Teleradiology interpretations may differ from final reads

Major discrepancies in interpretations by teleradiologists and in-house radiologists occur in approximately 6% of commonly ordered CT scans, according to a new paper.

The University of California, San Francisco-Fresno study identified eight major discrepancies due to teleradiology misinterpretation in 550 cases originating in an academic Level 1 trauma center (J Emerg Med 2008 Sep 22.[Epub ahead of print]).

“Our results support the cautious use of teleradiology interpretations,” said Dr. Timothy F. Platts-Mills, now of the department of emergency medicine at the University of North Carolina.

Of 787 imaging studies sent to teleradiology during the study period, 550 were scans of the head, cervical spine, chest, or abdomen and pelvis. Major discrepancies were identified in 32 of the 550 scans (5.8%), including seven of 160 head, one of 29 cervical spine, three of 64 chest, and 21 of 297 abdominopelvic, according to the paper. For each scan, discrepancies were characterized as major, minor, or no discrepancy.

“We attributed eight of the 32 major discrepancies to a teleradiology misinterpretation, with one case leading to an adverse event,” Platts-Mills said.

Platts-Mills concedes several study limitations. For one, the study compared a single teleradiology group and a single in-house radiology group. Also, in-house radiologists were not blinded to overnight teleradiology interpretations.

“We do not know if our findings are representative of other teleradiology and in-house radiology groups,” Platts-Mills said.

The study was not designed to compare two radiology groups. It attempted instead to determine how frequently an emergency physician would get a teleradiology interpretation that is significantly different from the “official” final read the next day by in-house radiology staff.

The study also suggested discrepant interpretations may be more common for certain types of pathology, such as intraparenchymal cerebral changes, small bowel pathology, renal calculi, and pulmonary emboli.

“Further study is needed to better define the sensitivity of teleradiology interpretations for identifying the types of pathology for which major discrepancies occur and the types of management errors patients are exposed to from such discrepancies,” Platts-Mills said.

Before the study, Platts-Mills said emergency physicians speculated that teleradiologists tend to overread CT scans, leading to numerous inappropriate admissions.

“But only two of the 550 CT scans involved had a major discrepancy leading to inappropriate admission,” he said. “In fact, the number of overreads by in-house radiologists was similar.”