<b>Evaluation of Emergency CT Scans of the Head:</b> Is There a Community Standard?

Erly, William K.; Ashdown, B C; Lucio, Richard W.; Carmody, Raymond F.; Seeger, Joachim F.; Alcala, Jennifer N.

doi:10.2214/ajr.180.6.1801727

Cited by 63 publications

(40 citation statements)

References 10 publications

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“…Neuroradiologists, oncologic radiologists, and mammography-trained specialists were better at interpreting images within their areas of expertise than community radiologists with many years of experience. [24][25][26] The converse argument also seems to be true. A study by Branstetter et al 27 documents that subspecialty radiologists outside of their field of expertise do worse than senior radiology residents when interpreting basic body films, further highlighting the importance of ongoing experience.…”

Section: Discussionmentioning

confidence: 93%

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

Babiarz¹,

Yousem²

2011

AJNR Am J Neuroradiol

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SUMMARY:Prior studies have found a 3%-6% clinically significant error rate in radiology practice. We set out to assess discrepancy rates between subspecialty-trained university-based neuroradiologists. Over 17 months, university neuroradiologists randomly reviewed 1000 studies and reports of previously read examinations of patients in whom follow-up studies were read. The discrepancies between the original and "second opinion" reports were scored according to a 5-point scale: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Of the 1000 studies, 876 (87.6%) showed agreements with the original report. The neuroradiology division had a 2.0% (20/1000; 95% CI, 1.1%-2.9%) rate of clinically significant discrepancies involving 8 CTs and 12 MR images. Discrepancies were classified as vascular (n ϭ 7), neoplastic (n ϭ 9), congenital (n ϭ 2), and artifacts (n ϭ 2). Individual neuroradiologist's scores ranged from 0% to 7.7% Ϯ 2.3% (n ϭ 18). Both CT and MR imaging studies had a discrepancy rate of 2.0%. Our quality assessment study could serve as initial data before intervention as part of a PQI project.ABBREVIATIONS: ABR ϭ American Board of Radiology; ACGME ϭ Accreditation Council for Graduate Medical Education; CI ϭ confidence interval; PQI ϭ practice quality improvement R adiologic detection and interpretation errors will not be fully eliminated until the advent of "perfect diagnostic tests" and "perfect observers." 1,2 In the meantime, radiologists, similar to other physicians, struggle with assessing physician performance and reporting quality, to improve and deliver the best care possible.3 L. Henry Garland pioneered the work on radiologic errors more than 60 years ago. [4][5][6] He uncovered a 30% rate of missed radiologic findings in a series of radiographs with abnormal findings among expert reviewers. Subsequently Garland's results have been replicated by other researchers. [7][8][9] Most interesting, comparable rates of "mistakes" were discovered in other specialties. 10,11 In deriving the radiologic error rate, Garland used exclusively abnormal studies-that is, he tested radiologists in environments in which disease prevalence reached 100%. Because in the typical clinical setting, there are a substantial number of examinations with normal findings, Garland hypothesized that the expected radiologic error rate in everyday practice is closer to 5%.Subsequent studies confirmed the radiologic error rate in all-comers radiology practice to be in the 3%-6% range. 3,12-14Soffa et al 14 sampled approximately 7000 cases read by 26 radiologists and uncovered a 3% disagreement rate in general radiology, 3.6% in diagnostic mammography, 5.8% in screening mammography, and 4.1% in sonography, yielding the overall error rate of 3.5%. Robinson et al 13 compared reports for skeletal, chest, and abdominal radiographs completed by 3 radiologists and found ...

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Section: Discussionmentioning

confidence: 93%

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

Babiarz¹,

Yousem²

2011

AJNR Am J Neuroradiol

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“…4 Opponents of overnight head CT interpretation by residents do not acknowledge the inherent error rate in interpretation by board-certified radiologists and that the residents' readings are ultimately compared with the attendings' readings, which have been shown to be an imperfect clinical standard. 12 With a more complete understanding of misinterpretation of intracranial hemorrhage by residents, their education can be tailored to help decrease its frequency in the future and ultimately help improve patient care.…”

Section: Resultsmentioning

confidence: 99%

“…One study specifically focused on the performance of community radiologists. Erly et al 12 attempted to quantify the error rate of community radiologists; 716 consecutive CT scans of the head were interpreted by community radiologists and then compared with the readings of neuroradiologists. They found a 2% rate of significant disagreement, in which there were cases of overlooked subdural hematomas, acute infarction, contusions, subarachnoid hemorrhage, and suprasellar masses.…”

Section: Discussionmentioning

confidence: 99%

Overnight Preliminary Head CT Interpretations Provided by Residents: Locations of Misidentified Intracranial Hemorrhage

Strub¹,

Leach²,

Tomsick³

et al. 2007

American Journal of Neuroradiology

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“…Higher rates of non-concordance have been demonstrated between the provisional reports of consultants in the emergency department and the final report: 13.3-24% [9,11,12]. A single study assessing the difference between the reports of board-certified general radiologists and neuroradiologists showed a discrepancy in 5%; 40% of these were deemed clinically significant [13]. Such discrepancies may have serious clinical implications given that these reports, unlike those of radiology trainees and emergency doctors, are not subsequently checked by a neuroradiologist.…”

Section: Discussionmentioning

confidence: 99%

Comparing the accuracy of initial head CT reporting by radiologists, radiology trainees, neuroradiographers and emergency doctors

Gallagher¹,

Tay²,

Vowler³

et al. 2011

BJR

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Objectives: Demand for out-of-hours cranial CT imaging is increasing and some departments have considered addressing this shortfall by allowing non-radiologists to provisionally report imaging studies. The aim of this work was to assess whether it is appropriate for non-radiologists to report head CTs by comparing the misreporting rates of those who regularly report head CTs with two groups of non-radiologists who do not usually report them: neuroradiographers and emergency doctors. Methods: 62 candidates were asked to report 30 head CTs, two-thirds of which were abnormal, and the results were compared by non-parametric statistical analysis. Results: There was no evidence of a difference in the score between neuroradiographers, neuroradiologists and general consultant radiologists. Neuroradiographers scored significantly higher than senior radiology trainees, and the emergency doctors scored least well. Conclusion:The results of this preliminary study show that appropriately trained neuroradiographers are competent at reporting the range of abnormalities assessed with this test and that their misreporting rates are similar to those who already independently report these studies.

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Evaluation of Emergency CT Scans of the Head: Is There a Community Standard?

Cited by 63 publications

References 10 publications

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

Overnight Preliminary Head CT Interpretations Provided by Residents: Locations of Misidentified Intracranial Hemorrhage

Comparing the accuracy of initial head CT reporting by radiologists, radiology trainees, neuroradiographers and emergency doctors

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