针对肺结节的随访建议报告。多变量逻辑回归用于确定肺结节随访建议的可能性。在专业科室内部量化了放射科医生之间的变异性。
NLP 将 24512 份报告中的 4939 份（20.1%）归类为对肺结节有随访建议。患者队列中男性占 45.3%（11097 人）；患者平均年龄为 61.4 岁（±14.1 岁）。大多数报告来自门诊研究（62.7%，15376/24512），为胸部 CT（75.9%，18615/24512），由胸部放射科医生解释（63.7%，15614/24512）。在多变量分析中，男性患者的研究（比值比 [OR]：0.9 [0.8-0.9]）和腹部 CT（与胸部 CT 相比，OR：0.6 [0.6-0.7]）不太可能有肺结节随访建议。年龄较大的患者随访建议率更高（每年增加 1 岁，OR：1.01）。科室层面的分析显示，同一专业科室的放射科医生在对肺结节进行随访建议的可能性方面存在高达 4.3 倍的差异。
在同一专业科室内部，放射科医生对肺结节进行随访建议的可能性存在显著差异。
