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Referring physicians underestimate the extent of abnormalities in final reports from myocardial perfusion imaging

Tragardh, Elin LU ; Höglund, Peter LU ; Ohlsson, Mattias LU ; Wieloch, Mattias LU and Edenbrandt, Lars LU (2012) In EJNMMI Research 2(1).
Abstract

Background It is important that referring physicians and other treating clinicians properly understand the final reports from diagnostic tests. The aim of the study was to investigate whether referring physicians interpret a final report for a myocardial perfusion scintigraphy (MPS) test in the same way that the reading nuclear medicine physician intended. Methods After viewing final reports containing only typical clinical verbiage and images, physicians in nuclear medicine and referring physicians (physicians in cardiology, internal medicine, and general practitioners) independently classified 60 MPS tests for the presence versus absence of ischemia/infarction according to objective grades of 1 to 5 (1 = no ischemia/infarction, 2 =... (More)

Background It is important that referring physicians and other treating clinicians properly understand the final reports from diagnostic tests. The aim of the study was to investigate whether referring physicians interpret a final report for a myocardial perfusion scintigraphy (MPS) test in the same way that the reading nuclear medicine physician intended. Methods After viewing final reports containing only typical clinical verbiage and images, physicians in nuclear medicine and referring physicians (physicians in cardiology, internal medicine, and general practitioners) independently classified 60 MPS tests for the presence versus absence of ischemia/infarction according to objective grades of 1 to 5 (1 = no ischemia/infarction, 2 = probably no ischemia/infarction, 3 = equivocal, 4 = probable ischemia/infarction, and 5 = certain ischemia/infarction). When ischemia and/or infarction were thought to be present in the left ventricle, all physicians were also asked to mark the involved segments based on the 17-segment model. Results There was good diagnostic agreement between physicians in nuclear medicine and referring physicians when assessing the general presence versus absence of both ischemia and infarction (median squared kappa coefficient of 0.92 for both). However, when using the 17- segment model, compared to the physicians in nuclear medicine, 12 of 23 referring physicians underestimated the extent of ischemic area while 6 underestimated and 1 overestimated the extent of infarcted area. Conclusions Whereas referring physicians gain a good understanding of the general presence versus absence of ischemia and infarction from MPS test reports, they often underestimate the extent of any ischemic or infarcted areas. This may have adverse clinical consequences, and thus the language in final reports from MPS tests might be further improved and standardized.

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organization
publishing date
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Contribution to journal
publication status
published
subject
keywords
Tc MPS, Infarction, Ischemia, Ischemic heart disease, Structured reporting
in
EJNMMI Research
volume
2
issue
1
publisher
BioMed Central
external identifiers
  • scopus:84875912291
ISSN
2191-219X
DOI
10.1186/2191-219X-2-27
language
English
LU publication?
yes
id
cdc8903d-03f0-463e-a67b-9ae49e48dfdd
date added to LUP
2017-05-17 08:05:43
date last changed
2017-05-23 09:27:52
@article{cdc8903d-03f0-463e-a67b-9ae49e48dfdd,
  abstract     = {<p>Background It is important that referring physicians and other treating clinicians properly understand the final reports from diagnostic tests. The aim of the study was to investigate whether referring physicians interpret a final report for a myocardial perfusion scintigraphy (MPS) test in the same way that the reading nuclear medicine physician intended. Methods After viewing final reports containing only typical clinical verbiage and images, physicians in nuclear medicine and referring physicians (physicians in cardiology, internal medicine, and general practitioners) independently classified 60 MPS tests for the presence versus absence of ischemia/infarction according to objective grades of 1 to 5 (1 = no ischemia/infarction, 2 = probably no ischemia/infarction, 3 = equivocal, 4 = probable ischemia/infarction, and 5 = certain ischemia/infarction). When ischemia and/or infarction were thought to be present in the left ventricle, all physicians were also asked to mark the involved segments based on the 17-segment model. Results There was good diagnostic agreement between physicians in nuclear medicine and referring physicians when assessing the general presence versus absence of both ischemia and infarction (median squared kappa coefficient of 0.92 for both). However, when using the 17- segment model, compared to the physicians in nuclear medicine, 12 of 23 referring physicians underestimated the extent of ischemic area while 6 underestimated and 1 overestimated the extent of infarcted area. Conclusions Whereas referring physicians gain a good understanding of the general presence versus absence of ischemia and infarction from MPS test reports, they often underestimate the extent of any ischemic or infarcted areas. This may have adverse clinical consequences, and thus the language in final reports from MPS tests might be further improved and standardized.</p>},
  author       = {Tragardh, Elin and Höglund, Peter and Ohlsson, Mattias and Wieloch, Mattias and Edenbrandt, Lars},
  issn         = {2191-219X},
  keyword      = {Tc MPS,Infarction,Ischemia,Ischemic heart disease,Structured reporting},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {EJNMMI Research},
  title        = {Referring physicians underestimate the extent of abnormalities in final reports from myocardial perfusion imaging},
  url          = {http://dx.doi.org/10.1186/2191-219X-2-27},
  volume       = {2},
  year         = {2012},
}