Importantly, the radiology report of the secondary interpretation may contain a recommendation to the referring clinician to perform further diagnostic tests, whether imaging or otherwise, to clarify findings of indeterminate nature. There is a lack of literature on how frequently recommendations in second opinion radiology reports are followed by referring clinicians and what determinants, if any, affect referring clinicians' compliance. Furthermore, the diagnostic outcome of recommendations in second opinion radiology reports remains unclear. Because the number of secondary interpretations and associated cumulative healthcare costs have risen considerably [1], insight into the practice and value of recommendations in second opinion radiology reports has become increasingly important. This information may be useful to improve communica-

radiology departments are increasing. Importantly, to ensure the clinical value of a second-opinion reading, the report filed by the radiologist should be read by the clinician who requested the report [11, 12]. Many clinicians receive more than 10 radiology reports per week [13]. Consequently, their inclination to read a particular report may depend on patient and clinical circumstances. Data are lacking about how often clinicians do not read second-opinion reports and what determinants may influence a clinician's decision to not read a report. This information may be valuable to radiology departments and health care policy makers to gain insight into the utility of second-opinion readings and to identify potential opportunities to improve the efficacy of this practice.Therefore, the purpose of this study was to investigate the frequency and determinants of clinicians not reading second-opinion radiology reports.

BACKGROUND AND PURPOSE: Second opinion reports of neurologic head and neck imaging are requested with increased regularity, and they may contain a recommendation to the clinician. Our aim was to investigate the frequency and determinants of the presence of a recommendation and the adherence by the referring physician to the recommendation in a second opinion neurology head and neck imaging report and the diagnostic yield of these recommendations. MATERIALS AND METHODS:This retrospective study included 994 consecutive second opinion reports of neurology head and neck imaging examinations performed at a tertiary care center. RESULTS:Of the 994 second opinion reports, 12.2% (121/994) contained a recommendation. An oncologic imaging indication was significantly (P ¼ .030) associated with a lower chance of a recommendation in the second opinion report (OR ¼ .67; 95% CI, 0.46-0.96). Clinicians followed 65.7% (88/134) of the recommendations. None of the investigated variables (patient age, sex, hospitalization status, indication for the second opinion report, experience of the radiologist who signed the second opinion report, strength of the recommendation, and whether the recommendation was made due to apparent quality issues of the original examination) were significantly associated with the compliance of the referring physician to this recommendation. The 134 individual recommendations eventually led to the establishment of 52 (38.2%) benign diagnoses and 28 (20.6%) malignant diagnoses, while no definitive diagnosis could be established in 56 (41.2%) cases. CONCLUSIONS:Recommendations are relatively common in second opinion reports of neurology head and neck imaging examinations, though less for oncologic indications. They are mostly followed by requesting physicians, thus affecting patient management. In most cases, they also lead to the establishment of a diagnosis, hence adding value to patient care.