title: The degree of abdominal imaging (AI) subspecialization of the reviewing radiologist significantly impacts the number of clinically relevant and incidental discrepancies identified during peer review of emergency after-hours body CT studies.
abstract: OBJECTIVE
  To evaluate if and to what extent the degree of subspecialization in abdominal imaging (AI) affects rates of discrepancies identified on review of body CT studies initially interpreted by board-certified radiologists not specialized in AI.
  
  
  METHODS
  AI division radiologists at one academic medical center were classified as primary or secondary members of the division based on whether they perform more or less than 50% of their clinical duties in AI. Primary AI division radiologists were further subdivided based on whether or not they focus their clinical duties almost exclusively in AI. All AI radiologists performed subspecialty review of all after-hours body CT studies initially interpreted by any non-division radiologist. The discrepancies identified in the subspecialty review of consecutive after-hours body CT scans performed between 7/1/10 and 12/31/10 were analyzed and placed into one of three categories: (1) discrepancies that potentially affect patient care ("clinically relevant discrepancies", or CRD); (2) discrepancies that would not affect patient care ("incidental discrepancies", or ID); and (3) other types of comments. Rates of CRD and ID detection were compared between subgroups of Abdominal Imaging Division radiologists divided by the degree of subspecialization.
  
  
  RESULTS
  1303 studies met the inclusion criteria. Of 742 cases reviewed by primary members of the AI division, 33 (4.4%) had CRD and 78 (10.5%) had ID. Of 561 cases reviewed by secondary members of the AI division, 11 (2.0%) had CRD and 36 (6.5%) had ID. The differences between the groups for both types of discrepancies were statistically significant (p = 0.01). When primary members of the AI division were further subdivided based on extent of clinical focus on abdominal imaging, rates of CRD and ID detection were higher for the subgroup with more clinical focus on abdominal imaging.
  
  
  CONCLUSIONS
  The degree of AI subspecialization affects the rate of clinically relevant and ID identified in body CT interpretations initially rendered by board certified but non-abdominal imaging subspecialized radiologists.
authors.affiliation: Department of Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Bell
authors.forename: Maitray D
authors.initials: MD
authors.lastname: Patel
mesh_terms: D039602:After-Hours Care / Q000379:methods / Q000706:statistics & numerical data*; D004630:Emergencies; D006801:Humans; D015588:Observer Variation; D010380:Peer Review / Q000379:methods*; D011860:Radiography, Abdominal / Q000379:methods* / Q000706:statistics & numerical data; D011871:Radiology / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013038:Specialization; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data