The customer is always right, even when you are justifiably wrong.

Abstract

Customer surveys are useful tools for understanding and improving a business. If performed well and interpreted in the appropriate context, they are also useful vehicles for the education of staff members and for the stimulation of positive corporate change. Whether we choose to acknowledge it or not, imaging is a service industry that provides a product. That product is our opinion and advice in the form of a written report. Although our training and the traditions of western medicine may lead us to believe otherwise, in imaging the client is generally the patient’s doctor rather than the patient. Through the process of referral, we are at least one step away from direct involvement in patient care, even though the information that we provide may be absolutely crucial to treatment choices and patient outcomes. Accordingly, a survey of the opinions of referring clinicians regarding imaging reports is, in essence, an assessment of customer satisfaction. The article by Karantanis et al. in the current issue of The Journal of Nuclear Medicine (1 )p rovides some interesting insights with respect to oncologic 18 FFDG PET/CT reporting. The authors surveyed 662 clinicians from See page 1925 a range of pertinent specialties, with the major groups being oncologists (36.1%) and surgeons (33.8%). There was representation from several continents, but most respondents were from Europe (47.3%) or North America (35.0%), and the vast majority (85.8%) of respondents were practicing in an academic environment. Because PET/CT systems have been widely available in academic centers in both of these regions for more than a decade, one can assume a reasonably high level of experience in both the users and the providers of PET/CT services. The specified aim of the survey was to understand the frequency and nature of errors in reporting, as perceived by the end user of the information provided. Overall, 59.3% of respondents estimated that rates of misinterpretation ranged from 5% to 20%. Although this range reflects the typical accuracy reported in individual series and meta-analyses of PET/CT across various malignancies, the upper end of this range may be higher than we, as providers, would like to imagine is the proportion of cases in which we are incorrect. Perhaps the most instructive finding of the survey was that a significantly greater proportion of respondents believed that the major source of errors in reporting of PET/CT studies related to overinterpretation (68.9%) rather than underinterpretation (8.7%). This finding may come as a surprise to many expert PET/CT interpreters, who may have expected the opposite. Since the days of stand-alone 18 F-FDG PET, multiple causes of falsepositive results have been recognized (2). The availability of the additional information provided by the CT component should fur