AUA 2017: Reading Reports vs Reviewing Images…How Important is it for Endourologists to Look at Films Prior to Decision-Making?

Boston, MA ( Our colleagues from India, lead by Dr. Thummar, presented their findings today at the AUA 2017 Annual Meeting in Boston Uroradiology poster session. The authors prospectively compared the diagnosis and management of 46 new endourology patients based on CT radiology reports alone vs. viewing of images by an experienced endourologist. For these patients, a diagnosis was made and a treatment plan formulated based on the CT report and physical exam. During the same visit, the images corresponding to the study were obtained and reviewed by the endourologist, a final diagnosis and treatment plan was assimilated, and comparisons were made between initial and final treatment plans.

The authors found there were changes in diagnosis or treatment plan after reviewing images in 29 patients (63%). Discrepant findings included: wrong side in report, inaccurate stone size, missing stones, inaccurate location of stones, number of stones, and degree of hydronephrosis. Additional findings that were not mentioned in the report included the presence of an angiomyolipoma, contralateral stones, crossing vessels, retrorenal colon, malrotated kidneys, duplicated collecting system, and horseshoe kidney. Changes that resulted in minor differences, but did not affect the overall surgical plan were observed in 11/29 (38%) of cases, changes to the type of procedure performed in 7/29 (24%) cases, changes in the decision for observation vs. surgery in 5 (11%) cases, changes resulting in an additional procedure needed during surgery were observed in 3 (7%) cases, and changes where a potentially severe complication was avoided (ie. retrorenal colon in case of PCNL, change in side of surgery, crossing vessel at UPJ in patient candidate for endopyelotomy) occurred in 3 patients (7%). Limitations of this study include the small sample size and lack of information regarding the training level of the radiologist on record.

As the authors have demonstrated in this study, and how we are taught from the beginning of training, it is crucial to review imaging for each patient clinical encounter. Ultimately, this is our professional responsibility to our field and most importantly for patient safety.

Presented By: Haresh Thummar, Sterling Hospital, Vadodara, India

Co-Authors: S Ponkhraj, D Shivang, N Thummar

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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