In the study on radiologist-initiated double reading of abdominal CT by Lauritzen et al., what was the most common category of pathology where double-reading identified clinically important changes?

1. Trauma
2. Cancer*
3. Infection
4. Obstruction

• Cancer was the most common category of pathology where double-reading identified clinically important changes. This was followed by possible premalignancies, infection, vascular, pancreaticobiliary system, leak/perforation, intestinal obstruction, hernia, and intestinal inflammation.

During which of the following activities is double-reading incorporated into routine practice?

1. Performance of invasive procedures
2. Curbside consults
3. Case conferences
4. Tumor boards*

• Tumor boards is an activity in which double-reading is incorporated into routine practice, along with reviewing the EMR and prior imaging.
• Curbside consults are an unofficial, undocumented review of an imaging study, usually performed at an outside institution.
• Performing invasive procedures and case conferences do not involve double-reading of studies.

Which of the following is a major advantage of prospective double reading over traditional retrospective peer review?

1. Diagnostic errors are identified before they impact patient care*
2. Less time to perform
3. Double reads can be submitted for reimbursement
4. Eliminates diagnostic errors

• One of the major advantages of prospective double reading is that diagnostic errors can be identified before they impact patient care.
• Prospective double reading currently does not take less time that traditional retrospective peer review (e.g. RADPEER) and cannot be submitted for reimbursement beyond the original interpretation.
• Prospective double reading has the potential to reduce diagnostic errors but will not eliminate errors because there are numerous contributing factors

Which of the following is an example of metacognition?

1. Using heuristics to make decisions when there is uncertainty
2. Employing pattern recognition to make a diagnosis
3. Tendency to be influenced by how a problem is presented
4. Recognizing instances when data are not fitting together*

• One key feature of metacognition is the ability to recognize incongruity, ambiguity, atypical presentations, and instances when data are not fitting together.
• Using heuristics to make decisions when there is uncertainty is a normal process for radiologists and other physicians. Being aware of the fact that you are using heuristics is an example of metacognition.
• Employing pattern recognition to make a diagnosis is a normal process for radiologists and other physicians. Being aware of the fact that pattern recognition can sometimes lead to diagnostic errors is an example of metacognition.
• The tendency to be influenced by how a problem is presented describes framing bias.

Which of the following strategies can be used by radiologists when they are interpreting a study and the data are not fitting together?

1. Recommend another imaging study
2. Consult a colleague*
3. Leave exam for someone else to interpret
4. Follow-up case to determine if an error was made

• Consulting a colleague is a strategy that can be used by radiologists when they are interpreting a study and the data are not fitting together.
• The remaining options are not effective strategies to address when data are not fitting together.