Background

Imaging and histopathology plays a tremendous role in identifying incidental and non-incidental malignancies. The Royal College of Radiologists state that there should be fail-safe alert procedures for significant unexpected findings. Sandwell and West Birmingham NHS Trusts (SWBH) have integrated a Rhapsody platform into their Trust in order to overcome such issues.

The Rhapsody system sends email alerts to relevant clinicians regarding radiology and pathology results.

Method

Retrospective data collection for all patients referred between January to March 2019 was looked at. Electronic databases were accessed to determine: who patients were referred by, imaging modality, and other relevant parameters. 

Results

38 patients were flagged during the 3-month data collection period; 55% due to suspicious radiographs and CT scans, indicative of potential lymphoma. 45% of rhapsody referrals were suspicious pathology reports. 92% of patients flagged through this pathway transpired to have a malignancy, of which 97% was a form of haematological malignancy. 

Nine patients were alerted up to more than 1 week after their imaging or pathological assessment was done - indicating a delay to department notification,

All results were compared to the Trust’s recommended standard and the cancer care pathway recommendations.

Conclusion

The Rhapsody alert system is efficient for alerting the haemato-oncology department in a timely manner for suspicious imaging however, there appears to be room for improvemnt. Limitations include: retrospective study and interobserver bias. Recommendations include: assess the effectiveness of the rhapsody alert system on a larger cohort, compare the results to outcomes prior to the implementation of the rhapsody alert system and ensure patients are appropriately flagged within a timely manner through educating the pathology and radiology departments.

Impact statement

The Rhapsody alert system is an efficient modality for alerting the haemato-oncology department in a timely manner of imaging and histological reports suspicious of malignancy.