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MP08-08: Reading reports Vs Reviewing images….How Important is it for Endourologists to Look at Films Prior to Decision-making?

Friday, May 12
9:30 AM - 11:30 AM
Location: BCEC: Room 160

Presentation Authors: Haresh Thummar*, Ponkhraj S, Shivang D, N Thummar, Vadodara, India

Introduction: The diagnosis and management of endourological conditions is highly dependent on imaging studies. Radiology reports do not always address all the issues relevant to decision-making, and on occasion can be inaccurate. To our knowledge, there is no data available in the endourological literature regarding the importance of self-viewing of images by treating physicians. We prospectively compared the diagnosis and management of endourology patients based on CT radiology reports alone vs. the viewing of images by an experienced endourologist.

Methods: We randomly selected 46 new patients referred to an endourology practice who came with CT radiology reports for evaluation. A diagnosis was rendered and a treatment plan was formulated based on the report and history and physical exam. Following this, during the visit, the actual images were obtained and reviewed in detail and a final diagnosis and treatment plan rendered. Comparative findings and decisions were graded according to our protocol.

Results: We saw changes in findings or treatment plan after reading of images in 29 patients (63.1%). Discrepant findings included wrong side in report, inaccurate stone size, missing stones, inaccurate location of stones, number of stones, degree of hydronephrosis etc. New findings included presence of AML, contralateral stones, crossing vessels, retrorenal colon, malrotated kidneys, duplicated collecting system, horseshoe kidney, scoliosis, and others. Missing information that affected treatment strategy included skin to stone distance, stone density, stone volume, and presence of encrustations on stent already in place. Grade 1 changes (defined as minor differences not affecting surgical plan) were observed in 11/29 (37.9%). Grade 2 changes (change in type of procedure) were noted in 7/29 (24.2%). Grade 3 changes (decision for observation vs. surgery) were observed in 5 (10.9%). Grade 4 changes (an additional procedure needed during surgery) were observed in 3 (6.5%). Grade 5 changes (potentially severe complication avoided, e.g. retrorenal colon in case of PCNL, change in side of surgery, crossing vessel at UPJ in patient candidate for endopyelotomy) were observed in 3 patients (6.5%).

Conclusions: Reviewing CT images rather than relying on a report alone results in a significant (grades 2 to 5) change in treatment plan in randomly selected endourology patients and can potentially avoid complications.


Source Of Funding: None

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