Does Direct Radiologist-Patient Verbal Communication Affect Follow-Up Compliance of Probably Benign Assessments?

PURPOSE: The aim of this study was to determine whether direct verbal communication of results by a radiologist affected follow-up compliance rates for probably benign breast imaging findings. METHODS: This study was institutional review board approved and HIPAA compliant. A retrospective search identified all patients from January 1, 2010 to December 31, 2010 who had breast findings newly assessed as probably benign (BI-RADS category 3). Patients were categorized by whether the radiologist or the technologist verbally communicated the result and follow-up recommendation. Patient adherence to 6-, 12-, and 24-month follow-up imaging recommendations was recorded. RESULTS: Compliance data were available for 770 of 819 patients in the study. Overall compliance was 83.0% (639 of 770) for 6-month examinations, 68.1% (524 of 770) for 6- and 12-month examinations, and 57.4% (442 of 770) for 6-, 12-, and 24-month examinations. For patients who initially underwent diagnostic mammography alone, there was no significant difference in compliance between those who had and those who did not have radiologist-patient communication (6 months, 81.9% vs 80.8% [P = .83]; 6 and 12 months, 70.8% vs 67.3% [P = .58]; 6, 12, and 24 months, 54.2% vs 58.4% [P = .53]). For patients who initially underwent diagnostic mammography alone versus ultrasound with or without diagnostic mammography, there was no significant difference in compliance (6 months, 81.1% vs 84.3% [P = .24]; 6 and 12 months, 68.1% vs 68.0% [P = .96]; 6, 12, and 24 months, 57.4% vs 57.4% [P = .00]). CONCLUSIONS: High initial compliance was achieved by radiologist or technologist verbal communication of findings and recommendations. Direct communication by the radiologist did not increase compliance compared with communication by a technologist.

Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

Ulcerlike projections developing in noncommunicating aortic dissections: CT findings and natural history.

OBJECTIVE: Aortic ulcerlike projections are focal, contrast-filled outpouchings projecting from the aortic lumen. Our aim was to document the CT findings and natural history of ulcerlike projections developing in patients with preexisting noncommunicating aortic dissection, including intramural hematoma or false lumen thrombosis. MATERIALS AND METHODS: By searching the radiology information system, we found 38 ulcerlike projections arising in an underlying noncommunicating aortic dissection that were identified at CT in 24 patients. Clinical factors were determined from patient records. CT scans were reviewed to determine aortic pathology type and appearance time of ulcerlike projections and to measure the diameters of the aorta and ulcerlike projections for comparison over time. Complications were defined as an increase of at least 20% in the diameters of the ulcerlike projections or aorta, the need for surgical repair, or both. Comparisons of ulcerlike projections with and without complications were performed using various statistical tests. RESULTS: The underlying aortic disease of the 38 ulcerlike projections was intramural hematoma in 26, false lumen thrombosis in nine, and unknown in three. The mean time of ulcerlike projection appearance was 2.4 months (SD, 1.8) for intramural hematoma and 19.3 months (SD, 18.1) for false lumen thrombosis. Nine of the 28 ulcerlike projections with follow-up scans showed stability, size decrease, or resolution; 10 increased in size; and nine were incorporated into an expanded aortic lumen. Four of 36 ulcerlike projections with imaging or clinical follow-up (or both) required surgical repair. The only clinical or imaging feature significantly associated with the development of complications was false lumen thrombosis (p = 0.04). CONCLUSION: Ulcerlike projections forming in noncommunicating dissections may enlarge over time, although they rarely require surgical repair. Given the potential for critical complications, these lesions should be followed with serial CT scans.