Double reading of current chest CT examinations: Clinical importance of changes to radiology reports

Lauritzen, Peter Mæhre; Stavem, Knut; Andersen, Jack Gunnar; Stokke, Mali; Tennstrand, Anne Lise; Bjerke, Gisle; Hurlen, Petter; Sandbæk, Gunnar; Dahl, Fredrik A.; Gulbrandsen, Pål

doi:10.1016/j.ejrad.2015.11.012

Cited by 18 publications

(14 citation statements)

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“…There are numerous studies evaluating the impact and cost of double reading imaging examinations in radiology, with most studies unable to demonstrate improvements in accuracy that justify the cost and resources of double reading (38,(56)(57)(58)(59)(60)(61)(62)(63)(64). Given that 60%-80% of diagnostic errors are perceptual errors (initially missed but visible in retrospect), we believe that prospective double reading may still be a promising approach to reduce the impact and frequency of diagnostic errors.…”

Section: Double Readingmentioning

confidence: 99%

Fundamentals of Diagnostic Error in Imaging

et al. 2018

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Imaging plays a pivotal role in the diagnostic process for many patients. With estimates of average diagnostic error rates ranging from 3% to 5%, there are approximately 40 million diagnostic errors involving imaging annually worldwide. The potential to improve diagnostic performance and reduce patient harm by identifying and learning from these errors is substantial. Yet these relatively high diagnostic error rates have persisted in our field despite decades of research and interventions. It may often seem as if diagnostic errors in radiology occur in a haphazard fashion. However, diagnostic problem solving in radiology is not a mysterious black box, and diagnostic errors are not random occurrences. Rather, diagnostic errors are predictable events with readily identifiable contributing factors, many of which are driven by how we think or related to the external environment. These contributing factors lead to both perceptual and interpretive errors. Identifying contributing factors is one of the keys to developing interventions that reduce or mitigate diagnostic errors. Developing a comprehensive process to identify diagnostic errors, analyze them to discover contributing factors and biases, and develop interventions based on the contributing factors is fundamental to learning from diagnostic error. Coupled with effective peer learning practices, supportive leadership, and a culture of quality, this process can unquestionably result in fewer diagnostic errors, improved patient outcomes, and increased satisfaction for all stakeholders. This article provides the foundational elements for implementing this type of process at a radiology practice, with examples to help radiologists and practice leaders achieve meaningful practice improvement. ©

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Section: Double Readingmentioning

confidence: 99%

Fundamentals of Diagnostic Error in Imaging

et al. 2018

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“…False positives, 0.9–3.9% for readers, 7.2% for CAD Double reading and CAD increased sensitivity, CAD more than double reading, at the cost of more false positives for CAD Rubin GD, USA [ 22 ] 2005 Pulmonary nodules on CT Independent reading by three radiologists, reference standard by two thoracic radiologists + CAD 20 Sensitivity single reading 50%, double reading 63%, single reading + CAD 76–85% Double reading increased sensitivity slightly. Inclusion of CAD increased sensitivity further Wormanns D, Germany [ 23 ] 2005 Chest CT for pulmonary nodules Independent double reading of low- and standard-dose CT 9 patients with 457 nodules Sensitivity of single reading, 64%; double reading, 79%; triple reading, 87% (low-dose CT) Double reading significantly increased sensitivity 5-mm slices used in the study Lauritzen PM, Norway [ 24 ] 2016 Chest CT Double reading, peer review 1,023 Clinically important changes in 9% Primary reader chose which studies should be double-read, thus probably more difficult cases. More clinically important changes were made to urgent examinations, chest radiologists made more clinically important changes than the other consultants Lian K, Canada [ 25 ] 2011 CT angiography of the head and neck Blinded double reading by two neuroradiologists in consensus, compared with original report by a neuroradiologist 503 26 significant discrepancies were found in 20 cases, overall miss rate of 5.2% Double reading may decrease the error rate Double reading by peers; radiography Markus JB, Canada [ 26 ] 1990 Double-contrast barium enema Double and triple reporting, colonoscopy as reference standard 60 Sensitivity/specificity of single reading, 68/96%; double reading.…”

Section: Resultsmentioning

confidence: 99%

“… In chest CT for pulmonary nodules, double reading increased sensitivity [ 8 , 22 , 23 ], but computer-aided diagnosis (CAD) was even more beneficial [ 8 , 22 ]. Another article found clinically important changes in 9% of cases [ 24 ]. …”

Section: Resultsmentioning

confidence: 99%

Added value of double reading in diagnostic radiology,a systematic review

Geijer

2018

Insights Imaging

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ObjectivesDouble reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.MethodsA systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.ResultsThe literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.ConclusionsThe systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.Key Points • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates. Electronic supplementary materialThe online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.

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“…The American Association of Physicists in Medicine, however, has stated that the risk from exposure to an effective radiation dose of less than 50 mSv is ‘too low to be detectable and may be non‐existent’. With typical reading times for abdominal and chest CT of around 17 and 11 min respectively, in a high‐volume radiology department, turnaround times may be adversely affected and misinterpretations increased (9 per cent and 14 per cent rate of clinically important changes at report review for chest and abdomen respectively). In the present cohort, chest CT would have to be undertaken at staging in 63 patients (1/0·016) to identify one patient with pulmonary metastasis, whereas 505 and 808 such scans would have to be performed to identify one patient with isolated pulmonary metastasis based on the series by Kong and co‐workers and Chong et al .…”

Section: Discussionmentioning

confidence: 99%

Routine chest CT for staging of gastric cancer

Chen

Chan

Lee

et al. 2019

British Journal of Surgery

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Background International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer. Methods This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size. Results Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X‐ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively. Conclusion This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected.

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Double reading of current chest CT examinations: Clinical importance of changes to radiology reports

Abstract: 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.

Cited by 18 publications

References 19 publications

Fundamentals of Diagnostic Error in Imaging

Fundamentals of Diagnostic Error in Imaging

Added value of double reading in diagnostic radiology,a systematic review

Routine chest CT for staging of gastric cancer

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