Director of Diversity, Equity, and Inclusion, 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, Harvard Medical School, Boston, Massachusetts; Director of Clinical Informatics, Harvard Medical School Library of Evidence, Boston, Massachusetts.
J Am Coll Radiol. 2021 Oct;18(10):1405-1414. doi: 10.1016/j.jacr.2021.06.007. Epub 2021 Jun 24.
This study aimed to determine the incidence, identify imaging and patient factors, and measure individual radiologist variation associated with follow-up recommendations for small focal cystic pancreatic lesions (FCPLs), a common incidental imaging finding.
This institutional review board-approved retrospective study analyzed 146,709 reports from abdominal CTs and MRIs performed in a large academic hospital from July 1, 2016, to June 30, 2018. A trained natural language processing tool identified 4,345 reports with FCPLs, which were manually reviewed to identify those containing one or more <1.5-cm pancreatic cysts. For these patients, patient, lesion, and radiologist features and follow-up recommendations for FCPL were extracted. A nonlinear random-effects model estimated degree of variation in follow-up recommendations across radiologists at department and division levels.
Of 2,872 reports with FCPLs < 1.5 cm, 708 (24.7%) had FCPL-related follow-up recommendations. Average patient age was 67 years (SD ± 11). In all, 1,721 (60.0%) reports were for female patients; 59.3% of patients had only one cyst. In multivariable analysis, older patients had slightly lower follow-up recommendation rates (odds ratio [OR]: 0.98 [0.98-1.00] per additional year), and lesions associated with main duct dilatation and septation were more likely to have a follow-up recommendation (ORs: 1.93 [1.11-3.36] and 2.88 [1.89-4.38], respectively). Radiologist years in practice (P = .51), trainee presence (P = .21), and radiologist gender (P = .52) were not associated with increased follow-up recommendations. There was significant interradiologist variation in the Abdominal Imaging Division (P = .04), but not in Emergency Radiology (P = .31) or Cancer Imaging Divisions (P = .29).
Interradiologist variation significantly contributes to variability in follow-up imaging recommendations for FCPLs.
本研究旨在确定小局灶性囊性胰腺病变（FCPL）随访建议的发生率，确定影像学和患者因素，并衡量个别放射科医生的变异，FCPL 是一种常见的偶然影像学发现。
这项经机构审查委员会批准的回顾性研究分析了 2016 年 7 月 1 日至 2018 年 6 月 30 日在一家大型学术医院进行的腹部 CT 和 MRI 的 146709 份报告。经过训练的自然语言处理工具识别出 4345 份含有 FCPL 的报告，这些报告经手动审查，以确定其中是否包含一个或多个<1.5cm 的胰腺囊肿。对于这些患者，提取了患者、病变和放射科医生的特征以及 FCPL 的随访建议。使用非线性随机效应模型估计了部门和科室层面上放射科医生之间随访建议的变异程度。
在 2872 份 FCPL<1.5cm 的报告中，有 708 份（24.7%）有 FCPL 相关的随访建议。患者平均年龄为 67 岁（标准差±11）。共有 1721 份（60.0%）报告为女性患者；59.3%的患者只有一个囊肿。多变量分析显示，年龄较大的患者随访建议率略低（比值比[OR]：每增加 1 岁为 0.98[0.98-1.00]），与主胰管扩张和分隔相关的病变更有可能得到随访建议（OR 分别为 1.93[1.11-3.36]和 2.88[1.89-4.38]）。放射科医生的从业年限（P=0.51）、受训者的存在（P=0.21）和放射科医生的性别（P=0.52）与增加的随访建议无关。在腹部影像学科（P=0.04）存在显著的放射科医生间变异，但在急诊放射科（P=0.31）或癌症影像学科（P=0.29）不存在这种变异。
放射科医生间的变异显著导致了对 FCPL 随访影像学建议的差异。
