OBJECTIVE: The American College of Radiology (ACR) Actionable Reporting Work Group defined three categories of imaging findings that require additional, nonroutine communication with the referring physician because of their urgency or unexpectedness. The objective of this study was to determine the prevalence of actionable findings in radiology reports, and to assess how well radiologists agree on the categorisation of actionable findings.
METHODS: From 124,909 consecutive radiology reports stored in the electronic health record system of a large university hospital, 1000 reports were randomly selected. Two radiologists independently annotated all actionable findings according to the three categories of urgency defined by the ACR Work Group. Annotation differences were resolved in a consensus meeting and a final category was established for each report. Interannotator agreement was measured by accuracy and the kappa coefficient.
RESULTS: The prevalence of the three categories of actionable findings together was 32.5 %. Of all reports, 10.9 % were from patients seen in the emergency department. Prevalence of actionable findings for these patients (45.9 %) was considerably higher than for patients in routine clinical care (30.9 %). Interannotator agreement scores on the categorisation of actionable findings were 0.812 for accuracy and 0.616 for kappa coefficient.
CONCLUSIONS: The prevalence of actionable findings in radiology reports is high. The interannotator agreement scores are moderate, indicating that categorisation of actionable findings is a difficult task. To avoid unneeded increase in the workload of radiologists, in particular in routine practice, clinical context may need to be considered in deciding whether a finding is actionable.

In order to document perceptions of text comments appearing in surgical pathology reports, questionnaires were distributed to 4 groups of caregivers: university staff pathologists, resident pathologists, faculty clinicians (other than pathologists), and resident clinicians at a teaching hospital. Results of this pilot study showed a wide degree of variability existed within each group of surgical pathology report users, with respect to percent confidence assigned to various phrases, commonly used to express diagnostic uncertainty, appearing often as free-text comments in surgical pathology reports. The unavailability of immunohistochemistry tests, or ambiguous immunohistochemistry test results, was especially problematic. With respect to modes of communication between the surgical pathology laboratory and its service users, clinicians indicated they preferred to use tumor boards/interdisciplinary conferences, face-to-face meetings, and phone calls to clarify their interpretations of a pathologist\'s diagnoses, as compared with simply reading free-text comments. On the other hand, surgical pathologists rely heavily on their use of the comment portion of a surgical pathology report to clarify, modify, or expand on the diagnoses they render. The majority of clinicians stated that they \"always\" read the free-text comment portion of a surgical pathology report, whereas some acknowledged they do not always read it. Pathology residents had significantly less confidence in the ability of a free-text comment on a surgical pathology report to clarify a diagnosis (χ2 = 46.36, P < .0001). Pathology departments should consider standardizing definitions and weighting the words and phrases they use in their free-text comment sections of surgical pathology reports.