title: Postprocedure radiologist's interpretation of ERCP x-ray films: a prospective outcomes study.
abstract: OBJECTIVE
  To prospectively determine if the current practice of radiologists' interpretation of post-ERCP spot images sent by endoscopists resulted in discrepancies in interpretation, affected subsequent management of patients, and resulted in additional costs.
  
  
  METHODS
  A prospective analysis of 145 consecutive patients who underwent ERCP over the course of 4 months was performed. A separate endoscopist, not involved in the patient's care, reviewed the radiologist's report of the ERCP x-ray films to determine whether there was either concordance or discordance with the procedural findings. All patients' clinical courses were prospectively followed for a minimum of 6 months to determine whether clinical decision-making was affected by the radiologists' interpretation of the x-ray films. Secondarily, the cost of the current practice of postprocedure interpretation of ECRP radiographs was measured.
  
  
  METHODS
  This study took place at University Hospitals of Cleveland, which is a tertiary care facility.
  
  
  RESULTS
  In total, there were 61 (47%) discordant interpretations of 130 cholangiograms and 27 (38%) discordant interpretations of 72 pancreatograms, with an overall discordance between an endoscopist and a radiologist in 80 (55%) of the 145 cases. Clinical management was subsequently affected in 3 (2.1%) cases, all of which involved a discordant reading. In each of the 3 cases, further testing validated the gastroenterologist's initial findings at the time of the procedure. Radiologists were reimbursed $5395 for interpretation of ERCP x-ray films. Extrapolated over the course of a year, the reimbursement at this single tertiary care hospital would be greater than $16,000. Additional testing based on discordant reports resulted in $2510 of reimbursement for 3 patients.
  
  
  CONCLUSIONS
  The limitation of this study is that it reflects data from only one academic institution.
  
  
  CONCLUSIONS
  Radiologists' interpretation of postprocedure ERCP films were inadequate, with a 47% discordance rate among cholangiograms and a 38% discordance rate among pancreatograms. The routine practice of postprocedure ERCP x-ray film interpretation by radiologists altered clinical practice in 2.1% of cases; subsequent care did not confirm radiologists' findings and imparted increased risk to the patients. This practice proved to be a misallocation of resources and should not be continued.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Kucera
authors.forename: Gerard
authors.initials: G
authors.lastname: Isenberg
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Richard C K
authors.initials: RC
authors.lastname: Wong
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Faulx
authors.forename: Michael V
authors.initials: MV
authors.lastname: Sivak
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D015607:Stents; D016896:Treatment Outcome