Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
Department of Medicine, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
BMC Med Imaging. 2022 Jun 11;22(1):111. doi: 10.1186/s12880-022-00837-y.
Interpretation of Low Dose CT scans and protocol driven management of findings is a key aspect of lung cancer screening program performance. Reliable and reproducible methods are needed to communicate radiologists' interpretation to the screening program or clinicians driving management decision.
We performed an audit of a subset of dictated reports from the PANCAN study to assess for omissions. We developed an electronic synoptic reporting tool for radiologists embedded in a clinical documentation system software. The tool was then used for reporting as part of the Alberta Lung Cancer Screening Study and McGill University Health Centre Pilot Lung Cancer Screening Program.
Fifty reports were audited for completeness. At least one omission was noted in 30 (70%) of reports, with a major omission (missing lobe, size, type of nodule in report or actionable incidental finding in recommendation section of report) in 24 (48%). Details of the reporting template and functionality such as automated nodule cancer risk assessment, Lung-RADS category assignment, auto-generated narrative type report as well as personalize participant results letter is provided. A description of the system's performance in its application in 2815 CT reports is then summarized.
We found that narrative type radiologist reports for lung cancer screening CT examinations frequently lacked specific discrete data elements required for management. We demonstrate the successful implementation of a radiology synoptic reporting system for use in lung cancer screening, and the use of this information to drive program management and communications.
低剂量 CT 扫描的解读以及基于协议的发现管理是肺癌筛查项目表现的关键方面。需要可靠且可重复的方法将放射科医生的解读传达给筛查项目或驱动管理决策的临床医生。
我们对 PANCAN 研究中的一部分口述报告进行了审核，以评估遗漏情况。我们为放射科医生开发了一个嵌入临床文档系统软件中的电子综述报告工具。然后，该工具被用于作为艾伯塔省肺癌筛查研究和麦吉尔大学健康中心试点肺癌筛查计划的一部分进行报告。
对 50 份报告进行了完整性审核。30 份（70%）报告中至少有一处遗漏，24 份（48%）报告中有主要遗漏（报告中缺失肺叶、大小、结节类型或建议部分的可操作偶然发现）。提供了报告模板和功能的详细信息，例如自动结节癌症风险评估、Lung-RADS 类别分配、自动生成叙述性报告类型以及个性化参与者结果信函。然后总结了该系统在 2815 份 CT 报告中的应用性能描述。
我们发现，用于肺癌筛查 CT 检查的叙述性放射科医生报告经常缺乏管理所需的具体离散数据元素。我们展示了一种成功实施用于肺癌筛查的放射学综述报告系统，并展示了如何利用这些信息来驱动项目管理和沟通。
