Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy (NQF 0511)

eMeasure Name Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy eMeasure Id 044C9BC2-F92C-42DF-82BD-4EB7FF537941
Version number 1 eMeasure Set Id FA160B6C-F23C-4AF3-8FB8-3B0F11FB6216
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of final reports for all patients, regardless of age, undergoing bone scintigraphy that include physician documentation of correlation with existing relevant imaging studies (eg, x-ray, MRI, CT) that were performed
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Radionuclide bone imaging plays an integral part in tumor staging and management; the majority of bone scans are performed in patients with a diagnosis of malignancy, especially carcinoma of the breast, prostate gland, and lung. This modality is extremely sensitive for detecting skeletal abnormalities, and numerous studies have confirmed that it is considerably more sensitive than conventional radiography for this purpose (American Society of Clinical Oncology, 2004). However, the specificity of bone scan abnormalities can be low since many other conditions may mimic tumor; therefore it is important that radionuclide bone scans are correlated with available, relevant imaging studies. Existing imaging studies that are available can help inform the diagnosis and treatment for the patient. Furthermore, correlation with existing radiographs is considered essential to insure that benign conditions are not interpreted as tumor. While there are no formal studies on variations in care in how often correlation with existing studies is not performed, there is significant anecdotal information from physicians practicing in the field that there is a gap in care and that correlation is not occurring frequently when images are available. Literature suggests that as many as 30% of Radiology reports contain errors, regardless of the imaging modality, Radiologist's experience, or time spent in interpretation (Reiner et al, 2007) . Evidence has also suggested that Radiology reports are largely non-standardized and commonly incomplete, vague, untimely, and error-prone and may not serve the needs of referring physicians (Johnson et al, 2004). Therefore, it is imperative that existing imaging reports be correlated with the Nuclear Medicine bone scintigraphy procedure to ensure proper diagnosis and appropriate patient treatment.
Clinical Recommendation Statement
Bone scintigraphic abnormalities should be correlated with appropriate physical examination and imaging studies to ascertain that osseous or soft-tissue abnormalities, which might cause cord or other nerve compression or pathologic fracture in an extremity, are not present. (SNM, 2003).

Relevant radiographs and/or MR imaging of painful sites to exclude cord compression or severe lytic lesions which carry an increased risk of pathologic fracture, should be examined by the physician (SNM, 2003).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Journal of Clinical Oncology. 22:2942-2953. 2004, American Society of Clinical Oncology.
Reference
Reiner B, Knight N, Siegel E. Radiology Reporting, Past, Present, and Future: The Radiologist's Perspective. J Am Coll Radiol 2007;4:313-319.
Reference
Johnson AJ, Ying J, Swan JS, Williams LS, Applegate KE, Littenberg B. Improving the quality of radiology reporting: a physician survey to define the target. J Am Coll Radiol 2004;1:497-505.
Reference
Donohoe KJ, Brown ML, Collier BD, Carretta RF, Henkin RE, Royal HD, O'Mara RE. Procedure guideline for bone scintigraphy, 3.0. Reston (VA): Society of Nuclear Medicine; 2003.
Definition
Relevant imaging studies are defined as studies that correspond to the same anatomical region in question.
Definition
Initial Patient Population(s): Patient Age: All patients regardless of age.
Diagnostic Study: Bone scintigraphy performed during the measurement period.
Definition
Denominator(s): All final reports for patients, regardless of age, undergoing bone scintigraphy.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Final reports that include physician documentation of correlation with existing relevant* imaging studies (e.g., x-ray, MRI, CT, etc.).
Definition
Denominator Exception(s): System reason(s) for not documenting correlation with existing relevant imaging studies in final report (e.g., no existing relevant imaging study available*, patient did not have a previous relevant imaging study)
*Correlative studies are considered to be unavailable if relevant studies (reports and/or actual examination material) from other imaging modalities exist but could not be obtained after reasonable efforts to retrieve the studies are made by the interpreting physician prior to the finalization of the bone scintigraphy report.
Guidance
Eligible cases for this measure included every final report for bone scintigraphy studies performed during the measurement period.  Each final report for bone scintigraphy counts separately in the denominator.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012