Anu E. Obaro and Andrew A. Plumb contributed equally to this work.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
To determine if polyp detection at computed tomographic colonography (CTC) is associated with (a) the number of CTC examinations interpreted per day and (b) the length of time spent scrutinising the scan.
Retrospective observational study from two hospitals. We extracted Radiology Information System data for CTC examinations from Jan 2012 to Dec 2015. For each examination, we determined how many prior CTCs had been interpreted by the reporting radiologist on that day and how long radiologists spent on interpretation. For each radiologist, we calculated their referral rate (proportion deemed positive for 6 mm+ polyp/cancer), positive predictive value (PPV) and endoscopic/surgically proven polyp detection rate (PDR). We also calculated the mean time each radiologist spent interpreting normal studies (“negative interpretation time”). We used multilevel logistic regression to investigate the relationship between the number of scans reported each day, negative interpretation time and referral rate, PPV and PDR.
Five thousand one hundred ninety-one scans were interpreted by seven radiologists; 892 (17.2%) were reported as positive, and 534 (10.3%) had polyps confirmed. Both referral rate and PDR reduced as more CTCs were reported on a given day (p < 0.001), the odds reducing by 7% for each successive CTC interpreted. Radiologists reporting more slowly than their colleagues detected more polyps (p = 0.028), with each 16% increase in interpretation time associated with a 1% increase in PDR. PPV was unaffected.
Reporting multiple CTCs on a given day and rapid CTC interpretation are associated with decreased polyp detection. Radiologists should be protected from requirements to report too many CTCs or too quickly.
• CT colonography services should protect radiologists from a need to report too fast (> 20 min per case) or for too long (> 4 cases consecutively without a break).
• Professional bodies should consider introducing a target minimum interpretation time for CT colonography examinations as a quality marker.
European Commission (2018) Eurostat: medical technologies - examinations by medical imaging techniques. https://ec.europa.eu/eurostat/data/database(navigate to hlth_co_exam). Accessed 13 Nov 2018
Health and Social Care Information Centre (2017) Diagnostic imaging dataset. Health and Social Care Information Centre. https://did.hscic.gov.uk/. Accessed 8 Aug 2017
Cake R, Cavanagh P, Gordon B (2015) Horizon scanning: an evaluation of imaging capacity across the NHS in England. https://www.cancerresearchuk.org/sites/default/files/horizon_scanning_-_final.pdf. Accessed June 2016
Edwards AJ, Ricketts C, Dubbins PA, Roobottom CA, Wells IP (2003) The effect of reporting speed on plain film reporting errors. Clin Radiol 58(12):971–979 CrossRef
Sokolovskaya E, Shinde T, Ruchman RB et al (2015) The effect of faster reporting speed for imaging studies on the number of misses and interpretation errors: a pilot study. J Am Coll Radiol 12(7):683–688 CrossRef
Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349(23):2191–2200 CrossRef
Johnson CD, Chen M-H, Toledano AY et al (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359(12):1207–1217 CrossRef
Atkin W, Dadswell E, Wooldrage K et al (2013) Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 381(9873):1194–1202 CrossRef
Halligan S, Wooldrage K, Dadswell E et al (2013) Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): a multicentre randomised trial. Lancet 381(9873):1185–1193 CrossRef
Wolfe JM, Horowitz TS, Kenner NM (2005) Cognitive psychology: rare items often missed in visual searches. Nature 435(7041):439–440 CrossRef
Plumb AA, Obaro A, Fanshawe T et al (2017) Prevalence and risk factors for post-investigation colorectal cancer (“interval cancer”) after computed tomographic colonography: protocol for a systematic review. Syst Rev 6(1):36 CrossRef
Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355(24):2533–2541 CrossRef
Lee TJW, Blanks RG, Rees CJ et al (2013) Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 45(1):20–26 PubMed
Shaukat A, Rector TS, Church TR et al (2015) Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy. Gastroenterology 149(4):952–957 CrossRef
Sanaka MR, Deepinder F, Thota PN, Lopez R, Burke CA (2009) Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol 104(7):1659–1664 quiz 65 CrossRef
Kaneshiro M, Ho A, Chan M, Cohen H, Spiegel BMR (2010) Colonoscopy yields fewer polyps as the day progresses despite using social influence theory to reverse the trend. Gastrointest Endosc 72(6):1233–1240 CrossRef
Wilson E (1927) Probable Inference, the Law of Succession, and Statistical Inference, Journal of the American Statistical Association, 22(158):209–212
R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available online at https://www.R-project.org/
Rutter MD, Beintaris I, Valori R et al (2018) World endoscopy organization consensus statements on post-colonoscopy and post-imaging colorectal cancer. Gastroenterology 155(3):909–25 e3 CrossRef
Obaro AE, Plumb AA, Fanshawe TR et al (2018) Post-imaging colorectal cancer or interval cancer rates after CT colonography: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 3(5):326–336 CrossRef
Plumb AA, Phillips P, Spence G et al (2017) Increasing navigation speed at endoluminal CT colonography reduces colonic visualization and polyp identification. Radiology 284(2):413–422 CrossRef
Rees CJ, Thomas Gibson S, Rutter MD et al (2016) UK key performance indicators and quality assurance standards for colonoscopy. Gut 65(12):1923–1929 CrossRef
Kaminski MF, Thomas-Gibson S, Bugajski M et al (2017) Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Endoscopy 49(4):378–397 CrossRef
Rex DK, Schoenfeld PS, Cohen J et al (2015) Quality indicators for colonoscopy. Am J Gastroenterol 110(1):72–90 CrossRef
Care Quality Commission (2018) Radiology review: a national review of radiology reporting within the NHS in England. https://www.cqc.org.uk/sites/default/files/20180718-radiology-reporting-review-report-final-for-web.pdf. Accessed 13 Nov 2018
Leffler DA, Kheraj R, Bhansali A et al (2012) Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies. Gastrointest Endosc 75(3):554–560 CrossRef
Lurix E, Hernandez AV, Thoma M, Castro F (2012) Adenoma detection rate is not influenced by full-day blocks, time, or modified queue position. Gastrointest Endosc 75(4):827–834 CrossRef
- Computed tomographic colonography: how many and how fast should radiologists report?
Anu E. Obaro
Andrew A. Plumb
Michael P. North
David N. Burling
- Springer Berlin Heidelberg
Neu im Fachgebiet Radiologie
Meistgelesene Bücher aus der Radiologie
Mail Icon II