title: Evaluation of Automated Fracture Risk Assessment Based on the Canadian Association of Radiologists and Osteoporosis Canada Assessment Tool.
abstract: Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) reports; evidence suggests that structured reporting (SR) tools may improve report clarity. The aim of this study is to compare fracture risk assessments automatically assigned by SR software in accordance with Canadian Association of Radiologists and Osteoporosis Canada (CAROC) recommendations to assessments from experts on narrative BMD reports. Charts for 500 adult patients who recently received a BMD exam were sampled from across University of Toronto's Joint Department of Medical Imaging. BMD measures and clinical details were manually abstracted from charts and were used to create structured reports with assessments generated by a software implementation of CAROC recommendations. CAROC calculations were statistically compared to experts' original assessments using percentage agreement (PA) and Krippendorff's alpha. Canadian FRAX calculations were also compared to experts', where possible. A total of 25 (5.0%) reported assessments did not conform to categorizations recommended by Canadian guidelines. Across the remainder, the Krippendorff's alpha relating software assigned assessments to physicians was high at 0.918; PA was 94.3%. Lower agreement was associated with reports for patients with documented modifying factors (alpha = 0.860, PA = 90.2%). Similar patterns of agreement related expert assessments to FRAX calculations, although statistics of agreement were lower. Categories of disagreement were defined by (1) gray areas in current guidelines, (2) margins of assessment categorizations, (3) dictation/transcription errors, (4) patients on low doses of steroids, and (5) ambiguous documentation of modifying factors. Results suggest that SR software can produce fracture risk assessments that agree with experts on most routine, adult BMD exams. Results also highlight situations where experts tend to diverge from guidelines and illustrate the potential for SR software to (1) reduce variability in, (2) ameliorate errors in, and (3) improve clarity of routine adult BMD exam reports.
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. Electronic address: s.allin@utoronto.ca.
authors.forename: Sonya
authors.initials: S
authors.lastname: Allin
authors.affiliation: Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON, Canada; Joint Department of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Bleakney
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Munce
authors.affiliation: Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON, Canada; Joint Department of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada; University Health Network Osteoporosis Program, Toronto General Hospital, Toronto, ON Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Osteoporosis Research Program, Women's College Research Institute, Toronto, ON, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Jaglal
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D001331:Automation; D015519:Bone Density; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D011871:Radiology; D018570:Risk Assessment; D012955:Societies, Medical; D012984:Software
keywords: Dual-energy X-ray; guidelines; osteoporosis; radiology information systems; structured reporting