The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 5.5 UCLA’s integrated radiology-pathology project


5.5.1 Background

The UCLA model expands the KUMC model to incorporate a broader range of cancer types and diagnostic modalities. The UCLA Radiology-Pathology project, which is currently under development, is a joint venture by the UCLA departments of Radiology and Pathology to develop a single integrated report that encompasses both diagnostic modalities for evaluation of a mass lesion. This format will combine diagnostic imaging reports with image-guided biopsy reports and detailed pathology reports that will contain pertinent clinical staging information for patients with newly diagnosed tumors in solid organs.

To accommodate the goals of the report, including inclusion of additional diagnostic modalities such as molecular testing for prognosis and response prediction, the report will be electronic and web-based. This electronic report will allow the end-user to access the different and specific aspects of the diagnostic studies in one place without the need to wade through nonessential information. The report will also have a print report tab that will allow the entire report to be printed as a paper document for inclusion in the hard copy medical record.

5.5.2 Workflow of the integrated UCLA model

The report will be initialized by the interventional radiologist performing the biopsy. The radiologist will be responsible for linking the most appropriate diagnostic radiological study and radiological procedure with the pathology specimen. This will ensure that the end-user will have access to the most relevant radiological studies when reviewing the pathology findings. The radiologist will flag and annotate pertinent images from the diagnostic radiology study for the Rad-Path report, and he or she will sign-out the radiology study which will also exist as a distinct radiology report in the hospital medical record.

To assist the radiologist and ensure adequate sampling, a cytotechnologist will be available in the radiology suite to perform adequacy checks on the specimen, partition the specimen as needed into appropriate specimen containers, and accession the specimen into the pathology laboratory information system. The pathology specimen accession number and the Rad-Path report number will be included within the body of the radiology procedure report.

The specimen will be processed in the pathology laboratory according to normal routine. The pathologist will sign-out the specimen as per usual and the normal pathology report will be included in the hospital medical record.  The pathology report will also include the Rad-Path accession number within the body of the report.

The Rad-Path report will be a separate report within the patient’s medical record that integrates information from the radiology and pathology reports and exists as an electronic document. To create the report, a program has been developed that processes HL7 data that is streamed from the pathology LIS system and radiology RIS system. To allow for automatic extraction, the radiology and pathology reports are specifically structured to facilitate retrieval of specific data from the reports to be inserted in the appropriate place in the Rad-Path report.

The pathologist and radiologist will communicate directly in person or by telephone to ensure appropriate coordination between the different diagnostic modalities for a unified report with correlated diagnostic results. This will alert the pathologist to potential discordance between the radiology findings and the pathology report before the final pathology report is issued. In doing so, the pathologist will be able to address the discordance in the pathology report, prevent diagnostic errors, or recommend further diagnostic testing before a final diagnosis is given to the patient.

5.5.3 Report format

Utilizing an electronic web-based report will enable many sections of the report to be collapsible into tabs to shrink the size of the report and reduce clutter (e.g. gross description, microscopic description, biopsy technique). Some ancillary studies, such as molecular diagnostic tests, may take several days to finalize. At that time, the results will be put into the front of the report and accessible by clickable tabs. All studies that are in progress will be highlighted pending. This process will enable the treating clinician to know exactly what tests have been ordered and the status of the tests. This will reduce unnecessary searches to see if tests have been ordered and save time. To notify the treating clinicians that Rad-Path report, shown in Appendix B, is finalized an email will be automatically sent to the ordering clinician with a link to the secured website for user login to view the results.

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