Is That Your Final Answer?

It can be difficult to decipher who has final say in radiology reports. Part 1 of 2.

Preliminary. Final. The words don’t remotely look or sound the same. Pretty much anyone with a grasp of the language could tell you their meanings are, to say the least, dissimilar.

The terms take on more specific applications during radiology residency, or indeed any postgraduate medical training in facilities that do not have 24/7/365 attending coverage. A “Prelim” report of a diagnostic-imaging study is one that has been furnished by a trainee, and focused on answering important questions of the moment…appendicitis, bleed, stroke, etc. When the attending radiologist reviews cases later on and makes necessary changes, the report is either amended to become (or entirely replaced by) a “Final.”

Many rads exiting residency leave the concept of a “Prelim” report behind them as they enter the “real world,” now attendings themselves. They might occasionally ask peers for input on challenging cases, but otherwise when they sign off a report, that’s the formal word. Clinicians know that, barring the creation of an addendum, the report is not awaiting approval by a rad with more experience.

I was therefore somewhat surprised when, upon my entry into the teleradiology scene, I found that even highly capable, Board-certified radiologists were routinely furnishing “Prelim” reports. And not just the telerads - sometimes, even the onsite radiologists who were providing night coverage were supplying Prelim reads for their facilities.

Taken at face value, it made sense: a single rad providing night-coverage for an entire hospital (or several) was not expected to generate formal reports for every study performed on his watch. Things would frequently be too busy to permit greater thoroughness, prior studies might not be available for comparison until the next day, subspecialty reads might ultimately be demanded, etc. Further, onsite rads (or their hospitals) might not trust offsite coverage, but rather wish to review each and every overnight report for accuracy.

In acknowledgement of the differences between a “Prelim” and a “Final” report (which might run one line and a couple of pages in length, respectively), not to mention the differences in liability, “Finals” seemed to get paid at better rates. In at least some of the telerad outfits I considered, this difference was passed along to the radiologists actually doing the interpretations. It might make sense for the fraction to be proportional to the differences in work (for instance, if it takes an average rad twice as long to render a “Final” as it does a “Prelim,” a “Prelim” might reasonably pay half as much), but I suspect negotiations between the telerad firms and the facilities they covered were based more on supply/demand factors.

As if all of that wasn’t complicated enough for a telerad newbie like myself, the definitions of “Prelim” and “Final” started getting murkier. More on that next time.