Specialty radiologists improve pediatric care and disagree with the interpretations of critical imaging studies by community general radiologists in about 40% of cases. A study in the American Journal of Roentgenology examined the imaging reports of all pediatric patients at a major medical center, and compared the interpretations by community radiologists with those of pediatric radiology and neuroradiology specialists. Major disagreements between the general radiologist and the specialty radiologist reads were found in 22% of the studies, or 170 of the 773 examinations. Most major disagreements concerned the presence of fracture and hemorrhage, two conditions that often require emergent diagnosis and treatment.
Twelve percent (12%) of neuroimaging studies, such as CT scans and MRI scans of the head and spine, had major differences in the report when re-read by neuroradiologists. A community radiologist made a diagnosis of hydrocephalus in a 3 year old boy, but failed to report the large tumor causing it. Thirty two percent (32%) of body imaging cases, such as CT scans and Ultrasound scans of the abdomen and pelvis, had major differences in the report when re-read by pediatric radiologists. One general radiologist reported a CT scan of the pelvis of a 4 year old girl as “normal” when upon re-read by a pediatric radiologist, a diagnosis of appendicitis was made. Second opinion interpretations at the time of treatment by specialty radiologists improve the quality of care for pediatric patients. The same is likely true for adult imaging as well.
Specialty radiology second interpretations could prevent many cases of radiology malpractice. Unfortunately, most insurers will not pay for a second opinion specialty read, and opportunities to timely diagnose and serious conditions, such as hemorrhage, brain injury and abdominal infections, are lost. Both the quality of the images and the experience of the radiologist are important in reaching the correct diagnosis. Specialty radiologists should review critical pediatric and neuroimaging studies to prevent missed diagnoses and improve pediatric care.