Radiographs in the Office: Is a Second Reading Always Needed?

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We evaluated the frequency, nature, and importance of the changes in patient care that occurred as a result of differences in outpatient radiograph readings for cases in which the primary care clinician, hypothetically, would not request a second reading by a radiologist.


During 4 months, 1393 pairs of radiographic readings were collected from 9 volunteer primary care practices with 86 clinicians and a second reading by one of 42 radiologists. For 553, hypothetically, the clinician would not request a consultation from a radiologist. Review analysis of the 553 pairs revealed 100 (18.1%) radiographs in which the radiologist's reading did not agree with the clinician's reading. Data from the original visit and subsequent related care were abstracted from patient charts and reviewed. Changes in clinical care resulting from the radiologist's reading were identified.


The radiologists' second reading of these 553 sets of radiographs resulted in 14 (2.5% of 553 and 14% of 100) cases of one or more changes in care. We found 38 documented or presumed changes in care and zero substantial changes in care.


Primary care clinicians are able to identify radiographs for which a second reading by a radiologist will not result in substantial changes in care.

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