The Composite Severity Score for Lumbar Spine MRI: a Metric of Cumulative Degenerative Disease Predicts Time Spent on...

Conventional measures of radiologist efficiency, such as the relative value unit, fail to account for variations in the complexity and difficulty of a given study. For lumbar spine MRI (LMRI), an ideal performance metric should account for the global severity of lumbar degenerative disease (LSDD) which may influence reporting time (RT), thereby affecting clinical productivity. This study aims to derive a global LSDD metric and estimate its effect on RT. A 10-year archive of LMRI reports comprising 13,388 exams was reviewed. Objective reporting timestamps were used to calculate RT. A natural language processing (NLP) tool was used to extract radiologist-assigned stenosis severity using a 6-point scale (0 = "normal" to 5 = "severe") at each lumbar level. The composite severity score (CSS) was calculated as the sum of each of 18 stenosis grades. The predictive values of CSS, sex, age, radiologist identity, and referring service on RT were examined with multiple regression models. The NLP tool accurately classified LSDD in 94.8% of cases in a validation set. The CSS increased with patient age and differed between men and women. In a univariable model, CSS was a significant predictor of mean RT (R² = 0.38, p < 0.001) and independent predictor of mean RT (p < 0.001) controlling for patient sex, patient age, service location, and interpreting radiologist. The predictive strength of CSS was stronger for the low CSS range (CSS = 0-25, R² = 0.83, p < 0.001) compared to higher CSS values (CSS > 25, R² = 0.15, p = 0.05). Individual radiologist study volume was negatively correlated with mean RT (Pearson's R =  - 0.35, p < 0.001). The composite severity score predicts radiologist reporting efficiency in LMRI, providing a quantitative measure of case complexity which may be useful for workflow planning and performance evaluation.