Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies

RATIONALE AND OBJECTIVES: To determine the incidence of radiology resident preliminary interpretation errors for plain film, body computed tomography, and neuroradiology (neuro)computed tomographic examinations read on call. MATERIALS AND METHODS: We retrospectively reviewed the data in a prospectively acquired resident quality assurance (QA) database dating between January 2000 and March 2007. The database comprises all imaging studies initially interpreted by an on-call resident and later reviewed by a board-certified attending radiologist who determined the level of discrepancy between the two interpretations according to a graded scale from 0 (no discrepancy) to 3 (major discrepancy). We reviewed the data with respect to resident training level, imaging modality, and variance level. Statistical analysis was performed with chi(2) test, alpha = 0.05. We compared our results with other published series studying resident and attending accuracy. RESULTS: A total of 141,381 cases were entered into the database during the review period. Of all examinations, 95.7% had zero variance, 3.3% minor variance, and 1.0% major variance. There was a slight, statistically significant increase in overall accuracy with increased resident year from 95.4% of examinations read by first-year residents (R1s) to 96.1% by fourth-year resident (R4s) (P < .0001). Overall percentages of exams with major discrepancies were 1.0% for R1s, 1.1% for second-year residents, 1.0% for third-year residents, and 0.98% for R4s. CONCLUSIONS: The majority of preliminary resident interpretations are highly accurate. The incidence of major discrepancies is extremely low and similar, even with R1s, to that of attending radiologists published in other studies. A slight, statistically significant decrease in the error rate is detectable as residents gain experience throughout the 4 years of residency.     

Overnight resident preliminary interpretations on CT Examinations: should the process continue?

We report our experience with resident preliminary interpretations given at night on both abdominal and neurological CT scans to quantify the discrepancy rate when compared to the final report. An attempt was also made to document any adverse clinical outcomes as a result of the preliminary interpretation. From January 1, 2004 to December 31, 2004, adult CT examinations were prospectively interpreted by residents at night at a level I trauma center. Both the neurological and body CT scans were reviewed beginning at 7:00 a.m. the following morning by the respective subspecialty staff and discrepancies were noted. Adult CT examinations (6,858) were prospectively interpreted by residents: 5,206 cranial spinal CT examinations and 1,652 body CT examinations. Among the neurological studies, there were six cases identified as major discrepancies (0.1%) and 185 minor discrepancies (3.5%). Among the body CT cases, there were seven cases identified as major discrepancies (0.4%) and 23 cases of minor discrepancies (1.4%). There is a low discrepancy rate (0.2% major and 3.1% minor) in the preliminary resident interpretations from the final report. The process of overnight preliminary CT interpretations should continue as it is not substandard care.Presented at the American Society of Emergency Radiology 2005 Annual Meeting, Tucson, Arizona.     

First year radiology residents not taking call: will there be a difference?

Currently, there is a debate in the academic radiology community about whether or not first year residents should take overnight call. The purpose of this study was to track discrepancies on overnight resident preliminary reads on radiographs from the emergency department to see if the experience level of the resident makes a difference. From October 1, 2005 to September 22, 2006, 13,213 radiographs were prospectively interpreted by residents at night at a Level I Trauma Center. Discrepancies were documented after review of the films with the staff radiologist in the morning. The patient’s medical record was then examined to determine if there was any adverse clinical outcome as a result of the reading. Of the 13,184 radiographs interpreted, 120 total discrepancies were identified (overall discrepancy rate 0.9%). First year residents showed a discrepancy rate of 1.59%, higher than other residents, which were ranged from 0.39 to 0.56%. Of the 54 patients with follow-up imaging, the abnormality that was felt to be present by staff persisted on follow-up imaging in 22 cases; however, the abnormality was not present on follow up of the other 32 patients (59.2% of discrepancies with follow-up imaging). Although there is higher rate of discrepancy among reports generated by first year residents, the difference compared to the other levels of experience is small, and its overall significance can be debated. Follow-up imaging often showed that staff interpretations were false positives when there was a discrepancy reported.     

Overnight preliminary head CT interpretations provided by residents: locations of misidentified intracranial hemorrhage

BACKGROUND AND PURPOSE: Our aim was to determine the patterns of error of radiology residents in the detection of intracranial hemorrhage on head CT examinations while on call. Follow-up studies were reviewed to determine if there was any adverse effect on patient outcome as a result of these preliminary interpretations. MATERIALS AND METHODS: Radiology residents prospectively interpreted 22,590 head CT examinations while on call from January 1, 2002, to July 31, 2006. The following morning, the studies were interpreted by staff neuroradiologists, and discrepancies from the preliminary report were documented. Patients' charts were reviewed for clinical outcomes and any imaging follow-up. RESULTS: There were a total of 1037 discrepancies identified, of which 141 were due to intracranial hemorrhage. The most common types of intracranial hemorrhage that were missed were subdural and subarachnoid hemorrhage occurring in 39% and 33% of the cases, respectively. The most common location for missed subdural hemorrhage was either parafalcine or frontal. The most common location of missed subarachnoid hemorrhage was in the interpeduncular cistern. There was 1 case of nontraumatic subarachnoid hemorrhage that was not described in the preliminary report. Fourteen patients were brought back to the emergency department for short-term follow-up imaging after being discharged. We did not observe any adverse clinical outcomes that resulted from a discrepant reading. CONCLUSION: Discrepancies due to intracranial hemorrhage are usually the result of subdural or subarachnoid hemorrhage. A more complete understanding of the locations of the missed hemorrhage can hopefully help decrease the discrepancy rate to help improve patient care.     

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.     

The role of specialist neuroradiology second opinion reporting: is there added value?

AIM: To assess the impact on patient management of formal neuroradiology "second reading" of computed tomography (CT) and magnetic resonance imaging (MRI) images initially interpreted by general radiologists. MATERIALS AND METHODS: Second opinion reports during the calendar year 2004 were compared with the original report and assessed for major or minor discrepancies. A major discrepancy was separated from a minor discrepancy whereby a change in opinion significantly affected patient management. RESULTS: There were 506 second opinions during 2004 given by three consultant neuroradiologists. Incomplete data were found in 141. Forty-one percent were CT images and the remainder MRI. The majority of second opinions were requested by neurologists. Most of the remaining referrals were from neurosurgeons or the primary radiologist. There was a 13% major and a 21% minor discrepancy rate. The remaining 66% were in complete agreement. There was a mixture of overcalls, misinterpretation, and undercalls. There were similar rates of minor and major discrepancies in both CT and MRI. CONCLUSION: There is a significant major discrepancy rate between specialist neuroradiology second opinion and general radiologists. The benefit of a formal specialist second opinion service is clearly demonstrated; however, it is time-consuming.     

Nonenhanced limited CT in children suspected of having appendicitis: prospective comparison of attending and resident interpretations.

PURPOSE: To prospectively compare resident and attending radiologic interpretations of nonenhanced limited computed tomographic (CT) scans obtained in children suspected of having appendicitis. MATERIALS AND METHODS: Seventy-five consecutive children underwent nonenhanced limited CT for suspected appendicitis. The scans were prospectively interpreted by a resident and an attending radiologist, each unaware of the other's interpretation. The probability that the findings indicated a diagnosis of appendicitis, level of certainty in the interpretation, and presence of an alternate diagnosis were statistically analyzed. RESULTS: Nineteen children (25%) had appendicitis. The area under the receiver operating characteristic curve was not significantly different between residents (0.97 +/- 0.02) and attendings (0.95 +/- 0.04). The percentage agreement between residents and attendings was 91% (kappa = 0.73 +/- 0.095). The average level of certainty tended to be higher for attendings (93% +/- 15) than residents (89% +/- 12). The sensitivity, specificity, and accuracy of resident interpretations were 63%, 96%, and 88%, respectively, compared with those of attending interpretations--95%, 98%, and 97%, respectively. Residents and attendings noted alternate diagnoses in 30% of children without appendicitis. CONCLUSION: A high level of agreement exists between resident and attending radiologists in the interpretation of nonenhanced limited CT scans in children suspected of having appendicitis. Residents, however, tend to be less confident in their interpretations.     

Second thoughts: Emergency clinicians see value in secondary interpretations

ObjectiveSecondary interpretations of imaging studies performed at another facility are increasingly common in radiology, particularly emergency radiology. While data suggests there are often discrepancies found between original and secondary reports, the benefit from the clinician perspective is unclear.Methods and materialsAn anonymous electronic survey on secondary interpretations was circulated to 58 attending adult emergency physicians and trauma surgeons at a Level I trauma center from March 2018 to April 2018. Chi-squared testing was used for statistical analysis.Results80.8% of respondents requested secondary interpretations either “always” or “most of the time.” Over half of the respondents cited trust in the house radiologist interpretation as the primary reason for secondary interpretation requests. 92.3% and 84.6% of respondents felt that the ability to obtain second interpretations improves patient care and facilitates disposition, respectively. 88.5% of respondents reported reduced imaging utilization due to secondary reads. When presented with conflicting interpretations, all trauma surgeons would rely on the in-house interpretation, whereas 50% of the emergency physicians would pursue further imaging (p < 0.05). 96.2% of respondents were uncertain about insurance coverage of secondary interpretations, but 73.1% would continue to order them, regardless.ConclusionSecondary reads were heavily utilized, felt to influence patient care, reduced additional imaging and aided in disposition, suggesting clinical benefit. When presented with conflicting reports, trauma surgeons would rely on the in-house interpretation whereas emergency physicians more often opted to pursue additional imaging. Most respondents would still request secondary interpretations despite being unaware of insurance coverage for these interpretations.     

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.     

Prevalence and clinical significance of misinterpretations of plain radiographs by orthopedic residents in a minor trauma emergency room

Purpose: (1) To determine the accuracy of interpretation of plain radiographs by orthopedic residents in a minor trauma emergency room, (2) to evaluate the clinical significance of misinterpretations for patient management, and (3) to evaluate the necessity of routine plain film review by a radiologist and an efficient patient recall system. Materials and methods: Our retrospective study evaluated discrepancies in plain film reading between orthopedic residents and radiologists. A total of 2283 radiographic examinations were evaluated for discrepancies. The medical records and X-rays in misinterpreted cases were assessed by a musculoskeletal radiologist and a staff orthopedist. The misinterpretations were categorized based on their clinical significance and influence on medical care. Misinterpretations which required immediate change in treatment or mandated further work-up were considered to have high clinical significance. Results: Forty-six (2 %) of the 2283 interpretations were defined as misinterpretations. Of the 46 cases, 27 (59 %) were missed fractures, 5 (11 %) were missed tumors, and 7 (15 %) were false positive readings of normal films. Twenty-one (46 %) of the misinterpretations had significant consequences. Forty-one percent of missed fractures had a high clinical significance, whereas only 14 % of false positive readings had a high clinical significance. Conclusion: The accuracy of plain film interpretation by orthopedic residents in the minor trauma setting is high (98 %). Nevertheless, 46 % of the misinterpretations have significant clinical consequences. This indicates that all emergency trauma films should be reviewed by an experienced radiologist, and an expedient method of informing the orthopedic department of any discrepancies in reading is recommended.     

Diagnostic accuracy with US: remote radiologists' versus on-site radiologists' interpretations

PURPOSE: To compare the diagnostic accuracy of radiologists interpreting static ultrasonographic (US) images electronically transmitted to an academic medical center (remote radiologists) with that of radiologists performing "hands-on" US at a community-based outpatient site (on-site radiologists). MATERIALS AND METHODS: During 8 months, 80 patients underwent pelvic US at a community-based outpatient site. Images were electronically transmitted to a remote medical center as they were acquired at the community site and were printed on a laser printer identical to the one used at the outpatient site. The reference standard for correct diagnosis was based on histopathologic findings (n = 13), additional imaging results (n = 34), or review by a second independent observer (n = 33). Both an on-site and a remote radiologist interpreted the images, and their interpretations were rated as agree, both correct; agree, both incorrect; or disagree. Cases of disagreement were rated as major or minor. RESULTS: On-site and remote radiologists agreed in 69 of 80 patients (86%), and both radiologists were correct in all of these cases. There were 10 minor discrepancies and one major discrepancy. The diagnostic accuracies of the one-site and remote radiologists were 92% and 94%, respectively. CONCLUSION: High levels of diagnostic accuracy can be achieved by radiologists interpreting static US images. Strict protocols and excellent communication between the radiologist and sonographer are necessary to avoid diagnostic errors.     

Resident vs. attending interpretation of on-call studies: clinical impact

Purpose: This study was performed to determine whether significant changes to patient treatment plan or outcome result from discrepancies between on-call radiology residents and follow-up attending radiologists in their interpretation of examinations. Methods: For 70 days we recorded on-call radiology residents' readings of all computed tomography and ultrasound examinations performed in our institution and the follow-up attending radiologists' readings of these same examinations. A chart review was performed to determine whether interpretation discrepancies changed the treatment plan and clinical outcome. Results: Eight-hundred thirty-four examinations met the study guidelines. The overall discrepancy rate was 5.16 %. Of these discrepancies, 6.98 % affected the treatment plan (0.36 % of all 834 studies) and none affected the clinical outcome. Conclusion: Where there is a discrepancy between interpretation of computed tomography and ultrasound after hours by on-call radiology residents and follow-up readings by attending radiologists, this discrepancy has no significant effect on the immediate or long-term care of patients.     

Discrepancy Rates and Clinical Impact of Imaging Secondary Interpretations: A Systematic Review and Meta-Analysis

PurposeTo conduct a meta-analysis of studies investigating discrepancy rates and clinical impact of imaging secondary interpretations and to identify factors influencing these rates.MethodsEMBASE and PubMed databases were searched for original research investigations reporting discrepancy rates for secondary interpretations performed by radiologists for imaging examinations initially interpreted at other institutions. Two reviewers extracted study information and assessed study quality. Meta-analysis was performed.ResultsTwenty-nine studies representing a total of 12,676 imaging secondary interpretations met inclusion criteria; 19 of these studies provided data specifically for oncologic imaging examinations. Primary risks of bias included availability of initial interpretations, other clinical information, and reference standard before the secondary interpretation. The overall discrepancy rate of secondary interpretations compared with primary interpretations was 32.2%, including a 20.4% discrepancy rate for major findings. Secondary interpretations were management changing in 18.6% of cases. Among discrepant interpretations with an available reference standard, the secondary interpretation accuracy rate was 90.5%. The overall discrepancy rates by examination types were 28.3% for CT, 31.2% for MRI, 32.7% for oncologic imaging, 43.8% for body imaging, 39.9% for breast imaging, 34.0% for musculoskeletal imaging, 23.8% for neuroradiologic imaging, 35.5% for pediatric imaging, and 19.7% for trauma imaging.ConclusionMost widely studied in the context of oncology, imaging secondary interpretations commonly result in discrepant interpretations that are management changing and more accurate than initial interpretations. Policymakers should consider these findings as they consider the value of, and payment for, secondary imaging interpretations.     

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.     

The role of face-to-face consultation in emergency radiology

To assess the impact of face-to-face exchange of clinical information between the radiologist and the emergency physician, a study was made of all plain films and computed tomograms (CTs) ordered in the Ohio State University Emergency Department between 11 am and 11 pm over a 4-week period. For each case, interpretations at three different times were recorded: (1) initial interpretation upon reception of the images, (2) interpretation after face-to-face discussion of clinical information with the emergency resident or attending physician, and (3) final interpretation after conferring with the attending radiologist. If any of the three interpretations differed in a given case, the case was flagged for review by a third attending radiologist to determine the clinical significance of the discrepancy. Cases which deviated from the standard model as described were excluded from the study. In total, 519 cases were ordered during the study period. Of which 231 (44.5 %) occurred in the standard order as described in the Methods section. Of these 231 cases, changes in diagnosis were observed in 31 (13 %) cases. In 12 (5.2 %) cases, the changes were judged to be clinically significant. In 19 (6 %) cases, the changes were judged to be clinically insignificant. The remaining 288 (55.5 %) cases diverged from the standard model described in our Methods section and were not included in our study. Of these, 93/519 (18 %) cases had only one interpretation because the resident radiologist, the emergency physician (resident and/or attending), and the attending radiologist were present for a single, simultaneous discussion. 77 (15 %) cases, there were only two interpretations because the initial interpretation occurred in the presence of both the resident radiologist and the emergency physician. In 69 (13 %) cases, there were two interpretations because the initial interpretation occurred in the presence of both the resident radiologist and the emergency physician. In 49 (9 %) cases, no face-to-face exchange between the resident radiologist and the emergency physician was recorded. Our data suggest that teleradiology's lack of face-to-face communication between the radiologist and the emergency physician may have an impact on the radiologic diagnosis, but only infrequently. Information contained in the images and the limited clinical history on the consult sheet appear to be sufficient for most purposes of radiologic interpretation.     

Accuracy of outside radiologists’ reports of computed tomography exams of emergently transferred patients

Purpose

Growing numbers of patient with advanced imaging being transferred to trauma centers has resulted in increased numbers of outside CT scans received at trauma centers. This study examines the degree of agreement between community radiologists’ interpretations of the CT scans of transferred patients and trauma center radiologists’ reinterpretation.

Methods

All CT scans of emergency transfer patients received over a 1 month period were reviewed by an emergency radiologist. Patients were classified as trauma or non-trauma and exams as neuro or non-neuro. Interpretive discrepancies between the emergency radiologist and community radiologist were classified as minor, moderate, or major. Major discrepancies were confirmed by review of a second emergency radiologist. Discrepancy rates were calculated on a per-patient and per exam basis.

Results

Six hundred twenty-seven CT scans of 326 patients were reviewed. Major discrepancies were encountered in 52 (16.0%, 95% CI 12.2–20.5) patients and 53 exams (8.5%, 95% CI 6.5–10.5). These were discovered in 46 trauma patients (21.6%, 95% CI 16.4–27.9) compared to six non-trauma patients (5.3%, 95% CI 2.2–11.7) (P?<?0.001). A significant difference in the major discrepancy rate was also found between non-neuro and neuro exams (12.4 vs 3.3%, respectively, P?<?0.001), primarily due to discrepancies in trauma patients, rather than non-trauma patients.

Conclusions

Potentially management-changing interpretive changes affected 16% of transferred patients and 8.5% of CT exams over a 1 month period. Trauma center reinterpretations of community hospital CT scans of transferred patients provide valuable additional information to the clinical services caring for critically ill patients.

     

On-Call Radiology Resident Discrepancies: Categorization by Patient Location and Severity

PurposeTo report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results.MethodsA HIPAA-compliant, institutional review board–exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded.ResultsRadiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up.ConclusionsOur resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.     

Ensuring Appropriateness of Pediatric Second Opinion Consultations

PurposeWe sought to evaluate discrepancy rates between outside interpretations, radiology trainee preliminary reports, and subspecialist attending final interpretations for pediatric second opinion consultations on plain film and computed tomography imaging and to evaluate the impact of a process improvement for second opinion consultations.MethodsOf a total of 572 requests for second opinion consultations during 1-year preintervention period, we utilized RADPEER to score concurrence of 158 requests which occurred overnight and included outside radiologist interpretations and resident preliminary reports. In consultation with clinician committees, we developed new guidelines for requesting second opinion consultations. We evaluated the impact on the number of consultations for the 1-year period following implementation of this process improvement.ResultsThere was concurrence between the outside interpretation and pediatric subspecialist second opinion in 146 of 158 cases (92%). There was concurrence between the radiology resident and pediatric subspecialist second opinion in 145 of 158 cases (92%). During the 1-year period following our process improvement implementation, the total number of second opinion consultations decreased to 185 (from 572, a decrease of 68%) and the number of overnight requests for resident preliminary reports decreased to 11 (from 158, a decrease of 93%).ConclusionsThere was a high degree of concurrence between interpretations provided by outside radiologists, overnight radiology residents, and attending pediatric radiologists at our institution. Analyzing institutional-specific discrepancy rates is a valuable first step in partnering with clinicians to develop appropriate guidelines for second opinion consultations.     

Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists

Objective

To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists.

Methods

Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated.

Results

CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19–88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation.

Conclusions

Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations.     

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.