May 17, 2018 - reading time 6 mins
By Hugh Harvey
No role in a hospital has evolved as much as that of radiologists over the past three decades.
From slow-paced wet film and written notes to the fully digitized, interconnected and volume-driven job of today, the work of the clinical radiologist has changed far faster than any other medical With an estimated one billion radiological examinations performed worldwide every year and the increasing use of diagnostic and interventional radiology services, radiologists have been elevated from a supporting role to Against this background, the continued surge in demand for diagnostic and interventional services is providing radiologists with end-to-end involvement in patient care from the point of admission. Take mechanical thrombectomy, for example, which is used for the treatment of acute stroke. While we must acknowledge the invaluable role of specialist physicians here, the stroke is actually diagnosed by a diagnostic radiologist interpreting a CT scan of the patient’s brain, followed by swift treatment of the stroke by an interventional neuroradiologist. Increasing demand, though, brings new challenges and responsibilities as radiologists become custodians of a greater proportion of a hospital’s resources, especially with regards to managing a
Despite this evolving role, diagnostic image interpretation remains at its heart and still makes up the bulk of a radiologist’s workload. Although technology is constantly improving to make image interpretation more sensitive and specific, discrepancies in radiology reporting still occur to the detriment of patients. Although the exact definition of a radiological error or discrepancy is a debate in itself, there is some agreement that a discrepancy encompasses any radiological interpretation that differs significantly from that of one’s peers. Such is the ambiguity as to what exactly is deemed as a discrepancy in radiology. As the Royal College of Radiologists in the UK states: “There are no objective benchmarks for acceptable levels of observation, interpretation or ambiguity discrepancies.” The published literature suggests discrepancy rates range from 3%–30% and, based on the estimated 40 million radiological examinations performed every year in the UK, even if we take the lowest of these figures (3%), there are approximately 1.2 million radiological discrepancies every year in that country alone. Radiology is a unique speciality in which nearly every radiological opinion is available for re-evaluation. Digital imaging archiving systems mean the loss of imaging data over time is virtually impossible and data is retrievable within minutes. It would be fair to say, then, that radiology is one of the few professions where the owner of the job captures all their mistakes in pictures – which is the essence of radiology department discrepancy meetings that are held on a regular basis in hospitals everywhere.
Comparing the diagnostic accuracy of radiologists with that of other The Kim-Mansfield radiological error classification system A much simpler approach is to broadly separate errors into two categories: perceptual (missed findings) and cognitive (misinterpretation of findings). Although discrepancies in both categories are due to a combination of system and human errors, it is clear the radiologist is as dependent on the clinician to provide accurate clinical information as the clinician is on the accuracy of the final radiological report. There is a well-documented example of procedural error whereby two Although perceptual errors account for a larger proportion of errors, cognitive errors might benefit most from better clinical input. More often than not, radiological findings can represent wide differential diagnoses of limited clinical value. In these situations, the initiative is on the radiologist to actively seek additional clinical information to produce a clinically relevant report. Radiology departments should ensure that strategies are in place to reduce errors where possible, whether through the use of computer-aided detection or the imminent arrival of AI systems to help identify and eliminate avoidable errors. For example, structured or synoptic reporting has been shown to provide clearer reports while also reducing typographic errors. Despite the increased exposure to discrepancies that come with the work’s volume and complexity, it is important that radiologists do not allow the fear of an error to alter their practice, as this can lead to non-committal and defensive reports that are often of little clinical value. It is This article was co-written by Dr. Shah Islam
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