Peter M Lauritzen1, Knut Stavem2, Jack Gunnar Andersen3, Mali Victoria Stokke4, Anne Lise Tennstrand5, Gisle Bjerke6, Petter Hurlen7, Gunnar Sandbæk8, Fredrik A Dahl9, Pål Gulbrandsen10. 1. Department of Diagnostic Imaging, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: peter.m.lauritzen@gmail.com. 2. Department of Pulmonary Medicine, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: knut.stavem@medisin.uio.no. 3. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway. Electronic address: uxjaga@ous-hf.no. 4. Department of Diagnostic Imaging, Vestre Viken Hospital, C/O Drammen Sykehus, NO-3004 Drammen, Norway. Electronic address: mali.victoria.stokke@vestreviken.no. 5. Department of Diagnostic Imaging, Vestre Viken Hospital, C/O Drammen Sykehus, NO-3004 Drammen, Norway. Electronic address: al-tenn@online.no. 6. Department of Pulmonary Medicine, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: gisle.bjerke@ahus.no. 7. Department of Diagnostic Imaging, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: petter@hurlen.no. 8. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: gsandb@ous-hf.no. 9. Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: fredrik.a.dahl@ahus.no. 10. Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: pal.gulbrandsen@medisin.uio.no.
Abstract
OBJECTIVES: Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Double reading reduces interpretation errors and increases sensitivity. Consultant radiologists in Norwegian hospitals submit 39% of computed tomography (CT) reports for quality assurance by double reading. Our objective was to estimate the proportion of radiology reports that were changed during double reading and to assess the potential clinical impact of these changes. MATERIALS AND METHODS: In this retrospective cross-sectional study we acquired preliminary and final reports from 1023 consecutive double read chest CT examinations conducted at five public hospitals. The preliminary and final reports were compared for changes in content. Three experienced pulmonologists independently rated the clinical importance of these changes. The severity of the radiological findings in clinically important changes was classified as increased, unchanged, or decreased. RESULTS: Changes were classified as clinically important in 91 (9%) of 1023 reports. Of these: 3 were critical (demanding immediate action), 15 were major (implying a change in treatment) and 73 were intermediate (affecting subsequent investigations). More clinically important changes were made to urgent examinations and less to female first readers. Chest radiologist made more clinically important changes than other second readers. The severity of the radiological findings was increased in 73 (80%) of the clinically important changes. CONCLUSION: A 9% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and targeting a selection of urgent cases prospectively may increase the yield of discrepant cases and reduce harm to patients.
OBJECTIVES: Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Double reading reduces interpretation errors and increases sensitivity. Consultant radiologists in Norwegian hospitals submit 39% of computed tomography (CT) reports for quality assurance by double reading. Our objective was to estimate the proportion of radiology reports that were changed during double reading and to assess the potential clinical impact of these changes. MATERIALS AND METHODS: In this retrospective cross-sectional study we acquired preliminary and final reports from 1023 consecutive double read chest CT examinations conducted at five public hospitals. The preliminary and final reports were compared for changes in content. Three experienced pulmonologists independently rated the clinical importance of these changes. The severity of the radiological findings in clinically important changes was classified as increased, unchanged, or decreased. RESULTS: Changes were classified as clinically important in 91 (9%) of 1023 reports. Of these: 3 were critical (demanding immediate action), 15 were major (implying a change in treatment) and 73 were intermediate (affecting subsequent investigations). More clinically important changes were made to urgent examinations and less to female first readers. Chest radiologist made more clinically important changes than other second readers. The severity of the radiological findings was increased in 73 (80%) of the clinically important changes. CONCLUSION: A 9% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and targeting a selection of urgent cases prospectively may increase the yield of discrepant cases and reduce harm to patients.