title: Journal club: Renal masses detected at abdominal CT: radiologists' adherence to guidelines regarding management recommendations and communication of critical results.
abstract: OBJECTIVE
  The purpose of this study was to assess radiologists' adherence to published guidelines for managing renal masses detected at abdominal CT at one institution and to a critical results communication policy.
  
  
  METHODS
  A validated natural language processing tool supplemented by manual review was used to randomly assemble a cohort of 97 radiology reports from all abdominal CT reports (n = 11,952) generated from July 2010 to June 2011. Critical renal mass findings warranted consideration for surgery, intervention, or imaging follow-up and required direct, separate, and timely communication to the referrer in addition to the radiology report. Primary outcomes were adherence to guidelines and institutional policy for communicating critical results. Sample size allowed a 95% CI ± 5% for primary outcome. Pearson chi-square test was performed to assess whether radiology subspecialization was predictive of the primary outcome.
  
  
  RESULTS
  Of all abdominal CT reports, 35.6% contained at least one renal mass finding (4.3% critical). Guideline adherence was lower for patients with critical than for those with noncritical findings (48/57 [84.2%] vs 40/40 [100%]; p = 0.01). Adherence to critical result communication policy was 73.7% (42/57). For critical findings, abdominal radiologists had higher guideline adherence (40/43 [93.0%] vs 8/14 [57.1%]; p = 0.001) and critical result communication policy adherence (36/43 [83.7%] vs 6/14 [42.9%]; p = 0.002) than nonabdominal radiologists.
  
  
  CONCLUSIONS
  In reporting renal masses detected at abdominal CT, radiologists largely adhered to management guidelines but did not adhere to the critical results communication policy in one of four reports. Subspecialization improved adherence to both management guidelines and the institution's critical result communication policy.
authors.affiliation: 1 Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Cleo K
authors.initials: CK
authors.lastname: Maehara
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Silverman
authors.forename: Ronilda
authors.initials: R
authors.lastname: Lacson
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D004282:Documentation / Q000592:standards / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal / Q000592:standards* / Q000706:statistics & numerical data; D011871:Radiology / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: American Urological Association guidelines; abdominal CT; critical test results; evidence-based practice; renal cyst; renal mass