title: Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports.
abstract: Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings.
  
  
  
  We retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased.
  
  
  
  Changes were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations.
  
  
  
  A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases.
authors.affiliation: Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway.
authors.forename: Peter Mæhre
authors.identifier: 0000-0002-2309-7218
authors.initials: PM
authors.lastname: Lauritzen
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Jack Gunnar
authors.initials: JG
authors.lastname: Andersen
authors.affiliation: Department of Radiology, Vestre Viken, Drammen Hospital, Drammen, Norway.
authors.forename: Mali Victoria
authors.initials: MV
authors.lastname: Stokke
authors.affiliation: Department of Radiology, Vestre Viken, Bærum Hospital, Sandvika, Norway.
authors.forename: Anne Lise
authors.initials: AL
authors.lastname: Tennstrand
authors.affiliation: Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Rolf
authors.initials: R
authors.lastname: Aamodt
authors.affiliation: Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heggelund
authors.affiliation: Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Fredrik A
authors.initials: FA
authors.lastname: Dahl
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sandbæk
authors.affiliation: Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Petter
authors.initials: P
authors.lastname: Hurlen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Pål
authors.identifier: 0000-0001-7434-5392
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D015588:Observer Variation; D011860:Radiography, Abdominal / Q000592:standards; D000072177:Radiologists / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards
keywords: Audit and feedback; Continuing education; Diagnostic errors; Healthcare quality improvement; Surgery; continuing professional development