title: Using radiology reports to encourage evidence-based practice in the evaluation of small, incidentally detected pulmonary nodules. A preliminary study.
abstract: BACKGROUND
  Standard radiology report forms do not guide ordering clinicians toward evidence-based practice.
  
  
  OBJECTIVE
  To test an enhanced radiology report that estimates the probability that a pulmonary nodule is malignant and provides explicit, professional guideline recommendations.
  
  
  METHODS
  Anonymous, institutional review board-approved, internet-based survey of all clinicians with privileges at the Dartmouth-Hitchcock Medical Center comparing a standard versus an enhanced chest computed tomography report for a 65-year-old former smoker with an incidentally detected 7-mm pulmonary nodule.
  
  
  RESULTS
  A total of 43% (n = 447) of 1045 eligible clinicians answered patient management questions after reading a standard and then an enhanced radiology report (which included the probability of malignancy and Fleischner Society guideline recommendations). With the enhanced report, more clinicians chose the correct management strategy (72% with enhanced versus 32% with standard report [40% difference; 95% confidence interval (CI) = 35-45%]), appropriately made fewer referrals to pulmonary for opinions or biopsy (21 vs. 41% [-40% difference; 95% CI = -25 to -16%]), ordered fewer positron emission tomography scans (3 versus 13%; -10% difference; 95% CI = -13 to -7%), and fewer computed tomography scans outside the recommended time interval (2 versus 7%; -5% difference; 95% CI = -7 to -2%). Most clinicians preferred or strongly preferred the enhanced report, and thought they had a better understanding of the nodule's significance and management.
  
  
  CONCLUSIONS
  An enhanced radiology report with probability estimates for malignancy and management recommendations was associated with improved clinicians' response to incidentally detected small pulmonary nodules in an internet-based survey of clinicians at one academic medical center, and was strongly preferred. The utility of this approach should be tested next in clinical practice.
authors.affiliation: 1 Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Steven
authors.initials: S
authors.lastname: Woloshin
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Schwartz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dann
authors.forename: William C
authors.initials: WC
authors.lastname: Black
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D004282:Documentation / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis*; D008505:Medical Staff, Hospital; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000379:methods*; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed