Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit.

OBJECTIVES: To evaluate organisational reporting infrastructure and patient-related reporting data in the diagnosis of vertebral fragility fractures (VFFs) as demonstrated on computed tomography (CT). METHODS: Organisational and patient-specific questionnaires were developed by consensus between The Royal College of Radiologists, the Royal College of Physicians, and the Royal Osteoporosis Society. The patient-specific component of the audit involved analysis of CT reporting data acquired from 50 consecutive non-traumatic studies including the thoracolumbar spine. Ethical approval for this type of study is not required in the UK. All UK radiology departments with an audit lead (auditor) registered with The Royal College of Radiologists (RCR) were invited to participate in this retrospective audit. RESULTS: In total, 127 out of 202 departments (63%) supplied data to the study, with inclusion of 6357 patients. Overall, 1362/6357 patients (21.4%) had a fracture present on auditor review of the CT imaging. There was a lack of compliance with all audit standards: 79% of reports commented on the vertebrae (target 100%), fracture severity was mentioned in 26.2% (target 100%), the recommended terminology 'vertebral fracture' was used in 60.1% (target 100%), and appropriate onward referral was recommended in 2.6% (target 100%). CONCLUSIONS: The findings from this study should be used to provide impetus to improve the diagnosis and care for patients with osteoporotic VFFs. Solutions are multifactorial, but radiologist and local osteoporosis/fracture liaison service engagement is fundamental, combined with necessary development of electronic report notification systems and expansion of supporting fracture services. KEY POINTS: • Early detection and diagnosis of vertebral fragility fractures (VFFs) significantly reduce patient morbidity and mortality. This study describes the results of a retrospective UK-wide audit evaluating current radiology reporting practice in the opportunistic diagnosis of VFFs as demonstrated on computed tomography (CT) studies including the spine. • Key audit standards included comment made on bone integrity in primary report (target 100%), comment made on severity of fractures (90%), report used recommended terminology 'fracture' (100%), and report made appropriate recommendations for referral/further assessment (100%). The audit results demonstrated a lack of compliance with all audit standards; lack of compliance was most marked in the use of recommended terminology (achieved 60.3%), in relation to comment on fracture severity (achieved 26.2%) and for recommendation for referral/further assessment (achieved 2.6%). • Solutions are challenging and multifactorial but the opportunity exists for all radiologists to examine their practice and directly improve patient care.

Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part II. Minor and major complications and procedure-related mortality.

PURPOSE: To determine the frequency of complications and death following image-guided and/or image-assisted liver biopsy and to identify significant variables associated with an increased risk of complications or death. MATERIALS AND METHODS: Institutional review board approval for this type of study is not required in the United Kingdom. United Kingdom radiology departments with a department leader for audit registered with the Royal College of Radiologists were invited to participate. The first 50 consecutive patients who underwent liver biopsy in 2008 were included. Audit standards were developed for minor pain (<30%), severe pain (<3%), vasovagal hypotension (<3%), significant hemorrhage (<0.5%), hemobilia (<0.1%), puncture of another organ (<0.1%), and death (<0.1%). Organizational, clinical, and coagulation variables were investigated statistically for their association with complications and/or death. RESULTS: Data were obtained from 87 of 210 departments (41%). Audit standards were met for pain, hypotension, hemorrhage, hemobilia, and puncture of another organ. There were four hemorrhage-related deaths, and this target was narrowly missed (rate achieved in practice, 0.11% [four of 3486 patients]). Fifteen additional patients experienced at least one major complication. The international normalized ratio (INR) was absent in 3% of cases (97 of 2951 patients), the platelet count was absent in 1% (32 of 2986 patients), the INR was more than 1 week old in 8% (229 of 2888 patients), and the platelet count was more than 1 week old in 10% (291 of 2955 patients). CONCLUSION: Results of this audit confirm that image-guided and image-assisted biopsy is performed safely in United Kingdom radiology departments, with complication rates within expected parameters. Preprocedural clotting assessment was inadequate in some cases and would merit repeat audit. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120224/-/DC1.

Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part I. Procedural aspects, diagnostic adequacy, and accuracy.

PURPOSE: To assess procedural aspects, diagnostic adequacy, and accuracy of liver biopsy across the United Kingdom. MATERIALS AND METHODS: Institutional review board approval for this type of study is not required in the United Kingdom. All radiology departments with an approved leader for departmental audit registered with the Royal College of Radiologists were invited to participate in this retrospective audit. The first 50 consecutive patients who underwent image-guided or image-assisted liver biopsy in 2008 were included. Audit standards relating to procedural aspects of biopsy, sample adequacy, and accuracy were prepared with reference to published data. Sensitivity, specificity, positive and negative likelihood ratios, and accuracy were calculated. Organizational and clinical variables were investigated for their association with diagnostic specimen quality. RESULTS: Eighty-seven (41%) of 210 departments supplied data for this study, with a total of 3496 cases (1225 focal disease, 2262 nonfocal disease, nine unspecified). Ultrasonographic (US) guidance was the technique most commonly used for focal lesions and for cases of nonfocal disease (2808 [96.38%] of 3490 cases). The audit standard for sample adequacy (98%) was narrowly missed in practice (3401 [97.96%] of 3472 cases); however, the standard for diagnostic accuracy (90%) was met (3187 [98.55%] of 3234 cases). Poor compliance with postbiopsy documentation was observed. CONCLUSION: The majority of liver biopsies in this audit were performed by radiologists using image guidance or assistance, usually in the form of US. Biopsies were performed with a high degree of accuracy. Some postprocedural aspects of biopsy failed to meet required standards and would merit reaudit after practice changes. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111562/-/DC1.