Which of the following is a solution to address incorrect or inadequate clinical history provided in imaging requests?

1. A hard stop in the ordering process requiring providers to enter a clinical question
2. IT mechanisms that link PACS and EMR to obtain pertinent history from medical records*
3. Financial rewards for ordering providers to enter more clinical information in imaging requests
4. Implementation of clinical decision support to ensure accurate clinical histories in imaging orders

• IT mechanisms that link PACS and EMR to obtain pertinent history from medical records is one approach to address incorrect or inadequate clinical history provided in imaging requests.
• A hard stop in the ordering process requiring providers to enter a clinical question and financial rewards for ordering providers have not been shown to improve incorrect or inadequate histories provided in imaging requests.
• Clinical decision support primarily involves ensuring that an appropriate indication or ICD code as associated with the imaging exam that is ordered. This does not necessarily address incorrect or inadequate clinical histories provided in imaging requests.

Which of the following is a common error that occurs as a result of using pre-populated report templates?

1. Contradictory statements within the final report*
2. Typographical errors
3. Missense errors such as omitted words
4. Voice recognition errors

What should a radiologist do when he identifies a missed sternal fracture on a chest CT interpreted by a resident overnight, and the patient has already been discharged?

1. Document the discrepancy in the final report
2. Call the ER but don’t document the discrepancy in the final report to protect the resident
3. Call the ER and document communication of the sternal fracture in the final report*
4. Send the case to the residency program director

• The radiologist should call the ER and document communication of the sternal fracture in the final report. This satisfies the ACR practice parameter on communication of significant changes between preliminary and final reports.
• Documenting the discrepancy in the final report and sending the case to the residency program director do not satisfy the ACR practice parameter on communication of significant changes between preliminary and final reports.
• There are instances in which documenting the discrepancy in the final report is an acceptable practice.

For which of the following scenarios does the ACR practice parameter for communication suggest that non-routine communication may be warranted?

1. Incidental 3.4 cm pancreatic cystic lesion*
2. Gallstones in a decompressed gallbladder
3. Healed rib fractures
4. Adrenal nodule measuring less than 10 Houndsfield units on unenhanced CT

• The ACR’s practice parameter on communication notes that non-routine communication may be warranted for findings that the interpreting physician reasonably believes may be seriously adverse to the patient’s health and may not require immediate attention but, if not acted on, may worsen over time and possibly result in an adverse patient outcome. This includes possible premalignant lesions such as incidentally detected cystic pancreatic lesions.
• Gallstones in a decompressed bladder and healed rib fractures are not findings that may warrant non-routine communication.
• An adrenal nodule measuring less than 10 Houndsfield units on unenhanced CT indicates a lipid rich adenoma and is not a finding that may warrant non-routine communication.

In the setting of trauma, what relevant information in the EMR can significantly impact diagnostic errors?

1. Lab values (e.g. white count and liver function tests)
2. Tumor markers
3. Prior surgeries
4. Localizing signs and symptom*

• Localizing signs and symptoms can help direct a radiologist’s attention to subtle findings on imaging performed in the setting of trauma.
• The remaining options are more appropriate for other clinical scenarios.