Double-reading of plain radiographs – no benefit with regard to earliness of diagnosis of cancer recurrence: a randomised follow-up study

Added value of double reading in diagnostic radiology,a systematic review

Objectives

Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.

Methods

A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.

Results

The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.

Conclusions

The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.

Key Points

• In double reading, two or more radiologists read the same images.

• A systematic literature review was performed.

• The discrepancy rates varied from 0.4 to 22% in various studies.

• Double reading by sub-specialists found high discrepancy rates.

Electronic supplementary material

The online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.

Double reading of radiological examinations in Norway

BACKGROUND

Double reading of images is a part of the quality assurance activities at many radiological centers.

PURPOSE

To investigate the extent of and routines for double reading in Norway and the institutional heads' attitudes toward double reading.

MATERIAL AND METHODS

A questionnaire was addressed to the heads of all radiological institutions in Norway. The questionnaire concerned staffing, examinations performed, extent of double reading per imaging modality (except mammography screening), guidelines for double reading, checks of completed radiology reports, frequency of regular quality assurance meetings to discuss missed findings, and the heads' attitudes toward double reading.

RESULTS

The response rate was 73% (53/73). The percentage across imaging modalities of examinations being double read was 41% overall: 56% at university hospitals, 37% at local hospitals, and 18% at private centers. Double reading was most common for positron emission tomography (PET)/PET-computed tomography (CT) examinations (100%), and clinical mammography (91%). Almost all examinations read by residents were double read. Only 15% of institutions had written guidelines for double reading, 15% performed random double readings of completed examinations, and 55% organized regular meetings to discuss missed findings. Forty-six percent of the institutional heads wanted an increased use of double reading.

CONCLUSION

Double reading is common in Norway, especially in residency training, mammography, and PET/PET-CT. It is less common at private centers. Established routines for double reading are scarce. Many institutional heads want more double reading. The potential of double reading to assure quality in radiology should be better exploited.