title: Double reading of current chest CT examinations: Clinical importance of changes to radiology reports.
abstract: OBJECTIVE
  Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Double reading reduces interpretation errors and increases sensitivity. Consultant radiologists in Norwegian hospitals submit 39% of computed tomography (CT) reports for quality assurance by double reading. Our objective was to estimate the proportion of radiology reports that were changed during double reading and to assess the potential clinical impact of these changes.
  
  
  METHODS
  In this retrospective cross-sectional study we acquired preliminary and final reports from 1023 consecutive double read chest CT examinations conducted at five public hospitals. The preliminary and final reports were compared for changes in content. Three experienced pulmonologists independently rated the clinical importance of these changes. The severity of the radiological findings in clinically important changes was classified as increased, unchanged, or decreased.
  
  
  RESULTS
  Changes were classified as clinically important in 91 (9%) of 1023 reports. Of these: 3 were critical (demanding immediate action), 15 were major (implying a change in treatment) and 73 were intermediate (affecting subsequent investigations). More clinically important changes were made to urgent examinations and less to female first readers. Chest radiologist made more clinically important changes than other second readers. The severity of the radiological findings was increased in 73 (80%) of the clinically important changes.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnostic Imaging, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: peter.m.lauritzen@gmail.com.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Lauritzen
authors.affiliation: Department of Pulmonary Medicine, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: knut.stavem@medisin.uio.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Stavem
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway. Electronic address: uxjaga@ous-hf.no.
authors.forename: Jack Gunnar
authors.initials: JG
authors.lastname: Andersen
authors.affiliation: Department of Diagnostic Imaging, Vestre Viken Hospital, C/O Drammen Sykehus, NO-3004 Drammen, Norway. Electronic address: mali.victoria.stokke@vestreviken.no.
authors.forename: Mali Victoria
authors.initials: MV
authors.lastname: Stokke
authors.affiliation: Department of Diagnostic Imaging, Vestre Viken Hospital, C/O Drammen Sykehus, NO-3004 Drammen, Norway. Electronic address: al-tenn@online.no.
authors.forename: Anne Lise
authors.initials: AL
authors.lastname: Tennstrand
authors.affiliation: Department of Pulmonary Medicine, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: gisle.bjerke@ahus.no.
authors.forename: Gisle
authors.initials: G
authors.lastname: Bjerke
authors.affiliation: Department of Diagnostic Imaging, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: petter@hurlen.no.
authors.forename: Petter
authors.initials: P
authors.lastname: Hurlen
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway. Electronic address: gsandb@ous-hf.no.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sandbæk
authors.affiliation: Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: fredrik.a.dahl@ahus.no.
authors.forename: Fredrik A
authors.initials: FA
authors.lastname: Dahl
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, NO-0318 Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Postboks 1000, NO-1478 Lørenskog, Norway. Electronic address: pal.gulbrandsen@medisin.uio.no.
authors.forename: Pål
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway; D015588:Observer Variation; D011785:Quality Assurance, Health Care / Q000379:methods*; D013902:Radiography, Thoracic / Q000592:standards*; D011872:Radiology Department, Hospital; D011873:Radiology Information Systems / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: Chest; Computed tomography; Continuing professional development; Diagnostic errors; Health care peer review; Health care quality assurance