Double reading rates and quality assurance practices in Norwegian hospital radiology departments: two parallel national surveys

Lauritzen, Peter Mæhre; Hurlen, Petter; Sandbæk, Gunnar; Gulbrandsen, Pål

doi:10.1177/0284185113519988

Cited by 14 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other departments, such double reading between peers is mandatory. A survey among Norwegian radiologists reported a double reading rate of 33% of all studies [ 1 ], which is consistent with a previous Norwegian survey [ 2 ].…”

Section: Introductionsupporting

confidence: 88%

“…This leads to the conclusion that it might be more efficient to strive for sub-specialised readers than to implement double reading. It might also be more cost-efficient considering the fact that in one study, double reading of one-third of all studies consumed an estimated 20–25% of all working hours in the institutions concerned [ 1 ]. In modern digital radiology it is easy to send images to another hospital, and it should thus be possible to include even small radiology departments in a large virtual department where all radiologists can be sub-specialised.…”

Section: Discussionmentioning

confidence: 99%

“…Arguments against are that it does not increase quality significantly, is time-consuming, and wastes time and resources. Despite these firm beliefs, there is comparatively scant evidence supporting either view, and both systems are widely practiced [ 1 ]. In some radiology departments or department sections, it is accepted that no systematic double reading is performed between specialists of a similar or above a certain degree of expertise.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Added value of double reading in diagnostic radiology,a systematic review

Geijer

2018

Insights Imaging

View full text Add to dashboard Cite

ObjectivesDouble reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.MethodsA systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.ResultsThe literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.ConclusionsThe systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.Key Points • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates. Electronic supplementary materialThe online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.

show abstract

Section: Introductionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Added value of double reading in diagnostic radiology,a systematic review

Geijer

2018

Insights Imaging

View full text Add to dashboard Cite

show abstract

“…16 For all examination techniques together, the practice consumes 20%-25% of consultant working hours. 16 The main goal is quality assurance of the report before it is finalised. Less than 10% of departments record discrepancy rates or engage in benchmarking of radiologist performance.…”

Section: Introductionmentioning

confidence: 99%

“…Less than 10% of departments record discrepancy rates or engage in benchmarking of radiologist performance. 16 The objective of this study was to estimate the proportion of radiology reports that were changed during prospective double reading of current abdominal CT examinations of surgical patients and to assess the potential clinical impact of these changes. We also aimed to explore whether characteristics of examinations or radiologists were associated with a higher proportion of clinically important changes.…”

Section: Introductionmentioning

confidence: 99%

Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundMisinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings.MethodsWe retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased.ResultsChanges were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations.ConclusionA 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases.

show abstract

Artificial intelligence-assisted double reading of chest radiographs to detect clinically relevant missed findings: a two-centre evaluation

Topff,

Steltenpool,

Ranschaert

et al. 2024

Eur Radiol

View full text Add to dashboard Cite

Objectives To evaluate an artificial intelligence (AI)–assisted double reading system for detecting clinically relevant missed findings on routinely reported chest radiographs. Methods A retrospective study was performed in two institutions, a secondary care hospital and tertiary referral oncology centre. Commercially available AI software performed a comparative analysis of chest radiographs and radiologists’ authorised reports using a deep learning and natural language processing algorithm, respectively. The AI-detected discrepant findings between images and reports were assessed for clinical relevance by an external radiologist, as part of the commercial service provided by the AI vendor. The selected missed findings were subsequently returned to the institution’s radiologist for final review. Results In total, 25,104 chest radiographs of 21,039 patients (mean age 61.1 years ± 16.2 [SD]; 10,436 men) were included. The AI software detected discrepancies between imaging and reports in 21.1% (5289 of 25,104). After review by the external radiologist, 0.9% (47 of 5289) of cases were deemed to contain clinically relevant missed findings. The institution’s radiologists confirmed 35 of 47 missed findings (74.5%) as clinically relevant (0.1% of all cases). Missed findings consisted of lung nodules (71.4%, 25 of 35), pneumothoraces (17.1%, 6 of 35) and consolidations (11.4%, 4 of 35). Conclusion The AI-assisted double reading system was able to identify missed findings on chest radiographs after report authorisation. The approach required an external radiologist to review the AI-detected discrepancies. The number of clinically relevant missed findings by radiologists was very low. Clinical relevance statement The AI-assisted double reader workflow was shown to detect diagnostic errors and could be applied as a quality assurance tool. Although clinically relevant missed findings were rare, there is potential impact given the common use of chest radiography. Key Points • A commercially available double reading system supported by artificial intelligence was evaluated to detect reporting errors in chest radiographs (n=25,104) from two institutions. • Clinically relevant missed findings were found in 0.1% of chest radiographs and consisted of unreported lung nodules, pneumothoraces and consolidations. • Applying AI software as a secondary reader after report authorisation can assist in reducing diagnostic errors without interrupting the radiologist’s reading workflow. However, the number of AI-detected discrepancies was considerable and required review by a radiologist to assess their relevance. Graphical Abstract

show abstract

Double reading rates and quality assurance practices in Norwegian hospital radiology departments: two parallel national surveys

Abstract: The rate of double reading in Norwegian hospital radiology is significantly correlated to department teaching status, but not to other practices of quality work.

Cited by 14 publications

References 26 publications

Added value of double reading in diagnostic radiology,a systematic review

Added value of double reading in diagnostic radiology,a systematic review

Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports

Artificial intelligence-assisted double reading of chest radiographs to detect clinically relevant missed findings: a two-centre evaluation

Contact Info

Product

Resources

About