Outsourcing of radiological reporting services has fundamentally altered communication between radiologists and clinicians in clinical decision making, which relies heavily on diagnostic imaging. The aim of this study was to understand clinicians' perspectives and experiences of interpretation of outsourced reports in clinical practice, if the author of imaging reports matters to clinicians, and actions taken to deal with perceived errors. 10/11/2018 e.Proofing http://eproofing.springer.com/journals_v2/printpage.php?token=zkWRMKZAaE-mTywvUV2Q3x1BVHaTk1Xiq52br2toHL6-y64ThBr4EA 3/14 This study found outsourcing of radiology reporting needs multidisciplinary team availability regarding the interpretation and discussions around capacity for effective communication. It raises important issues around often underacknowledged additional workloads imposed on in-house radiologists. There are financial and pragmatic clinical aspects in pathways of radiology practice which require further research and examination. Key Points • Utilisation of outsourcing is increasing in practice in response to imaging demands. • Outsourcing increases departmental primary reporting capacity but may increase the workload of the local radiologist. • The development of strategies for outsourcing examinations may lessen demands on the in-house workforce.

A previous study has looked at the estimated radiation dose to the lens of the eye during CT scanning of the orbit, pituitary fossa and brain with a recently installed GE 9800 Quick CT using a phantom simulating the lens of the eye. In this study the same phantom was used to compare the estimated radiation dose delivered to the lens of the eye by three other newly installed CT units of different manufacture. There was significant variation between the doses measured from the four machines when operated with the parameters commonly used in clinical practice. However, in all cases scanning of the phantom using routine techniques delivered a dose to the simulated lens which was much lower than the threshold dose for cataracts. There is, never-the-less, a potential for delivery of much higher doses.

A phantom simulating the lens of the eye has been used during estimation of the radiation dose to the lens of the eye during C.T. scanning of the orbit, pituitary fossa and brain. Routine scanning will deliver a dose to the lens which is many times less than the threshold for cataracts. However the potential exists to use techniques which will increase the dose substantially. Repeat examinations of this sort could theoretically exceed the threshold dose required to induce cataracts in the lens.

Low grade gliomas (LGG), including pilocytic astrocytoma (PCA), are the commonest paediatric brain tumours and their behaviour is well understood, typically following a benign course. BRAF fusion is common, particularly in PCA of the cerebellum and optic pathway. Here we present two patients whose LGG behaved in an unusual fashion. The first patient who was treated 6 years previously on LGG2 with vincristine and carboplatin for a tectal plate lesion was identified on routine imaging to have local tumour progression and underwent completion staging. This showed a new enhancing soft tissue abnormality within the spinal cord at the level of L2. Due to radiological dubiety both lesions were biopsied for histological and molecular analysis, confirming LGG of the tectal plate and finding the spinal lesion to be a myxopapillary ependymoma. The second patient presented with acute hydrocephalus following a 2 year history of neurocognitive impairments. He was found to have a large, complex tumour centred in and expanding the bodies of both lateral ventricles with significant mass effect. Radiologically this was most in keeping with a central neurocytoma but histological analysis confirmed it to be a PCA with KIAA1549-BRAF fusion. The first case demonstrates the utility of molecular analysis in confirming two distinct tumour types in one patient, in a situation where metastasis would not be expected and would significantly alter treatment and prognosis. The second is an example of how imaging can be misleading in a KIAA1549-BRAF fused PCA presenting as an intraventricular mass.

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