The purpose of this study was to study whether the benefits from introducing a picture archiving and communication systems (PACS) reported by innovators and early adopters also can be achieved by a hospital belonging to the "late majority" and to see whether such benefits are sustained, using report turnaround time (RTAT) as an indicator. Activity-related data was retrieved from the radiology information system (RIS) over a 2-year period. The median RTAT for preliminary reports was initially reduced from 12 to 2 h then increased to 3 h. For final reports, the median RTAT was initially reduced from 23 to 13 h then gradually reverted back to 22 h. Innovators and early adopters demonstrate not only that positive results can be achieved but also the importance of involving key personnel. We believe that such involvement and the focus on wider organizational concerns are important when introducing PACS to the late majority, both for achieving and sustaining positive results.

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.

In 138 male Norwegian prisoners the prevalence of hepatitis B virus (HBV) serum markers was 30.4% and closely related to their drug abuse. The highest frequency of the markers (82.8%) was found in young drug addicts admitting intravenous abuse and the lowest (14.3%) in prisoners denying such abuse. For comparison, the frequency of HBV serum markers in the general male population in Norway is about 4.1%. In young prisoners (less than 30 years), DMF teeth, percentage of gingival bleeding, and percentage of periodontal pockets greater than 4 mm were on an average 18.8, 38.2%, and 7.0%, respectively. These corresponding figures in the older age group (greater than 30 years) were 21.7, 38.5%, and 15.2%. These findings indicate a dental health status somewhere between that of the general population and disadvantaged groups in Norway previously surveyed. Other oral pathological conditions were present in more than one third of the prisoners, but mucosal lesions and disorders of psychosomatic origin did not extend normal ranges. No characteristic lesions attributable to drug abuse were observed. Dental care was given a low priority by the prisoners. Emergency procedures had been the treatment of choice at infrequent, irregular visits to the dentist, leading to enhanced risk of bleeding and of HBV transmission.

A 9% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and targeting a selection of urgent cases prospectively may increase the yield of discrepant cases and reduce harm to patients.