Critical radiology results in thoracic imaging; categorization by urgency and clinical outcome

Abstract

Background

Timely communication of critical radiology results (CRRs) is vital for patient safety. However, data on the categorization and active follow-up of CRRs in thoracic imaging remain limited.

Purpose

The aim of our study was to investigate the prevalence of CRRs in thoracic radiology and to assess the extent to which clinical follow-up was performed.

Materials and methods

We retrospectively reviewed 741 CRRs from chest computed tomography (CT) and radiography between August 2018 and March 2021 at a tertiary care hospital. All CRRs were classified using the American College of Radiology three-tier urgency system and communicated through a structured electronic alert system. Active follow-up was defined as documentation of diagnostic or therapeutic response.

Results

Of 741 CRRs, 667 (90.0 %) were from CT and 74 (10.0 %) from radiography. The most common clinical settings were outpatient (43.3 %), followed by inpatients (35.8 %) and emergency department (20.9 %). CRRs were categorized as Category 1 (15.8 %), Category 2 (70.6 %), and Category 3 (7.3 %) based on the urgency. Pulmonary embolism and suspected malignancy were the most frequent actionable findings. Active clinical responses were documented in 733 cases (98.9 %), including all Category 1 CRRs. However, 1.1 % of cases, mostly Category 3 or incidental findings, lacked documented follow-up, particularly in outpatient or cross-specialty scenarios.

Conclusion

A structured alert system for CRRs enabled prompt communication and follow-up adherence. However, non-urgent but actionable findings are still at risk of being lost to follow-up. Enhanced and integrated tracking systems are essential to ensure consistent and comprehensive management of all actionable radiologic findings.