Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas

Renata R. Almeida; Bernardo C. Bizzo; Ramandeep Singh; Katherine P. Andriole; Tarik K. Alkasab

doi:10.1016/j.acra.2021.01.019

Back

Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas

Journal article

Peer reviewed

Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas

Renata R. Almeida, Bernardo C. Bizzo, Ramandeep Singh, Katherine P. Andriole and Tarik K. Alkasab

Academic radiology, Vol.29(2), pp.236-244

02/2022

DOI: 10.1016/j.acra.2021.01.019

PMID: 33583714

View Online

Abstract

To assess the impact of using a computer-assisted reporting and decision support (CAR/DS) tool at the radiologist point-of-care on ordering provider compliance with recommendations for adrenal incidentaloma workup. Abdominal CT reports describing adrenal incidentalomas (2014 — 2016) were retrospectively extracted from the radiology database. Exclusion criteria were history of cancer, suspected functioning adrenal tumor, dominant nodule size < 1 cm or ≥ 4 cm, myelolipomas, cysts, and hematomas. Multivariable logistic regression models were employed to predict follow-up imaging (FUI) and hormonal screening orders as a function of patient age and sex, nodule size, and CAR/DS use. CAR/DS reports were compared to conventional reports regarding ordering provider compliance with, frequency, and completeness of, guideline-warranted recommendations for FUI and hormonal screening of adrenal incidentalomas using Chi-square test. Of 174 patients (mean age 62.4; 51.1% women) with adrenal incidentalomas, 62% (108/174) received CAR/DS-based recommendations versus 38% (66/174) unassisted recommendations. CAR/DS use was an independent predictor of provider compliance both with FUI (Odds Ratio [OR]=2.47, p = 0.02) and hormonal screening (OR=2.38, p = 0.04). CAR/DS reports recommended FUI (97.2%,105/108) and hormonal screening (87.0%,94/108) more often than conventional reports (respectively, 69.7% [46/66], 3.0% [2/66], both p <0.0001). CAR/DS recommendations more frequently included instructions for FUI time, protocol, and modality than conventional reports (all p <0.001). Ordering providers were at least twice as likely to comply with report recommendations for FUI and hormonal evaluation of adrenal incidentalomas generated using CAR/DS versus unassisted reporting. CAR/DS-directed recommendations were more adherent to guidelines than those generated without.

Adrenal Incidentaloma

Adrenal Nodule

Computed Tomography (CT)

Computer-assisted reporting

Decision Support Abbreviations Computer-assisted reporting and decision support (CAR/DS)

Follow-up Imaging (FUI)

Hounsfield Units (HU)

Magnetic resonance Imaging (MRI)

Odds Ratio (OR)

Details

Title: Subtitle: Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas
Creators: Renata R. Almeida - Brigham and Women's Hospital
Bernardo C. Bizzo - Massachusetts General Hospital
Ramandeep Singh - Massachusetts General Hospital
Katherine P. Andriole - MGH & BWH Center for Clinical Data Science, Suite 1303, 100 Cambridge St, Boston, MA 02114 (R.R.A., B.C.B., K.P.A., T.K.A.)
Tarik K. Alkasab - Massachusetts General Hospital
Resource Type: Journal article
Publication Details: Academic radiology, Vol.29(2), pp.236-244
Publisher: Elsevier Inc
DOI: 10.1016/j.acra.2021.01.019
PMID: 33583714
ISSN: 1076-6332
eISSN: 1878-4046
Language: English
Date published: 02/2022
Academic Unit: Radiology
Record Identifier: 9984697719202771

Metrics

5 Record Views

2 Times Cited - Web of Science