Elin Trägårdh, Peter Höglund, Mattias Ohlsson, Mattias Wieloch, and Lars Edenbrandt
Referring physicians underestimate the extent of abnormalities based on the final report in myocardial perfusion imaging
LU TP 12-20

Background It is of great importance that the treating clinician understands the report of a diagnostic examination. The aim of the study was to investigate whether referring physicians interprets the final report of a myocardial perfusion scintigraphy (MPS) the same way as the physician in nuclear medicine intended.

Methods Physicians in nuclear medicine and referring physicians (physicians in cardiology, internal medicine, and general practitioners) independently classified 60 examinations on the presence/absence of ischemia/infarction, based on the written final report, in grades of 1-5 (1 = No ischemia/infarction, 2 = Probably no ischemia/infarction 3 = Equivocal, 4 = Probable ischemia/infarction, and 5 = Certain ischemia/infarction). When ischemia and/or infarction were thought to be present in the left ventricle, the physicians were asked to mark the involved segments based on the 17-segment model.

Results Generally, there was a good agreement between the physicians in nuclear medicine and the referring physicians with a median squared kappa coefficient of 0.92 for both the assessment of ischemia and infarction. For the evaluation of the 17-segment model, 12 referring physicians underestimated the extent of the ischemic area. For 11 physicians, there were no statistically significant differences. For infarction, 6 referring physicians underestimated the extent of the infarcted area, 1 overestimated the area and for 16 physicians, there were no statistically significant differences.

Conclusions Generally, the main message about the presence or absence of ischemia or infarction was well understood by the referring physicians. However, the extent of the ischemic/infarcted area was often underestimated, which could lead to suboptimal treatment of the patient with a less frequent use of percutanous coronary intervention.

LU TP 12-20