1. Feedback from referring physicians: a novel
approach to improving reporting practices
Andrew J. Gunn, MD Thalia M. Krakower, MD
Claude I. Alabre, MD Kerri Palamara, MD
Susan E. Bennett, MD Dushyant V. Sahani, MD
Mira Kautzky, MD Garry Choy, MD

2. Financial Disclosure
The authors have no relevant financial disclosures that
would pose a conflict of interest with this study

3. Introduction
• There is increased interest in improving radiology reporting practices
• Peer review is an important component of quality improvement
• Most common form of peer review in radiology is interpretive
agreement between double-blinded radiologists

4. Introduction
• Peer review in radiology attempts to measure diagnostic accuracy
• Diagnostic accuracy has been defined as:
– Was the abnormality detected?
– Was the abnormality interpreted correctly?
– Was the abnormality reported correctly?
• Current strategies of peer review are limited
– Persistent dissatisfaction with radiology reporting
– Some criteria defining diagnostic accuracy are subjective

5. Question
Is it possible to design a peer review process that incorporates the
structured feedback of referring physicians?

6. Materials and Methods
• IRB approved, HIPAA compliant
• Referring physician participants
– Five (5) volunteers recruited from within our institution
– 4 females, 1 male
– Average of 10.4 years of clinical experience (range: 1-36 years)
– Primary care providers
– Satisfaction with radiology reporting was not significantly
different from a larger group of PCPs (P=0.85)

7. Materials and Methods
• Reports were eligible for review if:
– Abdominal US: “pain”
– Abdominal CT: “abdominal pain”
– Chest CT: “shortness of breath”
– Brain MRI: “headache”
• Reports were excluded from review if:
– Negative
– Ordered as follow-up for a known problem
• Eligible reports were randomized
– 12 reports from each modality were randomly selected (48 total)

8. Materials and Methods
Reports, a short accompanying clinical history, and a short
questionnaire were distributed to the referring physicians

9. Results
• 100% compliance from the referring physicians
• Overall, reports were found to be clinically useful (3.8; 1-5 scale)
• Reports allowed for good clinical decision-making (3.7; 1-5 scale)
• 35.4% of reports contained a radiologist recommendation
– 87.4% of recommendations were clinically useful
– 31% of reports without recommendations needed them
• 31.2% of reports without direct communication warranted direct
communication

10. # of incidences
10
15
20
25
30
35
40
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11. Discussion
• Current forms of peer review are limited as they provide only
radiologist-to-radiologist feedback
• It‟s possible that input from referring physicians may identify
systemic problems with reporting practices that may go unnoticed
by the radiologist
• Structured feedback from the referring physician is a novel
approach to improving reporting practices

12. Discussion
• Data suggest that radiologists should be more pro-active in making
recommendations within the report
• Data suggest that radiologists should have a lower threshold for
communicating results directly to referring physicians
• Made insightful suggestions in the „comments‟ section

13. Limitations
• Time limitations
• Selection bias amongst the reviewers
• Selected only positive, non-follow up, cross-sectional studies
• Only primary care physicians reviewed cases

14. Future Directions
Development of an online system (integrated with the electronic
medical record) where referring physicians could give structured
feedback regarding radiology reports

15. Selected References
1. Jackson VP, Cushing T, Abujudeh HH, et al. RADPEER™
scoring white paper. J Am Coll Radiol 2009; 6:21-25.
2. Mahgerefteh S, Kruskal JB, Yam CS, Blachar A, Sosna J. Peer
review in diagnostic radiology: current state and a vision for the
future. RadioGraphics 2009; 29:1221-31.
3. Kaewlai R, Abujudeh HH. Peer review in clinical radiology
practice. AJR Am J Roentgenol 2012; 199:W158-W162.

16. Comments or questions?
Please feel free to contact me via email at agunn@partners.org