Clinical impact of double reading of abdominal CT scans of surgical patients Poster No.: B-0037 Congress: ECR 2015 Type: Scientific Paper Authors: P. Lauritzen, J.-G. Andersen, M. V. Stokke, A. L. Tennstrand, 1 2 1 3 1 1 4 2 T. Heggelund, R. Aamodt, P. Hurlen, G. Sandbæk, P. 5 1 2 3 Gulbrandsen ; Lørenskog/NO, Oslo/NO, Drammen/NO, 4 5 Bærum/NO, Nordbyhagen/NO Keywords: Abdomen, Gastrointestinal tract, Management, CT, Audit and standards, Observer performance, Safety, Quality assurance, Economics, Outcomes DOI: 10.1594/ecr2015/B-0037 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 11
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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 evaluate the proportion of radiology reports that were changed during double reading of abdominal CT scans of surgical patients, 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 3 of 11
Images for this section: Fig. 1: Prospective double reading: work flow. Page 4 of 11
Methods and materials Pairs of preliminary and final reports from 1072 consecutive double read abdominal CT scans of surgical patients 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 6 Two experienced abdominal surgeons 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 "clinically important". We decided not to resolve discrepant ratings given by the two surgeons. In each case, the clinical importance 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 radiological findings was increased, decreased, or unchanged. Page 5 of 11
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 in radiology reports. References: Department of Diagnostic Imaging, Akershus University Hospital Lørenskog/NO Images for this section: Page 6 of 11
Fig. 2: Example of document comparison with color-coding. Fig. 3: Scale for rating the potential clinical impact of changes in radiology reports. Page 7 of 11
Results There were clinically important changes in content to 229 (21%) of the 1072 reports when classified according to the higher rating given. However, if we had chosen to classify clinical importance according to the lower rating given, changes to 126 (12%) of the reports would have been clinically important. Changes in content to 161 (15%) of the reports were classified as "intermediate", 61 (6%) were classified as "large" and 7 (<1%) were classified as "critical". The seven critical changes regarded vascular issues (2), intestinal or bowel obstruction (2), anastomotic leakage (2), and cancer (1). From the 229 clinically important changes 159 (69%) represented an increase in severity of the radiological findings, while 32 (14%) represented a decrease in severity. In 38 (17%) there was no change in severity. Conclusion Our data suggest that quality assurance by double reading of abdominal CT scans of surgical patients has a clinical impact. Clinically important changes were made in up to one fifth of reports as a result of double reading. Seven out of ten changes represented an increase in severity of the radiological findings. Personal information Corresponding author: Peter Lauritzen, MD (plau@ahus.no) Akershus University Hospital, Norway This study was a collaboration between: Akershus University Hospital, Norway, Oslo University Hospital, Norway and Vestre Viken Hospital (Bærum, Drammen and Ringerike Hospitals), Norway. Page 8 of 11
Fig. 4: Akershus University Hospital, Norway References: Akershus University Hospital, Norway Fig. 5: Oslo University Hospital, Norway References: Oslo University Hospital, Norway Fig. 6: Vestre Viken Hospital, Norway References: Vestre Viken Hospital, Norway This study received funding from: The Norwegian Medical Association's Fund for Quality Improvement and Patient Safety and The Norwegian Society of Radiology's Reseach Fund. Page 9 of 11
Fig. 7: The Norwegian Medical Association References: The Norwegian Medical Association Fig. 8: The Norwegian Society of Radiology References: The Norwegian Society of Radiology References 1. 2. 3. Heriot GS, McKelvie P, Pitman AG. Diagnostic errors in patients dying in hospital: Radiology's contribution. J Med Imaging Radiat Oncol. 2009;53(2):188-193. 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):1146-1150. 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):155-156. Page 10 of 11
4. 5. 6. 7. 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):78-86. Husby JA, Espeland A, Kalyanpur A, Brocker C, Haldorsen IS. Double reading of radiological examinations in Norway. Acta Radiol. 2011;52(5):516-521. Jackson VP, Cushing T, Abujudeh HH, et al. RADPEER scoring white paper. J Am Coll Radiol. 2009;6(1):21-25. Hurlen P, Østbye T, Borthne A, Gulbrandsen P. Introducing PACS to the Late Majority. A Longitudinal Study. J Digit Imaging. 2008;23(1):87-94. Page 11 of 11