Abdominal Aortic Aneurysm: Standardized Surveillance Imaging Recommendations to Reduce Rate of Rupture

From the 2018 HVPAA National Conference

Sameer Ahmed (Northwestern University Dept of Radiology), Upma Rawal (Radiology Partners), Jason Mitsky (Radiology Partners), Sheila Sheth (NYU Langone Health), Jay Bronner (RadPartners)


Abdominal aortic aneurysms (AAA) require careful surveillance to guide management, and patients with inadequate radiological surveillance of their AAA have increased rates of rupture and death, as well as decreased rates of elective repair.


The purpose of this study was to explore if a performance improvement initiative implemented across a large radiology practice successfully increased inclusion of best practice recommendations within the radiology report across the practice.


After best practice recommendation (BPR) for AAA surveillance was developed, a structured reporting macro for follow up recommendation was integrated into dictation software. Following a training period, inclusion of recommendations within the radiology report was monitored across 345 facilities within the practice. Performance was reported on a scorecard and distributed practice-wide each month. To measure practice improvement, inclusion of appropriate recommendation in radiology report post implementation was compared with pre implementation data.


During the period prior to BPR for AAA implementation, from 64,090 consecutive cross-sectional radiology reports reviewed during a 6 months period, 855 incidental AAA (1.3%) were identified, with 783 aneurysms measuring 2.6-5.4 cm requiring imaging surveillance; only 17 (2.1%) included follow-up recommendations within the radiology report. Post implementation, 2641/148,807 cross sectional imaging studies were positive for AAA requiring further intervention; 1533 (58.0%) of these radiology reports included follow-up imaging recommendations (97.0% of which followed our AAA BPR).

Based on published rates of aneurysm rupture, a predictive model was created to estimate the potential number of ruptures averted and lives saved, estimating that 106.7 ruptures can be potentially averted with appropriate adherence to surveillance recommendations and timely intervention. Assuming a mortality rate of 90% following spontaneous rupture, a total of 96 lives may be saved over the course of 16.5 months (combination of pre- and post-intervention periods).


Quality improvement initiatives to develop BPR for AAA surveillance and include these recommendations within the radiology report can be successfully implemented across large practices and are imperative to ensure imaging surveillance and avert AAA rupture.

Implications for the Patient

Quality improvement initiatives to promote the inclusion of AAA management recommendations within the radiology report are imperative to ensure imaging surveillance and avert AAA rupture. National implementation of this performance improvement initiative will result in measurable decreases in AAA rupture, thereby decreasing mortality rates and costs.

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