Mattana Francesco, Zanoni Lucia, Nanni Cristina, Mosconi Cristina, Brocchi Stefano, Golfieri Rita, Fanti Stefano
Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Nuclear Medicine, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20132 Milano, Italy.
Clin Transl Imaging. 2023;11(2):127-139. doi: 10.1007/s40336-023-00544-w. Epub 2023 Feb 18.
The American College of Radiology (ACR) defines "actionable findings" the ones requiring a special communication between radiologists and referring clinicians, suggesting to organize their categorization in a three-degree scale on the basis of the risk for the patient to develop complications. These cases may fall in a grey-zone communication between different care figures with the risk of being underestimated or even not being considered at all. In this paper, our aim is to adapt the ACR categorization to the most frequent actionable findings encountered when reporting PET/CT images in a Nuclear Medicine Department, describing the most frequent and relevant imaging features and presenting the modalities of communication and the related clinical interventions that can be modulated by the prognostic severity of the clinical cases.
We performed a descriptive, observational and critical analysis of the most relevant literature on the topic of "actionable findings", in particular, starting from the reports of the ACR Actionable Reporting Work Group, we categorised and described, in a narrative review, the most relevant "actionable findings" encountered in the Nuclear Medicine PET/CT daily practice.
To the best of our knowledge, to date there are no clear indications on this selective PET/CT topic, considering that the current recommendations target mainly radiologists and assume a certain level of radiological expertise. We resumed and classified the main imaging conditions under the term of "actionable findings" according to the corresponding anatomical districts, and we described their most relevant imaging features (independently of PET avidity or not). Furthermore, a different communication timing and strategy was suggested on the basis of the findings' urgency.
A systematic categorization of the actionable imaging findings according to their prognostic severity may help the reporting physician to choose how and when to communicate with the referring clinician or to identify cases requiring a prompt clinical evaluation. Effective communication is a critical component of diagnostic imaging: timely receipt of the information is more important than the method of delivery.
美国放射学会（ACR）将“可采取行动的发现”定义为那些需要放射科医生与转诊临床医生进行特殊沟通的发现，并建议根据患者发生并发症的风险将其分类为三个等级。这些情况可能处于不同医护人员之间的灰色沟通地带，存在被低估甚至完全被忽视的风险。在本文中，我们的目的是使ACR分类适用于核医学科报告PET/CT图像时遇到的最常见的可采取行动的发现，描述最常见和相关的影像特征，并介绍沟通方式以及可根据临床病例的预后严重程度进行调整的相关临床干预措施。
我们对关于“可采取行动的发现”这一主题的最相关文献进行了描述性、观察性和批判性分析，特别是从ACR可采取行动报告工作组的报告开始，我们在一篇叙述性综述中对核医学PET/CT日常实践中遇到的最相关的“可采取行动的发现”进行了分类和描述。
据我们所知，迄今为止，关于这个PET/CT特定主题尚无明确的指导意见，因为目前的建议主要针对放射科医生，并假定具备一定水平的放射学专业知识。我们根据相应的解剖区域，将主要影像情况归纳并分类在“可采取行动的发现”这一术语下，并描述了它们最相关的影像特征（无论是否与PET亲和力有关）。此外，根据发现的紧急程度提出了不同的沟通时机和策略。
根据可采取行动的影像发现的预后严重程度进行系统分类，可能有助于报告医生选择如何以及何时与转诊临床医生沟通，或识别需要立即进行临床评估的病例。有效的沟通是诊断性影像学的关键组成部分：及时收到信息比传递方式更重要。
