Factors Affecting Adherence to Recommendations for Additional Imaging of Incidental Findings in Radiology Reports

Objective: To determine the rate at which recommendations for additional imaging (RAIs) of incidental findings on CT are adhered to at a tertiary-care medical center and what factors influence adherence.

Methods: We used a radiology clinical informatics tool (mPower, Nuance Communications Inc, Burlington, Massachusetts) to identify RAIs in reports from all CT examinations performed at a tertiary-care medical center during a 6-month period. For those studies in which the RAI was for incidental findings, we reviewed the patients' charts to determine if there was appropriate follow-up of the lesion in question.

Results: The overall rate of adherence to RAIs was 39.1%, and in patients with a same-institution primary care provider (PCP), 56.8% (P < .0001). Adherence was higher in studies ordered in the outpatient setting (P < .0001) and in patients with a same-institution PCP (P < .0001). Among patients with a same-institution PCP, adherence was highest for outpatients (66.7%), followed by patients seen in the emergency department (46.0%) and inpatients (36.0%). Among outpatients, adherence was highest with PCPs (67%) followed by internal medicine subspecialties (50%) and surgery (38%).

Discussion: The rate of adherence to recommendations for additional imaging of incidental findings was 39.1% in this study and higher for patients with a same-institution PCP, studies ordered in the outpatient setting, and in studies ordered by PCPs.