Assessment of actionable findings in radiology reports

Abstract

Purpose: The American College of Radiology (ACR) Actionable Reporting Work Group defined three categories of imaging findings that require additional, nonroutine communication with the referring physician because of their urgency or unexpectedness. The objective of this study was to determine the prevalence of actionable findings in radiology reports, and to assess how well radiologists agree on the categorisation of actionable findings.

Method: From 124,909 consecutive radiology reports stored in the electronic health record system of a large university hospital, 1000 reports were randomly selected. Two radiologists independently annotated all actionable findings according to the three categories of urgency defined by the ACR Work Group. Annotation differences were resolved in a consensus meeting and a final category was established for each report. Interannotator agreement was measured by accuracy and the kappa coefficient.

Results: The prevalence of the three categories of actionable findings together was 32.5 %. Of all reports, 10.9 % were from patients seen in the emergency department. Prevalence of actionable findings for these patients (45.9 %) was considerably higher than for patients in routine clinical care (30.9 %). Interannotator agreement scores on the categorisation of actionable findings were 0.812 for accuracy and 0.616 for kappa coefficient.

Conclusions: The prevalence of actionable findings in radiology reports is high. The interannotator agreement scores are moderate, indicating that categorisation of actionable findings is a difficult task. To avoid unneeded increase in the workload of radiologists, in particular in routine practice, clinical context may need to be considered in deciding whether a finding is actionable.

Keywords: Incidental findings; Interobserver variability; Prevalence; Radiology information systems.