Elizabeth Lindgren MD, Presenter: Nothing to Disclose

Maitray D. Patel MD, Abstract Co-Author: Nothing to Disclose

Robert Jeffrey Melikian, Abstract Co-Author: Nothing to Disclose

Amy Kiyo Hara MD, Abstract Co-Author: License agreement, General Electric Company Researcher, General Electric Company

The purpose of this study is to determine the clinical impact and value of outside imaging reinterpretations by subspecialty-trained abdominal imagers.

Interpretation requests for outside abdominal studies were retrospectively identified from our radiology database. The outside and secondary radiology reports were compared and interpretive differences recorded. The electronic medical record clinical notes, pathology, imaging were reviewed to determine the final diagnosis and clinical impact of any interpretative differences. Interpretive errors were graded as high clinical impact if it led to an incorrect treatment plan, medium if it led to minor delays or unnecessary additional tests, or low/none clinical impact. Error type was graded as not reported, undercalled, overcalled, misinterpreted, or combination.

145 outside reports have been reviewed thus far (65M:80F, average age=57 yrs, range 18-95 years). The most common film type was CT (110), then MR (19), US (12), other (4). The expert radiologist identified a finding that differed from the original report and had high clinical impact in 8.3% (12/145) of cases and medium clinical impact in 6.2% (9/145). The types of outside interpretive errors were most commonly overcalls (13/21, 62%), followed by undercalls (4), not reported (3) and combination errors (1). Findings missed by the outside interpretation included a pancreatic cancer, pancreatitis and omental metastases. There were 2 cases where the subspecialty interpretation overcalled findings (small bowel dilatation, left ovarian lesion) and all were graded as medium clinical impact. There were no high clinical impact errors by the subspecialty/expert radiologist.

Expert review of abdominal outside imaging (mainly CT) identified discrepancies of high clinical impact in 8% of cases. The majority of interpretive errors consisted of overcalling the significance of benign findings, leading to unnecessary additional tests.

Reinterpretation of outside abdominal imaging exams by subspecialty radiologists can lead to cost savings and improved patient care in 8-14% of cases.

Lindgren, E, Patel, M, Melikian, R, Hara, A, Do Expert Secondary Reads of Outside Abdominal Imaging Add Clinical Value?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026918.html