Clinicians’ interpretation of ventilation/perfusion (V/Q) lung scan reports: Where are we today?
Article Sidebar
Main Article Content
Abstract
Background. Clinicians’ interpretation of lung scan reports will determine which further management decisions are taken when potentially fatal pulmonary embolism (PE) is suspected.
Objectives. To assess current referring clinicians’ interpretation of the terminology used in ventilation/perfusion (V/Q) scan reports, whether this interpretation is affected by experience level, and how it affects clinical management decisions.
Methods. This was a questionnaire-based cross-sectional study. Between September 2020 and May 2021, 300 questionnaires were distributed among clinicians who refer patients for V/Q scans.
Results. Of the 162 clinicians who responded, 94% thought that there is >85% likelihood of PE or definitely PE present when a scan is reported as ‘high probability of PE’; 87% interpreted ‘low probability of PE’ as <10% likelihood of PE or definitely no PE present. Overall,>70% of clinicians across all experience levels correctly interpreted the intended meaning of probability categories according to the Modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II criteria. Of the respondents, 77% agreed that clinically significant PE is ruled out by a normal scan. Further investigation for inconclusive findings, features of parenchymal lung disease and cardiomegaly were selected by 72%, 93% and 98% of clinicians, respectively.
Conclusion. The findings of this study regarding high-probability scan results were in line with existing literature on lung scan report interpretation. However, our findings regarding low-probability scan results and negative V/Q scan specificity contrasted with the findings in these articles, suggesting that clinicians are now more familiar with lung scan interpretation guidelines. Experience level did not significantly affect interpretation of reports. Although most clinicians agreed that a negative scan excludes clinically significant PE, two-thirds of them would still subject the patient to further unnecessary investigations to exclude PE.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Kearon C. Natural history of venous thromboembolism. Circulation 2003;107(23 Suppl 1):122-130. https://doi.org/10.1161/01.CIR0000078464.82671.78
Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B. EANM guidelines for ventilation/perfusion scintigraphy: Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging
;36(8):1356-1370. https://doi.org/10.1007/s00259-009-1170-5
Bajc M, Schümichen C, Grüning T, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019;46(12):2429-2451. https://doi.org/10.1007/s00259-019-04450-0
Jacobson BF, Louw S, Büller H, et al. Venous thromboembolism: Prophylactic and therapeutic practice guideline. S Afr Med J 2013;103(4 Pt 2):261-267. https://doi.org/10.7196/SAMJ.6706
Da Silva R, Shah M, Freeman L. Ventilation-perfusion (V/Q) lung scintigraphy: A long journey to a renewed position of prominence in diagnosing pulmonary embolism. Clin Transl Imaging 2014;2:369-378. https://doi.org/10.1007/s40336-014-0077-8
Gray HW, McKillop JH, Bessent RG. Lung scan reports: Interpretation by clinicians. Nucl Med Commun 1993;14(11):989-994. https://doi.org/10.1097/00006231-199311000-00009
Gray HW, McKillop JH, Bessent RG. Lung scan reporting language: What does it mean? Nucl Med Commun 1993;14(12):1084-1087. https://doi.org/10.1097/00006231-199312000-00006
Nickel B, Barratt A, Copp T, Moynihan R, McCaffery K. Words do matter: A systematic review on how different terminology for the same condition influences management preferences. BMJ Open 2017;7(7):e014129. https://doi.org/10.1136/
bmjopen-2016-014129
Lukaszewicz A, Uricchio J, Gerasymchuk G. The art of the radiology report: Practical and stylistic guidelines for perfecting the conveyance of imaging findings. Can Assoc Radiol J 2016;67(4):318-321. https://doi.org/10.1016/j.carj.2016.03.001
Siegel A, Holtzman SR, Bettmann MA, Black WC. Clinicians’ perceptions of the value of ventilation-perfusion scans. Clin Nucl Med 2004;29(7):419-425. https://doi.org/10.1097/01.rlu.0000129122.44998.17
Metter D, Tulchinsky M, Freeman LM. Current status of ventilation-perfusion scintigraphy for suspected pulmonary embolism. AJR Am J Roentgenol 2017;208(3):489-494. https://doi.org/10.2214/AJR.16.17195
Parker JA, Coleman RE, Grady E, et al. SNM practice guideline for lung scintigraphy 4.0. J Nucl Med Technol 2012;40(1):57-65. https://doi.org/10.2967/jnmt.111.101386
Kember PG, Euinton HA, Morcos SK. Clinicians’ interpretation of the indeterminate ventilation-perfusion scan report. Br J Radiol 1997;70(839):1109-1111. https://doi.org/10.1259/bjr.70.839.9536900
Nulty DD. The adequacy of response rates to online and paper surveys: What can be done? Assess Eval High Educ 2008;33(3):301-314. https://doi.org/10.1080/02602930701293231
Hartung MP, Bickle IC, Gaillard F, Kanne JP. How to create a great radiology report. Radiographics 2020;40(6):1658-1670. https://doi.org/10.1148/rg.2020200020
Royal College of Radiologists. Standards for interpretation and reporting of imaging investigations: Second edition. 2018. https://www.rcr.ac.uk. https://www.rcr.ac.uk/publication/standards-interpretation-and-reporting-imaging-investigations-secondedition
(accessed 31 July 2021).
Farmer CI, Bourne AM, O’Connor D, Jarvik JG, Buchbinder R. Enhancing clinician and patient understanding of radiology reports: A scoping review of international guidelines. Insights Imaging 2020;11:62. https://doi.org/10.1186/s13244-020-00864-9
Panicek DM, Hricak H. How sure are you, doctor? A standardised lexicon to describe the radiologist’s level of certainty. AJR Am J Roentgenol 2016;207(1):2-3. https://doi.org/10.2214/AJR.15.15895