CDS, education improves guideline adherence for CT-detected incidental ovarian lesions

Educating radiologists on ACR-recommended follow-up for incidental adnexal lesions and incorporating such guidelines into normal workflow significantly improved the rate of adherence, reported authors of a Feb. 26 study published in the American Journal of Roentgenology.

A team of researchers from Boston assessed the adherence rate of 40 abdominal radiologists by analyzing their pelvic CT reports for adnexal findings from October to December 2016. The specialists were surveyed to identify the top barriers to adherence, which were incorporated into interventions and implemented from Dec. 23, 2016, through February 15, 2017.

The adherence rate before interventions was 67 percent. Following the interventions, which included radiologist education and an easily accessible clinical decision support (CDS) tool embedded into radiology workflow, the adherence rate increased to 87 percent.

A crucial arm of the study included identifying the major barriers to following ACR recommendations, which were originally published as a white paper for inclusion in radiology reports, wrote Atul B. Shinagare, MD, Brigham and Women’s Hospital in Boston, and colleagues.

Twenty-eight of the 40 (70 percent) radiologists responded to the survey, of whom, eight (29 percent), “often or consistently” used the recommendations. Interestingly, the authors noted, 57 percent of radiologists claimed they faced no barriers, but “not remembering the details of recommendations” and “not having easy access” to them accounted for more than 80 percent of barriers cited by the respondents.

“Addressing these barriers by radiologist education and introduction of a simple CDS tool in the radiologist workflow at the point-of-care significantly improved the rate of adherence to the ACR white paper follow-up recommendations for incidental adnexal lesions,” Shinagare, with Brigham’s Center for Evidence-Based Imaging, and colleagues wrote.

Ovarian cancer is the leading cause of death among women with gynecologic cancers, the group explained. Incidental adnexal lesions are common, and most are benign cysts that resolve without intervention. Therefore, diagnosing ovarian cancer presents a “unique challenge,” the researchers added.

“The ultimate aim is early detection of ovarian cancer without unnecessary imaging or procedures for benign adnexal lesions,” wrote Shinagare et al. “As a result, there is often confusion regarding appropriate management of incidental adnexal lesions.”

The study was focused on ACR white paper follow-up adherence; therefore it did not look at outcomes of radiologist recommendations nor did it assess individual adherence rates. However, the authors wrote, they have incorporated the educational material and CDS tool into trainee reference material to help such interventions become standard practice.