JNM: Essential elements missing from most PET reports

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Michael M. Graham, MD, PhD, president of SNM

A study and an accompanying editorial published in the January issue of Journal of Nuclear Medicine suggests that essential elements were missing from many oncologic PET reports and these deficiencies may render reports less helpful to referring physicians and also lead to misdiagnoses as well as cause coding and billing errors.

R. Edward Coleman, MD, director of the department of radiology at Duke University Medical Center in Durham, N.C., and colleagues compiled a list of desirable elements in PET reports from the American College of Radiology and the Society of Nuclear Medicine guidelines and assessed the reports for 34 elements—21 primary and 11 additional questions related to six of these primary elements.

Coleman and colleagues found that several important elements were not included in more than 40 percent of the reports: the reason for the study, a description of treatment history, a statement about comparison to other imaging and time from radiopharmaceutical injection to imaging. Only nine of the 34 elements were found in more than 90 percent of the reports.

“The most disturbing thing is that in only 56 percent of the reports was the clinical indication for the study clearly addressed. This is probably the most important of the 34 elements," wrote Michael M. Graham, MD, PhD, professor at department of radiology, University of Iowa in Iowa City. The referring physician has sent the patient to get an 18F-FDG PET/CT study done to answer a specific question. If the reason for doing the study is not clearly addressed in the impression portion of the report, the report is unlikely to have any impact on patient management.”

“The problem sometimes is that the question is not well articulated, such as: 'Patient with lung cancer. Please do PET scan.' In only 58 percent of the reports is the reason for the study clearly indicated. If the request is not clear, it is the job of the PET center staff or the interpreting physician to ensure that a clear question is being asked,” added Graham.

“Essential elements that should be included in oncologic PET reports were missing from many reports...Interpreting physicians should audit their reports to ascertain that they include appropriate elements necessary for billing compliance and for effective communications with referring physicians,” concluded Coleman and colleagues.

“A possible weakness of the paper of Coleman et al. is that, for practical reasons, only 180 reports were examined to generate the results. The paper would have been stronger and might have brought additional points to light if all the reports submitted as part of NOPR [National Oncologic PET Registry] had been examined,” said Graham.

A training set of 20 randomly selected reports was evaluated in the study by the four-physician panel, and the results were used to formulate a consensus approach for assessing report content and quality. Each reviewer then scored 65 randomly selected reports—20 common to all reviewers.

Graham also noted that it may be possible to use computers to extract the presence or absence of the essential elements of a report. “If the automatic approach can be made reliable, all the NOPR reports can be evaluated and a more extensive analysis done. The approach could presumably be extended to other settings, including collection of outcome data to correlate with the PET/CT reports and the change-of-management decisions.”