2 articles of interest - Are more heads better than one?
lberlin at LIVE.COM
Sun Mar 3 22:57:16 UTC 2019
Dear Rob (whom I only know by name, but a friend anyway), and my good friends Mike and Kimberly:
Mike's article highlighting double reading refers to interpretations by residents vs interpretations by experienced staff radiologists. In that situation the overread makes sense and is probably necessary. As for addendums placed on interpretations that had been made and now when another radiologist sees something different as mentioned by Kimberly, then the addendum is probably necessary. But that doesn't occur often and is not a routine situation.
Much has been written regarding routine double-reading in the US literature, and it's almost universal that American radiologists have spoken against doing it. It's time-consuming and expensive to say the least, but consider the following scenario:
Rob orders an abdominal CT on a patient: radiologist 1 concludes that the findings indicate ABC; but a second reader (radiologist 2) who is routinely called, concludes that the findings are XYZ. So now a third radiologist-umpire is called to settle the difference: he agrees with rad 1, but disagrees with rad 2.There's no time to call a 4th radiologist, so Rob gets a report that concludes that "by a 2 to 1 margin, the findings are ABC."
I'm sure Rob would be really comfortable and well assured with a conclusion such as that!
On a more serious view, double reading is routinely done in a few European nations, mainly Norway. Articles written by them indicate that they do find and correct some errors in up to 10% of cases; however, whether the health of a significant number of patients improve as a result of routine double reading is vague at best.
As we all know, volume of radiologic studies, especially CTs and MRIs, has been increasing tremendously. Radiologists are unfortunately reading faster in order to keep up; taking time for a routine overread for every case is truly impossible, and of questionable value.
AI (artificial intelligence) may bring something new, indeed. However, how about Kimberly, or Mike, or myself, reads a C, then having it checked by a robot. But the robot disagrees; so another robot is called and it disagrees with the first robot. What do we do then??
Best to all, 😊 😢 😈
Leonard Berlin, MD, FACR
PS: Kimberly and Mike, I'll be speaking about discrepancies, errors, and double reading at the ARRS Annual Meeting beginning May 5. I don't know yet whether the ARRS leadership will have a second radiologist over-lecture my lecture, and if they decide to do so, what will happen if the second radiologist disagrees with me ?
Perhaps Kimberly or Mike can be the umpire!
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