Critical radiology results in thoracic imaging; categorization by urgency and clinical outcome

Timely communication of critical radiology results (CRRs) is vital for patient safety. However, data on the categorization and active follow-up of CRRs in thoracic imaging remain limited.

The aim of our study was to investigate the prevalence of CRRs in thoracic radiology and to assess the extent to which clinical follow-up was performed.

We retrospectively reviewed 741 CRRs from chest computed tomography (CT) and radiography between August 2018 and March 2021 at a tertiary care hospital. All CRRs were classified using the American College of Radiology three-tier urgency system and communicated through a structured electronic alert system. Active follow-up was defined as documentation of diagnostic or therapeutic response.

Of 741 CRRs, 667 (90.0 %) were from CT and 74 (10.0 %) from radiography. The most common clinical settings were outpatient (43.3 %), followed by inpatients (35.8 %) and emergency department (20.9 %). CRRs were categorized as Category 1 (15.8 %), Category 2 (70.6 %), and Category 3 (7.3 %) based on the urgency. Pulmonary embolism and suspected malignancy were the most frequent actionable findings. Active clinical responses were documented in 733 cases (98.9 %), including all Category 1 CRRs. However, 1.1 % of cases, mostly Category 3 or incidental findings, lacked documented follow-up, particularly in outpatient or cross-specialty scenarios.

A structured alert system for CRRs enabled prompt communication and follow-up adherence. However, non-urgent but actionable findings are still at risk of being lost to follow-up. Enhanced and integrated tracking systems are essential to ensure consistent and comprehensive management of all actionable radiologic findings.