Standard protocol calls for radiologists to report suspicious diagnostic image findings to the referring physician, but sometimes the correct follow-up is not initiated. Researchers from the University of Michigan and from the Department of Veterans Affairs, both in Ann Arbor, devised a semiautomated system to ensure that significant unexpected findings receive appropriate attention.

As reported in the April issue of the American Journal of Roentgenology, the researchers designed a process for coding abnormalities to facilitate appropriate follow-up for patients. They coded findings with a 1, 4 or 8: 1 indicated no unexpected findings requiring follow-up, 4 indicated an unexpected acute finding (but not cancer) that required follow-up, and 8 meant possible malignancy, which required follow-up.

In the event of an unexpected finding, an interpreting radiologist contacted the referring physician immediately and documented the contact in a report. Code 8s also were recorded in an electronic record. A tumor registrar received a list of the code 8s every week to ensure that follow-up had been arranged with the referring physician. If the registrar could not ascertain whether the referring physician had been made aware of the possible malignancy, or if an additional investigation had not been ordered, he/she would contact the provider directly and notify the hospital’s tumor board of head physicians.

Between April 2003 and March 2004, 37,736 radiology examinations were performed. Of these, 395 cases were assigned code 8, and all code 8 cases were tracked by the tumor board. Thirty-five cases did not have any follow-up information, and eight of these were caught by the semiautomated system. Five of these eight patients were diagnosed with malignancy.

The researchers believe the system will help ensure that significant findings receive correct and timely attention.