Abraham H. Dachman MD, Abstract Co-Author: Consultant, E-Z-EM, Inc Consultant, iCAD, Inc Research support, iCAD, Inc Consultant, General Electric Company Research support, Koninklijke Philips Electronics NV

Richard L. Baron MD, Abstract Co-Author: Nothing to Disclose

Paul J. Chang MD, Abstract Co-Author: Co-founder, Koninklijke Philips Electronics NV Medical Adivsory Board, Vital Images, Inc Medical Adivsory Board, Amirsys, Inc Medical Adivsory Board, Koninklijke Philips Electronics NV

Aytekin Oto MD, Abstract Co-Author: Nothing to Disclose

Michael Walter Vannier MD, Abstract Co-Author: Board of Directors, Vital Images, Inc Speakers Bureau, General Electric Company Research grant, Koninklijke Philips Electronics NV

Piotr Roman Obara MD, Presenter: Nothing to Disclose

Brian S. Funaki MD, Abstract Co-Author: Book contract, Thieme Medical Publishers, Inc Book contract, Springer Science+Business Media Deutschland GmbH Data Monitoring Safety Board, FoxHollow Technologies, Inc Editor, Thieme Medical Publishers, Inc

David M. Paushter MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

A PACS-integrated database system to compile interpretation error data was implemented and tested to assess its feasibility and potential impact on clinical practice quality and evaluation of improvement.

Entry of radiologist interpretation errors was done with a PACS integrated web form, followed by electronic based confidential periodic peer review of errors for quality improvement. Data for the following categories was entered for each error reviewed: imaging modality, organ, error grade, clinical significance, error overcall, and relevant imaging follow-up. Each error was assigned an initial grade on a 4-point scale based on the level of conspicuity of the pertinent abnormality, with 4 being most conspicuous. After group peer review, a final consensus grade and any key comments related to the nature of the error or disease process were also entered. Only errors with initial grade 3 or 4 were entered into the database. We collected data on 80 cases involving interpretation errors that were reviewed by radiologists in the abdominal imaging section of our institution during a year-long period.

Of the 80 cases scored as grade 3 or 4 errors, the initial prevalence of grade 4 errors was 10/80 (12%); grade 3 error prevalence was 70/80 (88%). After consensus review, the distribution of rescored cases among the 4 error grades was the following: grade 4 (7%), grade 3 (43%), grade 2 (23%), grade 1 (27%). The average difference between initial and final grade was 0.9 (range: 0-2), with a downgrade in all cases except for one. Half the cases had a clinically significant error. The organs or sites most frequently involved in an interpretation error were: lymph node (18%), liver (15%), lung (14%), and bowel (13%). The percentage of clinically significant errors was highest for bowel (90%) and liver (50%).

Using the PACS integrated interpretation error database, we concluded that interpretation errors most frequently involved the lymph nodes, and errors involving bowel were most likely to be clinically significant. This type of database can be used to assess interpretation error trends and potential corrective measures while maintaining workflow and peer review efficiency.

Peer review of interpretation errors is essential for monitoring quality of practice. Electronic integration of this process with PACS may improve review compliance, timeliness, and completeness.

Dachman, A, Baron, R, Chang, P, Oto, A, Vannier, M, Obara, P, Funaki, B, Paushter, D, et al, , Interpretation Error Assessment Using a PACS Integrated Database.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017967.html