AUDIT TO ESTIMATE THE PROPORTION OF RADIOLOGY REPORTS CHANGED DURING DOUBLE READING OF IMAGES AND TO ASSESS THEIR POTENTIAL CLINICAL IMPACT.

Abstract

Objectives: The objectives of this study were to estimate the proportion of radiology reports that were changed during double reading and to assess the potential clinical impact of these changes.
Material and methods: Rates of double reading in radiology department were explored in survey issued to consultant radiologists, covering practice of double reading, department guidelines and quality improvement work. The responses of consultant radiologists grouped according to workplace were used to validate management responses about working hours consumed by double reading. The clinical importance of changes to radiology reports was estimated retrospectively. We collected pairs of preliminary and final reports from 1500 double read examinations (CT, MRI, X ray, ultraspund).  Exploratory analysis of associations between clinically important changes and characteristics of patients, examinations, and readers was performed with multivariate logistic regression. We also constructed two random effects models to test for clustering of clinically important report changes in separate examinations read by the same radiologist.

Results: We found double reading rate of 21% for CT and MRI, 17% for X ray images, 15% for ultrasound and 5% for mammograms. All exams read by consultants, consuming an estimated 20-25% of consultant working hours. By modality double reading rates were highest for Magnetic Resonance Imaging (MRI) (47%) and CT (33%), intermediate for X-ray (24%) and fluoroscopy (23%), and lowest for ultrasonography (16%) and intervention (16%). Chest radiologists and sonologists made more clinically important changes than other second readers. The severity of the radiological findings was increased in 30% of the clinically important changes. Double reading caused upto 25% increase in time consumed for reporting.

Conclusion: Double reading has a major impact on workflow and output directly by consuming working hours. The rates of clinically important changes to radiology reports following double reading indicate that some quality assurance of radiological interpretation is warranted.