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The clinical impact of subspecialized radiologist reinterpretation of abdominal imaging studies, with analysis of the types and relative frequency of interpretation discrepancies

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Abstract

Purpose

The primary objective of this study was to determine the clinical impact and value of abdominal imaging reinterpretations by subspecialized abdominal imagers.

Methods

Secondary interpretations for computed tomography (CT), magnetic resonance (MR), and ultrasound (US) abdominal studies performed outside our institution over a 7-month period were retrospectively compared to the primary (outside) interpretation, with interpretive differences recorded. Clinical notes, pathology and subsequent imaging determined ground truth diagnosis and the clinical impact of any interpretive discrepancies were graded as having high, medium, or little/no clinical impact. Interpretive comparisons were scored into categories: (1) no difference; (2) incidental findings of no clinical impact; (3) finding not reported; (4) significance of finding undercalled; (5) significance of finding overcalled; (6) finding misinterpreted; and (7) multiple discrepancy types in one report.

Results

398 report comparisons were reviewed on 380 patients. There were 300 CT, 60 MR, and 38 US examinations. The primary report had 5.0% (20/398) high clinical impact interpretive discrepancies and 7.5% (30/398) medium clinical impact discrepancies. The subspecialized secondary report had no high clinical impact discrepancies and 8/398 (2.0%) medium clinical impact discrepancies. In order of frequency, high and medium impact discrepancies in the primary report consisted of 50% overcalls, 26% unreported findings, 18% undercalls, 4% misinterpretations, and 2% multiple discrepancies.

Conclusions

Subspecialty review of abdominal imaging exams can provide clinical benefit. Half of the discrepancies in this series of abdominal reinterpretations were due to overcalls.

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References

  1. Garland LH (1949) On the scientific evaluation of diagnostic procedures. Radiology 52:309–328

    Article  PubMed  CAS  Google Scholar 

  2. Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH (2004) RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol 1:59–65

    Article  PubMed  Google Scholar 

  3. Sung JC, Sodickson A, Ledbetter S (2009) Outside CT imaging among emergency department transfer patients. J Am Coll Radiol 6:626–632

    Article  PubMed  Google Scholar 

  4. Tilleman EH, Phoa SS, Van Delden OM, et al. (2003) Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy. Eur Radiol 13:1095–1099

    PubMed  Google Scholar 

  5. Zan E, Yousem DM, Carone M, Lewin JS (2010) Second-opinion consultations in neuroradiology. Radiology 255:135–141

    Article  PubMed  Google Scholar 

  6. Kalbhen CL, Yetter EM, Olson MC, Posniak HV, Aranha GV (1998) Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions. AJR Am J Roentgenol 171:1571–1576

    Article  PubMed  CAS  Google Scholar 

  7. Di Piro PJ, Van Sonnenberg E, Tumeh SS, Ros PR (2002) Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol 9:1430–1433

    Article  Google Scholar 

  8. Yoon LS, Haims AH, Brink JA, Rabinovici R, Forman HP (2002) Evaluation of an emergency radiology quality assurance program at a level I trauma center: abdominal and pelvic CT studies. Radiology 224:42–46

    Article  PubMed  Google Scholar 

  9. Eakins C, Ellis WD, Pruthi S, et al. (2012) Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol 199:916–920

    Article  PubMed  Google Scholar 

  10. Jeffers AB, Saghir A, Camacho M (2012) Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting. Emerg Radiol 19:187–193

    Article  PubMed  Google Scholar 

  11. Kazerooni NL, Kazerooni EA, Quint LE, Orringer MB (1998) Added value of thoracic radiology specialist interpretation of CT scans for lung cancer consultations in a thoracic surgery clinic (abstr). Radiology 209:171

    Google Scholar 

  12. Babiarz LS, Yousem DM (2012) Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists. AJNR Am J Neuroradiol 33:37–42

    Article  PubMed  CAS  Google Scholar 

  13. Briggs GM, Flynn PA, Worthington M, Rennie I, McKinstry CS (2008) The role of specialist neuroradiology second opinion reporting: is there added value? Clin Radiol 63:791–795

    Article  PubMed  CAS  Google Scholar 

  14. Jordan YJ, Jordan JE, Lightfoote JB, Ragland KD (2012) Quality outcomes of reinterpretation of brain CT studies by subspecialty experts in stroke imaging. AJR Am J Roentgenol 199:1365–1370

    Article  PubMed  Google Scholar 

  15. Gollub MJ, Panicek DM, Bach AM, Penalver A, Castellino RA (1999) Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology 210:109–112

    Article  PubMed  CAS  Google Scholar 

  16. Moser JW, Wilcox PA, Bjork SS, et al. (2006) Pay for performance in radiology: ACR white paper. J Am Coll Radiol 3:650–664

    Article  PubMed  Google Scholar 

  17. Carney E, Kempf J, DeCarvalho V, Yudd A, Nosher J (2003) Preliminary interpretations of after-hours CT and sonography by radiology residents versus final interpretations by body imaging radiologists at a level 1 trauma center. AJR Am J Roentgenol 181:367–373

    Article  PubMed  Google Scholar 

  18. Wysoki MG, Nassar CJ, Koenigsberg RA, et al. (1998) Head trauma: CT scan interpretation by radiology residents versus staff radiologists. Radiology 208:125–128

    Article  PubMed  CAS  Google Scholar 

  19. Cervini P, Bell CM, Roberts HC, et al. (2008) Radiology resident interpretation of on-call CT pulmonary angiograms. Acad Radiol 15:556–562

    Article  PubMed  Google Scholar 

  20. Chung JH, Strigel RM, Chew AR, Albrecht E, Gunn ML (2009) Overnight resident interpretation of torso CT at a level 1 trauma center an analysis and review of the literature. Acad Radiol 16:1155–1160

    Article  PubMed  Google Scholar 

  21. Cooper VF, Goodhartz LA, Nemcek AA Jr, Ryu RK (2008) Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies. Acad Radiol 15:1198–1204

    Article  PubMed  Google Scholar 

  22. Erly WK, Berger WG, Krupinski E, Seeger JF, Guisto JA (2002) Radiology resident evaluation of head CT scan orders in the emergency department. AJNR Am J Neuroradiol 23:103–107

    PubMed  Google Scholar 

  23. Lal NR, Murray UM, Eldevik OP, Desmond JS (2000) Clinical consequences of misinterpretations of neuroradiologic CT scans by on-call radiology residents. AJNR Am J Neuroradiol 21:124–129

    PubMed  CAS  Google Scholar 

  24. Le AH, Licurse A, Catanzano TM (2007) Interpretation of head CT scans in the emergency department by fellows versus general staff non-neuroradiologists: a closer look at the effectiveness of a quality control program. Emerg Radiol 14:311–316

    Article  PubMed  Google Scholar 

  25. Miyakoshi A, Nguyen QT, Cohen WA, Talner LB, Anzai Y (2009) Accuracy of preliminary interpretation of neurologic CT examinations by on-call radiology residents and assessment of patient outcomes at a level I trauma center. J Am Coll Radiol 6:864–870

    Article  PubMed  Google Scholar 

  26. Platts-Mills TF, Hendey GW, Ferguson B (2010) Teleradiology interpretations of emergency department computed tomography scans. J Emerg Med 38:188–195

    Article  PubMed  Google Scholar 

  27. Ruchman RB, Jaeger J, Wiggins EF 3rd, et al. (2007) Preliminary radiology resident interpretations versus final attending radiologist interpretations and the impact on patient care in a community hospital. AJR Am J Roentgenol 189:523–526

    Article  PubMed  Google Scholar 

  28. Rufener SL, Patel S, Kazerooni EA, Schipper M, Kelly AM (2008) Comparison of on-call radiology resident and faculty interpretation of 4- and 16-row multidetector CT pulmonary angiography with indirect CT venography. Acad Radiol 15:71–76

    Article  PubMed  Google Scholar 

  29. Strub WM, Leach JL, Tomsick T, Vagal A (2007) Overnight preliminary head CT interpretations provided by residents: locations of misidentified intracranial hemorrhage. AJNR Am J Neuroradiol 28:1679–1682

    Article  PubMed  CAS  Google Scholar 

  30. Tieng N, Grinberg D, Li SF (2007) Discrepancies in interpretation of ED body computed tomographic scans by radiology residents. Am J Emerg Med 25:45–48

    Article  PubMed  Google Scholar 

  31. Walls J, Hunter N, Brasher PM, Ho SG (2009) The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff. Emerg Radiol 16:303–308

    Article  PubMed  Google Scholar 

  32. Xiong L, Trout AT, Bailey JE, Brown RK, Kelly AM (2011) Comparison of discrepancy rates in resident and faculty interpretations of on-call PE CT and V/Q scans: is one study more reliable during off hours? J Am Coll Radiol 8:415–421

    Article  PubMed  Google Scholar 

  33. Yavas US, Calisir C, Ozkan IR (2008) The interobserver agreement between residents and experienced radiologists for detecting pulmonary embolism and DVT with using CT pulmonary angiography and indirect CT venography. Korean J Radiol 9:498–502

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wechsler RJ, Spettell CM, Kurtz AB, et al. (1996) Effects of training and experience in interpretation of emergency body CT scans. Radiology 199:717–720

    Article  PubMed  CAS  Google Scholar 

  35. Bechtold RE, Chen MY, Ott DJ, et al. (1997) Interpretation of abdominal CT: analysis of errors and their causes. J Comput Assist Tomogr 21:681–685

    Article  PubMed  CAS  Google Scholar 

  36. Filippi CG, Schneider B, Burbank HN, et al. (2008) Discrepancy rates of radiology resident interpretations of on-call neuroradiology MR imaging studies. Radiology 249:972–979

    Article  PubMed  Google Scholar 

  37. Soffa DJ, Lewis RS, Sunshine JH, Bhargavan M (2004) Disagreement in interpretation: a method for the development of benchmarks for quality assurance in imaging. J Am Coll Radiol 1:212–217

    Article  PubMed  Google Scholar 

  38. Thurfjell EL, Lernevall KA, Taube AA (1994) Benefit of independent double reading in a population-based mammography screening program. Radiology 191(241–244):9

    Google Scholar 

  39. Bell ME, Patel MD (2014) The degree of abdominal imaging (AI) Subspecialization of the reviewing radiologist significantly impacts the number of clinically-relevant and incidental discrepancies identified during peer review of emergency after-hours body CT studies. Abdom Imaging. doi:10.1007/s00261-014-0139-4

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Authors and Affiliations

  1. Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    Elizabeth A. Lindgren

  2. Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA

    Maitray D. Patel, Qing Wu, Jeff Melikian & Amy K. Hara

Authors
  1. Elizabeth A. Lindgren
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  2. Maitray D. Patel
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  3. Qing Wu
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  4. Jeff Melikian
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  5. Amy K. Hara
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Correspondence to Maitray D. Patel.

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Lindgren, E.A., Patel, M.D., Wu, Q. et al. The clinical impact of subspecialized radiologist reinterpretation of abdominal imaging studies, with analysis of the types and relative frequency of interpretation discrepancies. Abdom Imaging 39, 1119–1126 (2014). https://doi.org/10.1007/s00261-014-0140-y

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