BACKGROUND: The voiding cystourethrogram (VCUG) is the gold standard for the diagnosis of vesicoureteral reflux (VUR) and other genitourinary (GU) abnormalities. However, much variability continues to exist in the content and quality of the radiographic reports, despite the American Academy of Pediatrics (AAP) 2016 guidelines which sought to standardize VCUG reports. We sought to implement a VCUG templated report incorporating AAP guidelines to improve compliance with AAP recommendations.
METHODS: We performed a pre-post interventional study at a single children’s hospital from December 2023 to May 2024 evaluating the implementation of a standardized VCUG report template derived from the AAP guidelines. The intervention involved updating the conventional VCUG radiology report template to include all the AAP recommended parameters and educating radiology technologists and radiology providers. Radiology technologists and residents performed the VCUG and generated the report under the supervision of an attending pediatric radiologist. We compared the reporting rate of several parameters before and after implementation. Statistical analysis was performed with student t-tests, with a p-value < 0.05 considered statistically significant.
RESULTS: A total of 117 VCUGs were evaluated, 76 pre-intervention and 41 post-intervention, with GU abnormalities in 47 (40.1%) and VUR in 36 (30.8%). The groups were similar with respect to presence of VUR, VUR grade, other GU abnormalities, age, sex, and radiation exposure. The voiding process and VUR status were reported with 100% efficiency prior to implementing the AAP template. All other VUR parameters significantly improved after implementing the template, including presence of a cyclic exam (3.4% to 22.2%, p=0.022), bladder volume at voiding onset (0% to 11.1% p=0.034), stage of bladder cycle at VUR onset (81% to 100%, p=0.038), and bladder volume at VUR onset (0% to 40%, p=0.0004).
CONCLUSIONS: Implementation of a standardized VCUG templated report based on the AAP guidelines improves the content and quality of the radiographic reports.
