Clinical impact of double reading of thoracic CT
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1 Clinical impact of double reading of thoracic CT Poster No.: B-1259 Congress: ECR 2015 Type: Scientific Paper Authors: P. Lauritzen, J.-G. Andersen, M. V. Stokke, A. L. Tennstrand, G. Bjerke, K. Stavem, P. Hurlen, G. Sandbaek, P Gulbrandsen ; Lørenskog/NO, Oslo/NO, Drammen/NO, 4 5 Bærum/NO, Nordbyhagen/NO Keywords: Thorax, Respiratory system, Management, CT, CT-Angiography, CT-High Resolution, Safety, Observer performance, Audit and standards, Quality assurance, Outcomes, Economics DOI: /ecr2015/B-1259 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13
2 Purpose Radiology interpretation errors contribute to 41% of diagnostic errors in patients dying in hospital [1]. Double reading reduces errors and increases sensitivity, though it may reduce specificity [2, 3] Quality assurance by prospective double reading of current examinations is extensively applied in Norwegian hospital radiology [4, 5]. Consultant radiologists in Norwegian hospitals submit 39% of interpreted computed tomography (CT) scans for quality assurance by double reading [4]. This quality assurance method differs from most peer review practices by targeting current examinations (not previous), and by the first reader selecting examinations for double reading (not random) [6, 7]. Fig. 1 on page 4 Our purpose was to estimate the proportion of radiology reports that were changed during double reading of thoracic CT, and to assess the potential clinical impact of these changes. Fig. 1: Prospective double reading: work flow. References: Department of Diagnostic Imaging, Akershus University Hospital Lørenskog/NO Page 2 of 13
3 Page 3 of 13
4 Images for this section: Fig. 1: Prospective double reading: work flow. Department of Diagnostic Imaging, Akershus University Hospital - Lørenskog/NO Page 4 of 13
5 Methods and materials Pairs of preliminary and final reports from 1023 consecutive double read thoracic CT scans were collected from five hospitals with a combined catchment population of 1.1 million. The pairs of reports were compared with document comparison software, which labeled deletions, additions, and changes in the reports by colorcoding. Fig. 2 on page 7 Two experienced pulmonologists independently rated the potential clinical impact of all changes in content on a 5-point scale devised for this purpose. Fig. 3 on page 7 Changes not affecting investigation, controls or treatment, were rated "minimal" or "small", and considered "not clinically important". Changes affecting further investigations or controls were rated "intermediate". Changes implying a change of treatment or diagnosis were rated "large". Changes demanding immediate action were rated "critical". Intermediate, large, and critical changes were considered "clinially important". We decided not to resolve discrepant ratings given by the two pulmonologists. In each case clinical importance of change was classified according to the higher of the two ratings given. Changes were also classified according to the clinical issue concerned, and whether the severity of the radiological findings was increased, decreased, or unchanged. Page 5 of 13
6 Fig. 2: Example of document comparison with color-coding References: Department of Diagnostic Imaging, Akershus University Hospital Lørenskog/NO Fig. 3: Scale for rating the potential clinical impact of changes to radiology reports References: Department of Diagnostic Imaging, Akershus University Hospital Lørenskog/NO Page 6 of 13
7 Images for this section: Fig. 2: Example of document comparison with color-coding Department of Diagnostic Imaging, Akershus University Hospital - Lørenskog/NO Fig. 3: Scale for rating the potential clinical impact of changes to radiology reports Department of Diagnostic Imaging, Akershus University Hospital - Lørenskog/NO Page 7 of 13
8 Results There were clinically important changes in content to 130 (13%) of the 1023 reports when classified according to the higher rating. However, if we had chosen to classify clinical importance according to the lowest rating given, changes to 42 (4%) would have been classified as clinically important. Changes in 73 (7%) of the reports were classified as "intermediate", 50 (5%) were classified as "large" and seven (<1%) were classified as "critical". Five of the seven "critical" changes concerned cardiovascular issues. From the 130 clinically important changes, 95 (73%) represented an increase in severity of radiological findings, while 21 (16%) represented a decrease in severity. In 14 cases (11%) there was no change in severity. Page 8 of 13
9 Conclusion Our data suggest that quality assurance by double reading of current examinations has clinical impact. Clinically important changes were made in up to 13% of reports as a result of double reading. Three out of four changes represented an increase in the severity of radiological findings. Page 9 of 13
10 Personal information Corresponding author: Peter Lauritzen, MD Akershus University Hospital, Norway This study was a collaboration of: Akershus University Hospital, Norway Oslo University Hospital, Norway, and Vestre Viken Hospital (Bærum, Drammen & Ringerike Hospitals), Norway. Fig. 4: Akershus University Hospital, Norway References: Akershus University Hospital, Norway Fig. 5: Oslo University Hospital, Norway References: Oslo University Hospital, Norway Page 10 of 13
11 Fig. 6: Vestre Viken Hospital, Norway References: Vestre Viken Hospital, Norway The study received funding from: The Norwegian Medical Association's Fund for Quality Improvement and Patient Safety and The Norwegian Society of Radiology's research fund. Fig. 7: The Norwegian Medical Association References: The Norwegian Medical Association Page 11 of 13
12 Fig. 8: The Norwegian Society of Radiology References: The Norwegian Society of Radiology Page 12 of 13
13 References Heriot GS, McKelvie P, Pitman AG. Diagnostic errors in patients dying in hospital: Radiology's contribution. J Med Imaging Radiat Oncol. 2009;53(2): Quekel LG, Goei R, Kessels AG, van Engelshoven JM. Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading. J Clin Epidemiol. 2001;54(11): Markus JB, Somers S, O Malley BP, Stevenson GW. Double-contrast barium enema studies: effect of multiple reading on perception error. Radiology. 1990;175(1): Lauritzen PM, Hurlen P, Sandbaek G, Gulbrandsen P. Double reading rates and quality assurance practices in Norwegian hospital radiology departments: two parallel national surveys. Acta Radiol. 2015;56(1): Husby JA, Espeland A, Kalyanpur A, Brocker C, Haldorsen IS. Double reading of radiological examinations in Norway. Acta Radiol. 2011;52(5): Jackson VP, Cushing T, Abujudeh HH, et al. RADPEER scoring white paper. J Am Coll Radiol. 2009;6(1): Hurlen P, Østbye T, Borthne A, Gulbrandsen P. Introducing PACS to the Late Majority. A Longitudinal Study. J Digit Imaging. 2008;23(1): Page 13 of 13
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