Recommendations made in computed tomography (CT) reports: a comparison between outsourced and internal reports at a...

Outsourcing is used in many centres as a standard approach to dealing with increasing unmet reporting demand. Anecdotally, some believe that outsourced reports may increase local workload due to requests to re-review externally reported imaging. Our aim was to compare reports issued by in-house radiologists and outsourcing providers and assess the difference in imaging and nonimaging recommendations made.

A total of 248 computed tomography of the chest, abdomen, and pelvis (CTCAP) studies reported by outsourcing providers were compared with 248 in-house reports and the summaries assessed for the inclusion of imaging and nonimaging recommendations, as well as speciality advice or consultation. These recommendations were assessed by two in-house consultants and consensus agreed as to their appropriateness. A comparison between the two groups including assessment of significant differences was then made.

Outsourcing providers recommended more follow-up imaging overall (76 individual studies vs 48), a greater proportion of which were considered inappropriate (20 [26%] vs 4 [8%]; P=0.019). While in-house radiologists tended to recommend more nonimaging recommendations and speciality consultations, these differences were not significant (P=0.599 and P=0.057, respectively). There were more occasions in outsourced reports where recommended imaging follow-up was subjectively unclear or vague.

Our study suggests that reports issued by outsourcing providers recommend more inappropriate imaging follow-ups than reports issued by in-house radiologists. This has the potential to increase the workload and costs for local radiology departments, in turn reducing the cost-effectiveness of outsourcing as a means of tackling the increasing reporting demand.