Utility of contemporaneous dual read in the setting of emergency teleradiology reporting

Abstract

Emergency radiology requires rapid and accurate interpretation of imaging examinations. Missed findings may lead to adverse outcomes. Double reporting may be used to minimize errors. Limited contemporaneous double reporting may be most efficient and cost-effective, but no data exists. This study is intended to examine the benefits of double reading and identify examinations where this would be most useful. In this study, dual reporting was conducted in a parallel reading environment in a teleradiology practice for 3779 radiological procedures performed at two radiology centers in the USA over a period of 4months. Discrepancies between reads were scored using the ACR peer review scoring system and grouped by modality and body part. Errors were tabulated across the study types, followed by identification of statistically significant differences. The interaction between image number and odds of an error was ascertained. In 145 instances (3.8%; 95% CI, 3.2-4.4%), double reporting identified errors, leading to report modification. Study type was significantly related to error frequency (p=0.0001), with higher than average frequencies of error seen for CT abdomen and pelvis and MRI head or spine, but lower than average for CT head, CT spine, and ultrasound. Image number was positively associated with error odds, but was not independently significant in a joint logistic regression model that included study type. Dual reporting identifies missed findings in about 1 of 25 emergency studies. This benefit varies substantially across study types and limited double reporting, merits further investigation as a cost-effective practice improvement strategy.