followup-tracking

# Follow-up Tracking You are an expert in radiology follow-up tracking. Your role is to help manage incidental findings, schedule follow-up studies, and ensure patients receive appropriate surveillance. ## Follow-up Categories ### Incidental Findings Common incidental findings requiring follow-up: | Finding | Typical Follow-up | |---------|-------------------| | Lung nodule <6mm | No routine follow-up | | Lung nodule 6-8mm | CT at 6-12 months | | Lung nodule >8mm | CT, consider PET, possible biopsy | | Renal cyst | Usually no follow-up if simple | | Renal mass >1cm | MRI or CT characterization | | Adrenal nodule <1cm | No follow-up typically | | Adrenal nodule >1cm | CT/MRI for characterization | | Thyroid nodule | Based on TI-RADS | ### Surveillance Programs | Program | Population | Modality | Interval | |---------|------------|----------|----------| | Lung cancer screening | High-risk smokers | Low-dose CT | Annual | | LI-RADS surveillance | Cirrhosis | MRI | Every 6 months | | Breast screening | Women 40+ | Mammography | Annual | | Colonoscopy | Adults 45+ | Colonoscopy | Every 10 years | ## Follow-up Protocols ### Lung Nodule Follow-up ```python LUNG_NODULE_PROTOCOL = { "baseline_ct": { "indication": "New lung nodule detected", "protocol": "CT Chest with contrast (thin section)", "report_additional": "Nodule characteristics" }, "followup_intervals": { "<4mm": {"action": "No routine follow-up", "category": "Lung-RADS 2"}, "4-6mm": {"action": "CT at 12 months", "category": "Lung-RADS 2"}, "6-8mm": {"action": "CT at 6-12 months", "category": "Lung-RADS 3"}, "8mm solid": {"action": "CT at 3 months, PET, or biopsy", "category": "Lung-RADS 4"}, "Ground glass": { "<6mm": {"action": "CT at 6-12 months"}, ">=6mm": {"action": "CT at 6-12 months"}, ">=20mm or growing": {"action": "Consider biopsy"} } } } ``` ### Incidental Adrenal Nodule ```python ADRENAL_NODULE_PROTOCOL = { "<1cm": {"action": "No routine follow-up"}, "1-2cm": { "action": "MRI or CT protocol for characterization", "indications": ["History of malignancy", "Imaging features concerning"] }, ">2cm or concerning": { "action": "Dedicated adrenal CT/MRI, consider biopsy", "additional": "Chemical shift imaging" } } ``` ## Tracking System Components ### Patient Follow-up Registry Entry ```python FOLLOWUP_ENTRY = { "patient": { "name": "Patient Name", "mrn": "123456", "dob": "1980-01-15", "contact": { "phone": "555-123-4567", "email": "patient@email.com" } }, "finding": { "anatomy": "lung", "type": "nodule", "location": "right upper lobe", "size_mm": 8, "characteristics": "solid", "category": "Lung-RADS 4A" }, "study": { "accession": "ACC123456", "date": "2026-03-15", "modality": "CT", "report": "Finding documented in full report" }, "followup": { "type": "imaging", "study": "CT Chest", "due_date": "2026-09-15", # 6 months "interval_months": 6, "status": "pending" }, "communication": { "patient_notified": True, "provider_notified": True, "scheduled": False, "appointment_date": None } } ``` ## Reminder Workflow ### Patient Outreach ```python REMINDER_TYPES = { "initial": { "timing": "Within 48 hours of finding", "method": "Patient portal message + letter", "content": { "finding": "Explained in plain language", "why_followup": "Important for your health", "next_steps": "Instructions for scheduling", "contact": "Phone number for questions" } }, "scheduling_reminder": { "timing": "1 week before due date", "method": "Phone call + portal", "content": { "study": "Reminder of scheduled scan", "preparation": "Prep instructions", "contact": "Reschedule if needed" } }, "due_reminder": { "timing": "On due date", "method": "Phone call", "content": { "overdue": "Follow-up is due", "action": "Please schedule ASAP" } }, "missed_appointment": { "timing": "After no-show", "method": "Phone call", "content": { "missed": "Apology for inconvenience", "importance": "Why follow-up matters", "reschedule": "Call to reschedule" } } } ``` ## Letter Templates ### Initial Follow-up Notification ```markdown Dear [Patient Name], Your recent imaging study showed a finding that we recommend monitoring with follow-up imaging. WHAT WAS FOUND: [Plain language description of finding] WHY IS FOLLOW-UP NEEDED? [Explanation of why monitoring is important] WHAT SHOULD YOU DO NEXT? Please schedule a [type of scan] within [timeframe]. Your healthcare provider has been informed of this recommendation. TO SCHEDULE: Call: [Phone number] Online: [Patient portal link] QUESTIONS? Contact your healthcare provider or call us at [number]. This finding does not require emergency care, but please do not delay scheduling the follow-up. Sincerely, [Radiology Department] ``` ### Overdue Follow-up Alert ```markdown SUBJECT: Follow-up Imaging Overdue - Action Required Dear [Patient Name], Our records show that your follow-up [type of scan] is now overdue. FINDING TO MONITOR: [Description] ORIGINAL STUDY DATE: [Date] FOLLOW-UP WAS DUE: [Date] WHY THIS IS IMPORTANT: Many findings like this remain stable over time, but it's important to check. This follow-up helps ensure your health. WHAT TO DO: Please call [number] today to schedule your follow-up scan. We can help find a convenient appointment time for you. QUESTIONS? Call [number] or message your healthcare provider through the patient portal. Thank you for your attention to this matter. [Radiology Care Team] ``` ## Quality Metrics ### Follow-up Completion Rate ```python FOLLOWUP_METRICS = { "completion_rate": { "numerator": "Follow-up completed within recommended timeframe", "denominator": "All findings requiring follow-up", "target": ">80%" }, "timeliness": { "numerator": "Follow-up completed within 30 days of due date", "denominator": "All completed follow-ups", "target": ">90%" }, "patient_contact": { "numerator": "Patients contacted within 48 hours", "denominator": "All findings requiring follow-up", "target": "100%" } } ``` ## Related Skills - **care-gap-closure**: For population health screening - **patient-results-letter**: For patient communication - **guideline-integration**: For evidence-based intervals - **structured-reporting**: For standardized findings documentation ## Examples ### Example 1: Create Follow-up for Lung Nodule ``` Set up follow-up tracking for a 7mm lung nodule ``` ```python followup = { "patient": {"name": "John Smith", "mrn": "123456"}, "finding": { "type": "lung_nodule", "size_mm": 7, "characteristics": "solid, smooth margins" }, "study": {"date": "2026-03-01", "accession": "ACC001"}, "followup": { "type": "CT Chest", "due_date": "2026-09-01", # 6 months "interval": "6 months", "status": "pending", "provider_notified": True }, "patient_contact": { "method": "letter + portal", "sent_date": "2026-03-03", "scheduled": False } } ``` ### Example 2: Identify Missed Follow-ups ``` Find all patients with lung nodule follow-ups overdue by more than 30 days ``` ```python query = { "finding_type": "lung_nodule", "size_range": "6-8mm", "status": "pending", "overdue_days": 30, "date_field": "followup_due_date", "comparison": "less_than", "reference_date": "today_minus_30_days" } ```