Academic radiology and the emergency department: does it need changing?

RATIONAL AND OBJECTIVES: The increasing importance of imaging for both diagnosis and management in patient care has resulted in a demand for radiology services 7 days a week, 24 hours a day, especially in the emergency department (ED). We hypothesized the resident preliminary reports were better than generalist radiology interpretations, although inferior to subspecialty interpretations. MATERIALS AND METHODS: Total radiology volume through our Level I pediatric and adult academic trauma ED was obtained from the radiology information system. We conducted a literature search for error and discordant rates between radiologists of varying experience. For a 2-week prospective period, all preliminary reports generated by the residents and final interpretations were collected. Significant changes in the report were tabulated. RESULTS: The ED requested 72,886 imaging studies in 2004 (16% of the total radiology department volume). In a 2-week period, 12 of 1929 (0.6%) preliminary reports by residents were discordant to the final subspecialty dictation. In the 15 peer-reviewed publications documenting error rates in radiology, the error rate between American Board of Radiology (ABR)-certified radiologists is greater than that between residents and subspecialists in the literature and in our study. However, the perceived error rate by clinicians outside radiology is significantly higher. CONCLUSION: Sixteen percent of the volume of imaging studies comes through the ED. The residents handle off-hours cases with a radiology-detected error rate below the error rate between ABR-certified radiologists. To decrease the perceived clinician-identified error rate, we need to change how academic radiology handles ED cases.     

Preliminary Reports in the Emergency Department: Is a Subspecialist Radiologist More Accurate Than a Radiology Resident?

RATIONALE AND OBJECTIVES: To determine whether emergency department (ED) preliminary reports rendered by subspecialist attending radiologists who are reading outside their field of expertise are more accurate than reports rendered by radiology residents, and to compare error rates between radiologists and nonradiologists in the ED setting. MATERIALS AND METHODS: The study was performed at a large academic medical center with a busy ED. An electronic preliminary report generator was used in the ED to capture preliminary interpretations rendered in a clinical setting by radiology residents, junior attendings (within 2 years of taking their oral boards), senior attendings, and ED clinicians between August 1999 and November 2004. Each preliminary report was later reviewed by a final interpreting radiologist, and the preliminary interpretation was adjudicated for the presence of substantial discordances, defined as a difference in interpretation that might immediately impact the care of the patient. Of the 612,890 preliminary reports in the database, 65,780 (11%) met inclusion criteria for this study. A log-linear analysis was used to assess the effects of modality and type of author on preliminary report error rates. RESULTS: ED clinicians had significantly higher error rates when compared with any type of radiologist, regardless of modality. Within the radiologists, residents and junior attendings had lower error rates than did senior attendings, but the differences were not statistically significant. CONCLUSION: Subspecialized attending radiologists who interpret ED examinations outside their area of expertise have error rates similar to those of radiology residents. Nonradiologists have significantly higher error rates than radiologists and radiology residents when interpreting examinations in the ED.     

Clinical consequences of misinterpretations of neuroradiologic CT scans by on-call radiology residents

BACKGROUND AND PURPOSE: Studies have looked at the accuracy of radiologic interpretations by radiology residents as compared with staff radiologists with regard to emergency room plain films, emergency room body CT scans, and trauma head CT scans; however, to our knowledge, no study has evaluated on-call resident interpretations of all types of neuroradiologic CT scans. Both as a part of our departmental quality control program and to address concerns of clinical services about misinterpretation of neuroradiologic CT scans by on-call radiology residents, we evaluated the frequency of incorrect preliminary interpretations of neuroradiologic CT scans by on-call radiology residents and the effect of such misinterpretations on clinical management and patient outcome. METHODS: As determined by the staff neuroradiologist the next day, all potentially clinically significant changes to preliminary reports of emergency neuroradiologic CT scans rendered by on-call radiology residents were recorded over a 9-month period. A panel of neuroradiologists reviewed and graded all the changed cases by consensus. An emergency department staff physician reviewed medical records of all submitted cases to determine clinical consequences of the misinterpretations. RESULTS: Significant misinterpretations were made in 21 (0.9%) of 2388 cases during the study period. There was a significant change in patient management in 12 of the cases, with a potentially serious change in patient outcome in two cases (0.08%). CONCLUSION: On-call radiology residents have a low rate of significant misinterpretations of neuroradiologic CT scans, and the potential to affect patient outcome is rare.     

Redefining radiology education for first-year medical students: shifting from a passive to an active case-based approach

RATIONALE AND OBJECTIVES: The aim of the study is to design and implement an elective course in which first-year medical students learn about radiology by actively integrating imaging with hospital records and radiology reports, rather than passively observing radiologists or images. MATERIALS AND METHODS: Twenty students enrolled in an elective entitled "Introduction to Clinical Radiology." Students were divided into groups of two or three and given a case file describing the hospital visit of a patient with a common computed tomographic (CT) diagnosis. Files contained a PowerPoint presentation with all images from the patient's CT examination (allowing students to scroll through the images as if viewed on a picture archive and communication system workstation), as well as emergency department records, admission and discharge summaries, surgical notes, pathology reports, and radiology reports. Group discussion was facilitated by radiology staff acting as consultants, rather than instructors. As a final project, each group presented its case to the students and faculty. RESULTS: Compared with before the course, students' understanding of the role of radiologists in the clinical management of patients significantly increased, but interest in radiology as a specialty was unchanged. Students significantly preferred scrolling through images on their own, rather than being shown static images in a didactic format. Students significantly agreed that they would recommend the course to a classmate. CONCLUSION: Case-based instruction in radiology, in which first-year medical students are actively engaged in the integration of clinical and imaging information, can affect students' views on the role of radiologists and their clinical management of patients.     

Evaluation of emergency CT scans of the head: is there a community standard?

OBJECTIVE: This study was designed to assess the accuracy of general radiologists in the interpretation via teleradiology of emergency CT scans of the head. MATERIALS AND METHODS: We studied the interpretations of 716 consecutive emergency CT scans of the head by a group of 15 board-certified general radiologists practicing in the community (as opposed to an academic setting). The scans were sent via teleradiology, and the preliminary interpretations were made. Three of the general radiologists were functioning as nighthawks, and the remaining 12 were acting as on-call radiologists in addition to their normal daytime duties. Each CT examination was interpreted by one of five neuroradiologists the day after the initial interpretation had been performed. The findings of the final interpretation and the preliminary interpretation were categorized as showing agreement, insignificant disagreement, or significant disagreement. The reports in the two categories indicating disagreement were reviewed and reclassified by a consensus of three university-based neuroradiologists. RESULTS: Agreement between the initial interpretation by the general radiologist and the final interpretation by the neuroradiologist was found in 95% of the CT scans. The interpretations were judged to show insignificant disagreement in 3% (23/716) of the scans and to show significant disagreement in 2% (16/716). Of the 16 significant errors, five were false-positive findings and 11 were false-negative findings. Forty-seven CT scans depicted significant or active disease, and in 11 (23%) of these scans, the final report differed significantly from the preliminary interpretation. Three patients had pituitary masses, none of which had been described on the preliminary interpretation. CONCLUSION: The rate of significant discordance between board-certified on-call general radiologists and neuroradiologists in the interpretation of emergency CT scans was 2%, which was comparable to previously published reports of residents' performance. The pituitary gland may be a blind spot, and additional attention should be focused on this area.     

Pediatric Emergency Imaging Studies in Academic Radiology Departments: A Nationwide Survey of Staffing Practices

ObjectiveParticularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests.MethodsWe conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher’s exact test and an α of 0.05.ResultsSurveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend.DiscussionA minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.     

Radiology resident interpretation of on-call CT pulmonary angiograms

RATIONALE AND OBJECTIVES: To evaluate the interpretation of computed tomographic pulmonary angiograms performed outside of regular reporting hours, comparing the initial interpretation by the radiology resident to the attending radiologist. MATERIALS AND METHODS: Records for 840 consecutive computed tomographic pulmonary angiograms (CTPA) performed outside of regular reporting hours at two tertiary referral centers from January 1, 2004-December 31, 2005 were reviewed. The preliminary interpretation by the on-call radiology resident was compared to the subsequent final report issued by a subspecialty trained chest radiologist. Studies were stratified as positive, negative, or equivocal for pulmonary embolus. Cases with discordant interpretations or negative CTPA were reviewed to determine impact on clinical outcome. Patients were followed up to 12 months after CTPA to document any subsequent thromboembolic event. RESULTS: Sixteen percent (131/840) of CTPAs were reported positive by the staff radiologist. There was agreement in 90% (752/840) of studies (P = .76, 95% confidence interval, 0.71-0.81) with 86% (114/133) agreement for studies interpreted as positive by residents, 95% (582/612) for studies interpreted as negative by residents, and 63% (60/95) for studies interpreted as equivocal by residents. Studies of optimal quality had higher interobserver agreement than studies of suboptimal quality (P < .0001). In-patient studies were more likely to be positive than emergency room patients (20% vs. 13%) (P = .004). No adverse clinical outcomes were attributed to discordant interpretations. CONCLUSIONS: Radiology residents provide a high level interpretation of on-call CTPA studies, achieving good concordance with the attending radiologists' assessment.     

The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff

At many academic hospitals, radiology residents provide preliminary interpretations of CT studies performed outside of regular working hours. We examined the rate of discrepancies between resident interpretations and final reports issued by staff. We prospectively obtained 1,756 preliminary reports and corresponding final reports for computed tomography (CT) scans performed on call between November 2006 and March 2007. The overall rate of clinically significant discrepancies (those that would potentially alter the patient’s clinical course prior to issue of the final report) was 2.0%. Major discrepancy rates for abdominal/pelvic, chest, cervical spine and head CT were 4.1%, 2.5%, 1.0% and 0.7%, respectively. Senior residents had fewer major discrepancies compared to their junior colleagues. Time of interpretation was also evaluated, but a statistically significant relationship was not observed. In summary, this study demonstrates a low discrepancy rate between residents and staff radiologists and identifies areas where after-hours service may be further improved.     

Emergency physician error rates for interpretation of plain radiographs and utilization of radiologist consultation

Emergency physicians’ errors of interpretation of plain radiographs and these physicians’ utilization of radiologist consultation services were studied. During daytime hours over a 3-month period, 953 radiograph packets on emergency department patients were reviewed in the radiology department after initial interpretation by an emergency department physician. Consultation requests and clinically significant discordances between radiology and emergency department interpretations were tabulated. Discordances were categorized by the type of examination and the type of error. The time between each packet’s arrival in the radiology department and issuance of a report was recorded. After completion of data collection, all of the discrepant cases were reviewed by a staff emergency room physician and a staff radiologist to establish the proper interpretation and the source of the discordance. Radiologist consultation was requested for 106 (11.1%) of the packets. Of the 847 packets for which the emergency room physician did not request radiologist consultation, radiologist and emergency physician interpretations agreed in 776 (91.6%) and were discordant in 71 (8.4%) of the packets. Of 65 cases available for discrepancy review, the reviewers agreed with the radiologist’s interpretation in 60 (92%) of the cases and disagreed in 5 (8%) of the cases. Ten (17%) of the discordances were the result of overcalls, 47 (78%) were the result of overlooked findings, and 3 (5%) were the result of misinterpretations of findings. Sixty-eight percent of the discordances in interpretation were made to chest studies, 15% to abdominal studies, and 17% to musculoskeletal studies. Emergency physicians at the study institution requested consultations from a radiologist in 11.1% of cases. They made potentially important errors on independent interpretation of plain radiographs in 60 of 847 (7.1%) of cases for which consultation was not sought. Radiologists misinterpreted radiographs in 5 cases. These data suggest that radiologists play an important role in emergency health care delivery and should continue to routinely interpret all emergency department radiographs.     

Is terminology used effectively to convey diagnostic certainty in radiology reports?

RATIONALE AND OBJECTIVES: This study was performed to assess the extent of agreement among radiologists and nonradiologists in perception of diagnostic certainty conveyed by words and phrases commonly used in radiology reports. MATERIALS AND METHODS: The study was performed in a large academic radiology department. To determine the commonly used terminology for conveying diagnostic certainty in radiology reports, 12 randomly selected radiologists from six different subspecialties were interviewed. The authors identified the 15 most commonly used words and phrases and included these in random order in a questionnaire sent to all staff radiologists (n = 45) and to 158 referring physicians. Physicians were asked to rank the 15 phrases in order of the diagnostic certainty conveyed by each, from 1 (most certain) to 15 (least certain), using each number only once. The kappa statistic was used to assess agreement in rank order among physicians. RESULTS: The questionnaire response rate was 76% (n = 34) for radiologists and 49% (n = 78) for nonradiologists. There was excellent agreement among radiologists (kappa = 0.95) and nonradiologists (kappa = 0.93) in the rank order for the phrase diagnostic of. Although there was good agreement (kappa = 0.45) among radiologists for the word unlikely, agreement among nonradiologists was poor (kappa = 0.27). There was very poor agreement among all physicians for the rank order of the other 13 phrases. CONCLUSION: Among radiologists and nonradiologists, concordance was poor regarding the diagnostic certainty associated with phrases commonly used in radiology reports. Because poor agreement could lead to suboptimal quality of care, the standardization of terminology would benefit all parties.     

Emergency department radiology: Reality or luxury? An international comparison

Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that.The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging.     

Comparison of interpretations of CT angiograms in the evaluation of suspected pulmonary embolism by on-call radiology fellows and subsequently by radiology faculty

OBJECTIVE: Our objective was to evaluate interobserver variability in interpretations performed by on-call radiology fellows and subsequently by attending radiologists of CT angiograms obtained for clinically suspected pulmonary embolism and to evaluate factors contributing to discrepancies. MATERIALS AND METHODS: Written interpretations made by on-call fellows were compared with reports approved by attending radiologists for all CT angiograms obtained for suspected pulmonary embolism after work hours and on weekends in a recent 19-month period. Interpretations were stratified as positive, negative, or equivocal for pulmonary embolism. In cases of discordant interpretations, those CT angiograms were rereviewed by two thoracic radiologists; then patient medical records were reviewed for evidence of clinical effect. Technical and patient-related reasons for discordant interpretations of CT angiograms were recorded. RESULTS: Six hundred fifty-eight oncology patients were examined on CT angiography; five were examined twice. The fellows reported 137 CT angiograms (21%) as positive, 498 (75%) as negative, and 28 (4%) as equivocal for pulmonary embolism. Interpretations of the fellows and attending radiologists agreed in 93% (615/663) of CT angiograms (kappa = 0.80). The concordance rates for CT angiograms interpreted by fellows as positive (89%, 122/137), negative (96%, 479/498), and equivocal (50%, 14/28) were significantly different from each other (p < 0.001 for each). A significantly greater proportion of CT angiograms with discordant interpretations was reported to be technically limited (p < 0.01). No clear adverse clinical events were attributed to discordant interpretations of CT angiograms, although the death of one patient in that subgroup was of indeterminate cause. CONCLUSION: In the evaluation of CT angiograms obtained for suspected pulmonary embolism, on-call fellows showed good agreement with attending radiologists. CT angiograms with discordant interpretations often were limited by technical or patient-related factors.     

On-call services provided by radiology residents in a university hospital environment.

OBJECTIVE: To better understand the consultative role of the radiology resident after hours. METHODS: Data were collected prospectively from Mar. 15, 1999, to Jan. 5, 2001, during on-call coverage hours at our university hospital. Urgent radiologic examinations for which the on-call resident rendered a preliminary interpretation were included in our analysis, with the following entered into a database: patient demographics, consultative time and weekday, imaging modality, consulting clinical service and indication for each study. RESULTS: A total of 1784 studies were performed on 1451 patients; most were requested by the emergency department (844 cases [47.3%]). The mean number of radiographic studies performed was 20.1 (standard error of the mean [SEM] 1.1) per weekday (n = 44) and 49.4 (SEM 1.8) per weekend day or holiday (n = 18). There were 1227 (68.8%) computed tomographic (CT), 338 (18.9%) ultrasonographic, 98 (5.5%) plain radiograph, 63 (3.5%) nuclear medicine, 21 (1.2%) interventional, 20 (1.1%) fluoroscopic and 17 (1.0%) magnetic resonance imaging examinations. The 3 most common studies were CT of the head in 692 cases, CT of the abdomen in 230 and venous Doppler ultrasonography in 158. CONCLUSIONS: Radiology residents are performing a diverse and increasing number of emergent diagnostic examinations after hours. It is therefore important that radiology departments are aware of these consultative needs to best ensure that appropriate resident skills are developed to meet these demands.     

Impact of the Closure of a Large,Urban Safety-Net Hospital on a Neighboring Academic Center: A Philadelphia Case Study

ObjectivesWe examined how the closure of 496-bed Hahnemann University Hospital (HUH), a level I trauma and stroke center and safety-net hospital in Philadelphia, Pennsylvania, impacted the emergency department (ED) and radiology workflow in our neighboring hospital (Thomas Jefferson University Hospital) located <1 mile away.MethodsOn June 30, 2019, HUH announced its imminent closure and began diverting trauma patients, with its ED officially closing in mid-August. Trends of our ED and radiology workflow were analyzed using QlikView analytics software for 3 months before and after the closure. Data were compared to workflow from the same time period in 2018.ResultsThe average monthly number of patients presenting to our ED after the closure increased 20.2% with a corresponding 16% increase in ED imaging studies, primarily in radiographs (+16%) and CT (+20%). Radiology orders by advanced practice providers increased 74%. Turnaround time from imaging order placed to final diagnostic radiology report did not change substantially after the closure.ConclusionWorkflow in our ED and radiology department was significantly impacted by the closure of HUH. This study provides insight into how our practice patterns changed and compensated after the closure of a neighboring, large, urban safety-net hospital; it is important for radiologists to be aware of citywide practice patterns to adapt to acute change.     

Proctoring of New Emergency Radiologists to Promote Clinical Excellence and Ensure Quality of Care

PurposeThe authors’ institution provides 24/7 attending radiologist final interpretations for all emergency, urgent, and inpatient studies. As a supplement to the existing emergency radiology faculty, the institution relies on two groups of radiologists to provide final imaging interpretations after hours: radiology fellows (RFs) and newly hired subspecialty radiologists (NRs). For both groups, subspecialty services provide overreads the following day to improve the skills of the staff members and ensure clinical excellence. The purpose of this study was to compare the clinical significance and rate of discrepancies between RFs and NRs.MethodsA retrospective review of all overreads from July 1, 2012, to June 30, 2015, was performed. Discrepancy rates for RFs and NRs were calculated. Error significance for cases requiring addenda was categorized as follows: acute, likely malignant, indeterminate, unlikely to be of clinical significance, insignificant typographic error, or significant typographic error.ResultsIn total, 10,796 studies were rechecked, of which 1.9% (n = 205) required addenda, 3.6% (n = 384) were deemed addendum-optional, and 94.5% (n = 10,207) required no comments. There was no significant difference in cases requiring addenda (RFs, 1.7% [119 of 6,847]; NRs, 2.2% [86 of 3,949]; P = .11). Of the 205 cases requiring addenda, 21.0% (n = 43) were deemed to be acute, 4.9% (n = 10) likely malignant, 28.3% (n = 58) indeterminate, 32.7% (n = 67) unlikely to be of clinical significance, and 13.1% (n = 27) secondary to typographic errors (66.7% [n = 18] deemed to be significant).ConclusionsAfter-hours coverage with RFs and NRs allows high-quality final, actionable interpretations with low discrepancy rates and no significant difference between both groups for addendum-needed cases. The program strikes a balance between the need for timely interpretations and the need to continually monitor and improve the quality of interpretations through subspecialist feedback.     

Emergency abdominal radiography: Discrepancies of preliminary and final interpretation and management relevance

The purpose of this study was to determine the discrepancy rate between the preliminary interpretation of abdominal radiographs by emergency physicians compared to the final report rendered by gastrointestinal radiologists, and to assess the impact of such discrepancies on patient management. A retrospective analysis was performed on a sample of abdominal plain radiographs obtained in the emergency department of a private urban teaching hospital. Written preliminary interpretations by the emergency physician were compared to the final dictated reports of the gastrointestinal radiologist. An emergency physician determined whether availability of the final interpretation would have changed patient management. There were 387 abdominal plain film studies that satisfied the criteria for inclusion. Of these, 98 discordant interpretations were noted (an interpretive discrepancy rate of 25.3%). In 16 of the 98 cases (16%), the interpretive discrepancy was deemed to have resulted in a difference in patient management, i.e., a management-relevant discrepancy rate of 4.1% of the total study population. This analysis shows a higher interpretive discrepancy rate for emergency department interpretation of abdominal radiographs than has been reported with emergency department interpretations of other types of radiographs. The most common clinically relevant interpretive discrepancies were misinterpretation of intestinal obstruction and unrecognized urinary tract calculi. Presented at the 6th Annual Scientific Program, American Society of Emergency Radiology, Scottsdale, AZ, March 28, 1995.     

Preliminary Radiology Report Discordances and Patient Outcomes

Rationale and ObjectivesAt our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance.Materials and MethodsFor our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome.ResultsOf the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change.ConclusionAdverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.     

Does reporting of plain chest radiographs affect the immediate management of patients admitted to a medical assessment unit?

AIM: The purpose of our study was to investigate whether reporting of plain chest radiographs affects immediate management of patients admitted to a medical assessment unit. MATERIALS AND METHODS: During a 3 month period we prospectively evaluated 200 patients who had a plain chest radiograph on admission. After the post on-call ward round, an independent medical specialist registrar reviewed the notes, retrieving relevant clinical details. The plain chest films were reported independently by a trainee radiologist and consultant, reaching a consensus report. RESULTS: There was 93% agreement between trainee and consultant radiologists (95% CI=89-96%). Seventy percent had documented reports by the on-call medical team. There was disagreement between radiology and medical reports in 49% of reported films (95% CI=40-57%). The radiologist's report led to a direct change in the immediate management of 22 patients (11%). CONCLUSION: Only 70% of films had documented reports in the clinical notes despite this being a legal requirement. Radiology reporting does cause a direct change in patient management. Chest radiographs of patients admitted to a medical admissions unit should be reported by a radiologist with the minimum of delay.     

24/7/365 Neuroradiologist Coverage Improves Resident Perception of Educational Experience,Referring Physician Satisfaction,and Turnaround Time

PurposeTo quantitatively and qualitatively assess the impact of attending neuroradiology coverage on radiology resident perceptions of the on-call experience, referring physician satisfaction, and final report turnaround times.Materials and Methods24/7/365 attending neuroradiologist coverage began in October 2016 at our institution. In March 2017, an online survey of referring physicians, (emergency medicine, neurosurgery, and stroke neurology) and radiology residents was administered at a large academic medical center. Referring physicians were queried regarding their perceptions of patient care, report accuracy, timeliness, and availability of attending radiologists before and after the implementation of overnight neuroradiology coverage. Radiology residents were asked about their level of independence, workload, and education while on-call. Turnaround time (TAT) was measured over a 5-month period before and after the implementation of overnight neuroradiology coverage.ResultsA total of 28 of 64 referring physicians surveyed responded, for a response rate of 67%. Specifically, 19 of 23 second (junior resident on-call) and third year radiology residents (senior resident on-call) replied, 4 of 4 stroke neurology fellows replied, 8 of 21 neurosurgery residents, and 16 of 39 emergency medicine residents replied. Ninety-five percent of radiology residents stated they had adequate independence on call, 100% felt they have enough faculty support while on call, and 84% reported that overnight attending coverage has improved the educational value of their on-call experience. Residents who were present both before and after the implementation of TAT metrics thought their education, and independence had been positively affected. After overnight neuroradiology coverage, 85% of emergency physicians perceived improved accuracy of reports, 69% noted improved timeliness, and 77% found that attending radiologists were more accessible for consultation. The surveyed stroke neurology fellows and neurosurgery residents reported positive perception of the TAT, report quality, and availability of accessibility of attending radiologist.ConclusionsIn concordance with prior results, overnight attending coverage significantly reduced turnaround time. As expected, referring physicians report increased satisfaction with overnight attending coverage, particularly with respect to patient care and report accuracy. In contrast to some prior studies, radiology residents reported both improved educational value of the on-call shifts and preserved independence. This may be due to the tasking the overnight neuroradiology attending with dual goals of optimized TAT, and trainee growth. Unique implementation including subspecialty trained attendings may facilitate radiology resident independence and educational experience with improved finalized report turnaround.     

Second-Opinion Reads in Interstitial Lung Disease Imaging: Added Value of Subspecialty Interpretation

PurposeThe purpose of this study was to determine how often a second-opinion interpretation of interstitial lung disease (ILD) by an academic cardiothoracic radiologist is discordant with the initial interpretation by a nonacademic radiologists and how often the clinical diagnosis determined by multidisciplinary consensus agrees with the initial and second-opinion interpretations.MethodsThis retrospective study included 364 consecutive second-opinion CT examination reports of imaging from nonacademic radiology practices from July 2014 to May 2016. The second-opinion interpretations, provided by seven fellowship-trained cardiothoracic radiologists, were compared with the initial interpretations and the clinical diagnoses determined by multidisciplinary consensus.ResultsTwo hundred ninety-six consecutive reports met the inclusion criteria, and two hundred had findings of ILD. The initial interpretations lacked specific diagnoses in 41% of reports, but the second-opinion reports lacked specific diagnoses in only 7%. When a diagnosis was provided, the second-opinion diagnosis disagreed with the initial interpretation in 25% of cases. The clinical-consensus diagnosis was concordant with that of the academic radiologists 85% of the time but concordant with the initial interpretation only 44% of the time. The academic radiologists’ diagnostic sensitivity was higher than that of the initial radiologists for the four most common diagnoses: usual interstitial pneumonitis (0.91 versus 0.4), sarcoidosis (0.94 versus 0.60), hypersensitivity pneumonitis (0.79 versus 0.17), and nonspecific interstitial pneumonitis (0.72 versus 0.14).ConclusionsAcademic cardiothoracic radiologists were more likely to provide specific diagnoses for ILD, and these diagnoses were more likely to be concordant with the multidisciplinary consensus.