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Development and Implementation of a Synoptic MRI Report for Preoperative Staging of Rectal Cancer on a Population-Based Level

Kennedy, Erin D. M.D., Ph.D.1–4; Milot, Laurent M.D.3,5; Fruitman, Mark M.D.3,6; Al-Sukhni, Eisar M.D.1–4; Heine, Gabrielle B.Kin.2; Schmocker, Selina B.Sc.1,2; Brown, Gina M.D.7; McLeod, Robin S. M.D.1–4,8

Diseases of the Colon & Rectum: June 2014 - Volume 57 - Issue 6 - p 700–708
doi: 10.1097/DCR.0000000000000123
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: Colorectal cancer physician champions across the province of Ontario, Canada, reported significant concern about appropriate selection of patients for preoperative chemoradiotherapy because of perceived variation in the completeness and consistency of MRI reports.

OBJECTIVE: The purpose of this work was to develop, pilot test, and implement a synoptic MRI report for preoperative staging of rectal cancer.

DESIGN: This was an integrated knowledge translation project.

SETTINGS: This study was conducted in Ontario, Canada.

PATIENTS: Surgeons, radiologists, radiation oncologists, medical oncologists, and pathologists treating patients with rectal cancer were included in this study.

INTERVENTIONS: A multifaceted knowledge translation strategy was used to develop, pilot test, and implement a synoptic MRI report. This strategy included physician champions, audit and feedback, assessment of barriers, and tailoring to the local context. A radiology webinar was conducted to pilot test the synoptic MRI report.

MAIN OUTCOME MEASURES: Seventy-three (66%) of 111 Ontario radiologists participated in the radiology webinar and evaluated the synoptic MRI report.

RESULTS: A total of 78% and 90% radiologists expressed that the synoptic MRI report was easy to use and included all of the appropriate items; 82% noted that the synoptic MRI report improved the overall quality of their information, and 83% indicated they would consider using this report in their clinical practice. An MRI report audit after implementation of the synoptic MRI report showed a 39% improvement in the completeness of MRI reports and a 37% uptake of the synoptic MRI report format across the province.

LIMITATIONS: Radiologists evaluating the synoptic MRI report and participating in the radiology webinar may not be representative of gastroenterologic radiologists in other geographic jurisdictions. The evaluation of completeness and uptake of the synoptic MRI reports is limited because of unmeasured differences that may occur before and after the MRI.

CONCLUSIONS: A synoptic MRI report for preoperative staging of rectal cancer was successfully developed and pilot tested in the province of Ontario, Canada.

1Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada

2Zane Cohen Centre for Digestive Diseases, Toronto, Ontario, Canada

3Department of Medicine, University of Toronto, Toronto, Ontario, Canada

4Institute of the Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

5Department of Medical Imaging, Sunnybrook Health Science Centre, Toronto, Ontario, Canada

6Department of Medical Imaging, Saint Joseph’s Health Centre, Toronto, Ontario, Canada

7Department of Medical Imaging, The Royal Marsden Hospital, London, United Kingdom

8Samuel Lunenfeld Research Institute, Toronto, Ontario, Canada

Funding/Support: This study was supported by the Cancer Services Innovation Partnership, a joint initiative of Cancer Care Ontario and the Canadian Cancer Society.

Financial Disclosure: None reported.

Correspondence: Erin Kennedy, M.D., Ph.D., Mount Sinai Hospital, Room 455, 600 University Ave, Toronto, Ontario, Canada M5G 1X5. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons