Do radiologists need to review abdominal ultrasound examinations reported as ‘normal’ by the sonographer?

Abstract

Introduction Sonographers demonstrate a high standard of diagnostic performance and work with a considerable degree of professional independence. In Australasia, sonographers typically generate a preliminary report which is reviewed by the radiologist who issues a final report. The aim of this study was to determine whether radiologist's review is required in cases reported as normal by the sonographer. Methods This study was a retrospective review of 1000 abdominal US examinations considered normal by sonographers that were subsequently reported by radiologists. Any findings reported by radiologists that were not reported by sonographers were analysed and separated into errors or discrepancies according to commonly accepted definition. Results The 1000 abdominal examinations included 244 complete abdominal, 200 hepatobiliary, 506 urinary tract and 50 other abdominal examinations. Patients’ age ranged from < 1 to 94 years (mean = 35 years, median = 32 years). US examinations were performed by any one of 14 sonographers with 1–21 years (mean = 6 years, median = 7 years) of clinical experience. Two diagnostic errors were made by sonographers and two errors by radiologists. In no single case did the radiologist uncover a case of an acute or serious illness, illness requiring admission or urgent clinical review, nor did the radiologist identify the cause for the presenting symptoms. Eighteen discrepancies were found, but these were of trivial nature and most were rated by specialist clinicians as irrelevant. Conclusion Sonographers are accurate in distinguishing normal abdominal US examinations. The involvement of a radiologist in a second reading of normal abdominal US examinations is unnecessary.

Australian sonographers’ perceptions of patient safety in ultrasound imaging: Part 1 – identifying the main safety concerns, a qualitative study

“…Sonographers do not generate final reports in Australia but contribute significantly by providing evidence, such as sonographer worksheets and still images, which form the report. 27,28 Some sonographers view this mechanism as an opportunity ‘to have a second set of eyes look at things’ (PS17). For others, this only increases the points at which errors in reporting could occur due to breakdown or misinterpretation in communication in translating findings from a dynamic scan via static modes of communication.…”

“…Studies show close correlation between sonographer findings and reports. 29,28 However, evidence has shown that sonographers tend to use disclaimers regarding image quality, which presents uncertainty in sonographers’ findings from their worksheets. 29 Errors in radiological diagnosis can arise at different phases, including acquisition of images, interpretation of findings as well as missed diagnoses.…”

Routine disclosure statements about ultrasound examinations during Covid‐19 pandemic are unhelpful and should be avoided

“…Sonographers are highly accurate diagnosticians whose diagnostic performance in US has been shown to be on a par with that of radiologists in a number of studies. [23][24][25][26][27][28][29][30] There is therefore no reason to suspect that under the additional pressure of a pandemic, the sonographer's diagnostic performance would somehow become compromised.…”

The accuracy of sonographers in reporting abnormal ultrasound findings: A prospective study comparing sonographers' and radiologists' reports in 1000 hospital patients

“…Sonographers demonstrate a high standard of diagnostic performance and work with a considerable degree of professional independence 1 . The high accuracy of sonographers' diagnostic opinion has been documented in numerous studies across all subspecialties with sonographers demonstrating comparable diagnostic performance to radiologists 2–15 . A recent large study involving 1000 abdominal ultrasound (US) examinations reported as ‘normal’ by sonographers, demonstrated that sonographers have near perfect accuracy in distinguishing a normal examination and commit the same number of reporting errors as radiologists 15 .…”

“…The high accuracy of sonographers' diagnostic opinion has been documented in numerous studies across all subspecialties with sonographers demonstrating comparable diagnostic performance to radiologists 2–15 . A recent large study involving 1000 abdominal ultrasound (US) examinations reported as ‘normal’ by sonographers, demonstrated that sonographers have near perfect accuracy in distinguishing a normal examination and commit the same number of reporting errors as radiologists 15 . The aim of this study was to compare the abnormal US findings independently reported by sonographers with the final reports issued by radiologists in the complex working environment of a large tertiary teaching hospital.…”