2211. Facilitating Surveillance of Incidental Findings with a Novel Reporting Template: Proof of Concept in Patients with Pancreatic Abnormalities
Authors * Denotes Presenting Author
  1. William Smith *; University of Texas Southwestern Medical Center
  2. Gaurav Khatri; University of Texas Southwestern Medical Center
  3. Travis Browning; University of Texas Southwestern Medical Center
  4. Nisa Kubiliun; University of Texas Southwestern Medical Center
  5. John Mansour; University of Texas Southwestern Medical Center
  6. Ivan Pedrosa; University of Texas Southwestern Medical Center
  7. John Leyendecker; University of Texas Southwestern Medical Center
Incidental pancreatic cystic lesions are reported in 2-20% of abdominal cross-sectional examinations [1,2] and may represent a distinct pathway for development of certain pancreatic cancers. Patients with known family history or genetic risk factors for pancreatic cancer and those with incidental pancreatic abnormalities are followed in a multidisciplinary high-risk pancreas clinic (PC) at our institution. In order to facilitate appropriate surveillance of high-risk patients, we implemented a unique discrete field within radiology dictation templates that automates notification to PC. Our goal was to analyze the utilization rate of this novel field and assess its utility in facilitating successful patient referral to PC.

Materials and Methods:
This quality improvement project met criteria for IRB-waiver. We queried our department radiology report database for all structured CT/MRI reports containing a dedicated pancreas findings section. Reports of studies in patients with known pancreatic abnormalities and duplicate studies on the same patient were excluded. Keyword matching was used to identify presence of incidental pancreas findings and the unique discrete field in reports to determine ‘flagged’ (containing incidental findings and the discrete field) and ‘unflagged’ (containing incidental findings but no discrete field) reports. We assessed trends and appropriateness in use of the discrete field and compared rates of PC referral between flagged and unflagged reports.

1031 of 40,265 (2.6%) CT/MRI imaging reports had incidental pancreatic abnormalities. The discrete field was used in 399 of 1031 (38.7%) reports. Use of the discrete field was associated with a higher likelihood of patients being seen in PC (40.9% vs. 11.2%; p<0.001). The field was more likely to be used in reports dictated by trainees and attendings rather than attendings alone (44.6% vs. 26.2%; p<0.001), for incidental cystic lesions rather than solid lesions (47.9% vs. 14.1%; p<0.001), for focal lesions rather than ductal abnormalities (42.6% vs. 11%; p<0.001), and in patients without known non-pancreatic malignancy rather than those with known non-pancreatic malignancy (41.4% vs. 31.3%; p=0.003).

We describe use of a novel discrete field within radiology dictations for reporting of incidental pancreatic findings. Use of the field facilitated patient referral to the PC. Radiologist compliance for use of the discrete field was low. We identified trends in radiologist non-compliance that can be targeted to increase use of the discrete field. Out initial experience with use of this novel discrete field for pancreatic abnormalities demonstrates future applicability of this process for reporting and surveillance of incidental findings seen on CT and MRI in other organ systems.