Marn and his colleagues, including lead author and U-M radiology lecturer Vaishali Choksi, M.B.B.S., D.M.R.D., D.N.B., developed a system of codes that radiologists could assign to each medical image as electronic "tags." The study focused on scans that received a "Code 8" tag, meaning that the radiologist spotted an unexpected sign of cancer that required immediate follow-up by the patient's own physician.
Such scans were reported to the patient's physician via a written report and a direct phone notification about the unexpected finding that might indicate cancer. But as a backup, each week a staff member pulled up the computerized records tagged with Code 8s and checked if each had received follow-up care. If they hadn't, she contacted the patient's physician, as well as the hospital's cancer-care group.
Of the 37,736 medical images made at the VA in the one-year study period, 395 received Code 8s, and 360 of those patients' computerized records showed that they had appropriate follow-up within two weeks.
For the 35 patients whose records showed no sign of follow-up, the staff member's contact with the doctors revealed that there had been follow-up for 25 of the patients, but it hadn't been noted in the computerized records yet. One other patient died soon after the Code 8 scan, and another elected not to have follow-up care.
But for eight patients, the doctor who had ordered the scan had not reacted to the Code 8 report from the radiologist, for whatever reason. Once follow-up care was initiated, five of those patients turned out to have malignant cancer, making up 2 percent of all cancers detected in the study year and 0.02 percent of all scans performed during the year.
Why would doctors fail to react to a radiologist's report about a potential cancer? There are many reasons, Marn says. For instance, an unexpected finding of canc
Contact: Kara Gavin
University of Michigan Health System