Improving performance by multiple interpretations of chest radiographs: effectiveness and cost

Area of Science:

• Radiology
• Medical Imaging Analysis
• Diagnostic Accuracy

Background:

• Duplicate reading of medical images is common practice.
• Assessing the cost-effectiveness and accuracy of different duplicate reading strategies is crucial for optimizing diagnostic workflows.

Purpose of the Study:

• To evaluate the accuracy and cost of four distinct duplicate reading methods for chest radiographs.
• To determine the most effective method for improving diagnostic accuracy while considering financial implications.

Main Methods:

• Eight radiologists interpreted 100 random chest radiographs.
• Four methods of duplicate reading were assessed, including a novel "Pseudoarbitration" technique.
• Error rates, correct interpretation rates, and cost increases were quantified for each method.

Main Results:

• "Pseudoarbitration" was the most effective method, reducing errors by 37% and increasing correct interpretations by 18%, at a 19% cost increase.
• Prioritizing positive diagnoses minimized omissions but significantly increased false positives.
• Other methods showed varying trade-offs between accuracy and cost.

Conclusions:

• "Pseudoarbitration" offers a significant improvement in diagnostic accuracy for chest radiographs.
• The optimal duplicate reading strategy requires careful consideration of clinical context, desired accuracy improvements, patient care impact, and associated costs.