Time is Spine: A Novel Radiology Reporting System for Optimizing Spine Oncology Decision-Making and Reducing Time to Treatment

BACKGROUND AND PURPOSE: Patients with spinal metastases are at risk of instability and cord compression, requiring prompt diagnosis and timely intervention. Effective communication between radiologists and treatment teams is critical to ensure timely treatment. To address this, we developed a novel dictation macro incorporating spine oncology imaging findings and a linked automated notification system to accelerate spine oncology referrals and enhance care delivery.

MATERIALS AND METHODS: A spine MRI dictation macro was developed incorporating MRI-relevant elements of the Spine Imaging Neoplastic Score and an expanded Epidural Spinal Cord Compression scale into a Spine Oncology Imaging Score (SOIS). Finalized reports containing the macro triggered an automated email notification to a multidisciplinary spine oncology treatment team. Neuroradiologists were educated on the macro, but its use was optional. Time between MRIs to follow-up spine oncology clinic visits and subsequent treatment were compared for outpatients with and without the macro in a Cox proportional hazards model.

RESULTS: Between April 2021 and February 2023, 274 outpatients with spinal metastasis had MRI reports with the macro. Among these, 213 (77.7%) had follow-up visits related to the MRI findings and 154 (56.2%) received treatment. During this same period, 152 outpatients had MRI reports did not utilize this macro and 117 (77.0%) had follow-up visits and 58 (38.2%) received treatment. After controlling for SOIS, age, visit department, and treatment type, use of the macro was associated with earlier spine oncology visits (p=0.004) and treatment (p=0.03).

CONCLUSIONS: The implementation of a structured spine oncology macro combined with an automated notification system to a specialized spine oncology team significantly reduced time to consultation and treatment in patients with spinal metastases. This suggests that incorporating structured reporting tools with critical elements like SOIS, coupled with an efficient notification system, can enhance clinical workflow and expedite decision making in oncology care.

ABBREVIATIONS: SINS ＝ Spine Instability Neoplastic Score; ESCC ＝ Epidural Spinal Cord Compression; SOaR² = Spine Surgery, Medical Oncology, and Radiation Oncology/Radiology); SOIS = Spine Oncology Imaging Score; SQL = Structured Query Language; IQR = interquartile range; CMS = Centers for Medicare & Medicaid Services