ARRS 2022 Abstracts

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E1532. Radiologists in Sync: Standardized Follow-up Recommendations Improve Reporting of Incidental Renal Lesions
Authors
  1. Saralyn Beckius; Providence Sacred Heart Medical Center
  2. Scott King; Providence Sacred Heart Medical Center
  3. Michael Johnston; Washington State University
  4. Skyler Burke; Washington State University
Background
Renal cell carcinoma (RCC) is the sixth most common cancer in men and the eight most common cancer in women. In the absence of clinical signs such as hematuria and palpable flank mass, imaging remains the most reliable means of incidentally detecting lesions concerning for RCC. However, there is generally low adherence to follow-up imaging recommendations for incidental findings including incidentally detected renal lesions, and variable concordance between radiology reports and societal guidelines. This project demonstrates the increased concordance between radiology report recommendations (including recommendations regarding timing and duration of total follow-up) and societal guidelines after the implementation of standardized reporting.

Educational Goals / Teaching Points
This exhibit will illustrate a quality improvement process of developing and deploying standardized follow-up recommendations for incidentally detected renal lesions; analyze the impact of structured follow-up language on completeness and accuracy of follow-up recommendations; and demonstrate improved follow-up imaging appropriateness regarding imaging work-up of incidental renal lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiology report impressions of exams in which an incidental renal lesion was initially detected were assessed for completeness of the follow-up recommendation. This analysis included whether a follow-up recommendation was made, an appropriate modality recommended, and ACR whitepaper suggestions were adhered to for work-up of incidental renal lesions. Initial data demonstrated that 35 out of 110 (32%) studies had correct recommendations, 57 of 110 (52%) had incorrect or incomplete recommendations, and 18 of 110 (16%) had no recommendation at all. Of the 36 studies for which MRI at 6-12 months was appropriate, 30 of them had MRIs ordered within 1-3 months after the initial study. These cases were associated predominantly with a variety of either incorrect/incomplete recommendations or no recommendations. After development and implementation of a set of standardized follow-up recommendations, initial data shows improved radiology report impression completeness of recommendations and a concomitant decrease in incomplete or absent recommendations. Of the total renal MRIs evaluated (and equivalent characterizing studies), 57 of 109 (53%) had correct recommendations, 39 of 109 (36%) had incorrect/incomplete recommendations, and 13 of 109 (12%) had no recommendation. Of the 41 studies for which MRI at 6-12 months was appropriate, 24 had their MRIs within 1-3 months after the original study.

Conclusion
We demonstrate that incorporating and promoting standardized follow-up recommendations improves radiologist adherence to radiology best practices regarding the work-up of incidentally detected renal lesions. This enhances imaging appropriateness, decreases wasteful imaging, and facilitates improved referring provider communication. Structured recommendations also facilitate tracking of follow-up adherence, potentially decreasing loss to follow-up of patients with intermediate or high-risk lesions.