title: Communication of unexpected and significant findings on chest radiographs with an automated PACS alert system.
abstract: OBJECTIVE
  An integral part of realizing the enormous potential of imaging in patient care is close communication between radiologists and referring physicians. One key element of this process is the communication of unexpected significant findings. The authors examined the performance of a PACS-based alert system in the appropriate communication of reports containing unexpected significant findings to referring physicians.
  
  
  METHODS
  A PACS-integrated key word system was developed such that an e-mail was sent to the referring clinician if a radiologist detected a significant unexpected finding. The number, source, and outcome of chest radiographic unexpected findings over a 14-month period were analyzed. The time for response of the referring physician plus time for follow-up were also examined.
  
  
  RESULTS
  Key words were applied to 158 of the 39,665 chest radiographs (0.4%) obtained during the study period. The emergency department was the most frequent referral location (46.2%). Final diagnostic categories included malignancy (13.9%), benign lesion (49.4%), and no abnormality (20.2%). The average time to acknowledgment by clinicians of notification was 3.1 days, although 57.6% were acknowledged within 24 hours. The mean time interval to the next relevant radiologic investigation was 26 days among the 77.8% of findings that underwent radiologic follow-up.
  
  
  CONCLUSIONS
  The development of electronic alert systems, which are integrated into PACS, can aid greatly in report communication and eliminate the risk associated with unread reports that contain significant or unexpected findings.
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Hayes
authors.affiliation: Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Breen
authors.affiliation: Department of Emergency & Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McLaughlin
authors.affiliation: Department of Radiology, University College Cork, Cork, Ireland.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Murphy
authors.affiliation: Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Henry
authors.affiliation: Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Cork, Ireland.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Maher
authors.affiliation: Department of Radiology, Cork University Hospital, Cork, Ireland. Electronic address: maxf.ryan@hse.ie.
authors.forename: Max F
authors.initials: MF
authors.lastname: Ryan
mesh_terms: D003937:Diagnosis, Differential; D034742:Electronic Mail; D006801:Humans; D033183:Interdisciplinary Communication; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D011785:Quality Assurance, Health Care; D013902:Radiography, Thoracic; D011873:Radiology Information Systems / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration
keywords: PACS; chest radiograph; lung cancer; medicolegal risk; unexpected clinical findings