title: Use of a clinical pathway to manage unsuspected radiographic findings.
abstract: OBJECTIVE
  To describe our 5-year experience with a clinical pathway used to ensure the timely communication and evaluation of unsuspected radiologic findings (URFs) noted on clinically requested chest imaging.
  
  
  METHODS
  Prospective data collection on clinical practice.
  
  
  METHODS
  Academically affiliated Veterans Affairs medical center.
  
  
  METHODS
  Pulmonary physicians, nurses, and radiologists.
  
  
  RESULTS
  Over a period of 5 years, 1,629 URFs were referred to the pathway (from chest radiographs, 1,359 [83.4%]; from CT scans, 270 [16.6%]). Most URFs (78%) were nodules, with a specific diagnosis made in one third of URFs, and with a specific diagnosis thought to be clinically significant in another one third of URFs. The most common diagnosis was neoplasm, with over two thirds of these diagnoses being lung cancer. One third of lung cancers detected were either stage 1 or 2, with 1 in 17 of all URFs being stage IA lung cancer. The cost of the pathway was estimated at 28,600 dollars per year.
  
  
  CONCLUSIONS
  URFs noted on chest imaging are frequently clinically significant, and a systematic approach to managing URFs, such as a clinical pathway, can significantly improve care in a large teaching hospital.
authors.affiliation: Medical Service, Pulmonary and Critical Care Section, Portland Veterans Administration Medical Center, Portland, OR 97201, USA. william.holden@med.va.gov
authors.forename: William E
authors.initials: WE
authors.lastname: Holden
authors.forename: David M
authors.initials: DM
authors.lastname: Lewinsohn
authors.forename: Molly L
authors.initials: ML
authors.lastname: Osborne
authors.forename: Chris
authors.initials: C
authors.lastname: Griffin
authors.forename: Ann
authors.initials: A
authors.lastname: Spencer
authors.forename: Carol
authors.initials: C
authors.lastname: Duncan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Deffebach
mesh_terms: D000368:Aged; D019091:Critical Pathways / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans / Q000191:economics / Q000592:standards; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D009922:Oregon; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000592:standards*; D011873:Radiology Information Systems / Q000191:economics; D014481:United States; D014493:United States Department of Veterans Affairs