Outsourced radiology reports less thorough than in-house ones, researchers claim
Outsourced radiology reports are less thorough than those prepared in-house, according to new peer-reviewed research published Wednesday.
Technological advances and market forces have helped drive the prevalence of teleradiology offerings since the mid-1990s. Over 83% of radiology departments in the U.K. were outsourcing at least some image interpretation last year, according to the Royal College of Radiologists.
Researchers with the North Manchester General Hospital sought to better understand the quality of this work, sharing their findings in Cureus [1]. Analyzing abdominal CT exams from 192 patients treated in the hospital’s general surgery unit, experts found that outside rads underreported important anatomical structures.
“Free-text reporting was associated with significant omissions in abdominal anatomical structures, which could negatively affect clinical decision-making and management plans,” surgeon Emmanuel Obayi, MBBS, and colleagues wrote Nov. 6. “Further studies are recommended to evaluate the comprehensiveness of outsourced radiology reporting and to ensure standardization in reporting, ultimately providing patients with high-quality emergency care.”
The retrospective, single-center study included patients admitted for accidents and emergencies requiring general surgery between August and October 2023. Radiologists employed at the hospital in northwest England handled 113 of the exams (59%) while another 79 (41%) were interpreted by an outside radiology service. Incidental findings were noted in 36 scans (19%), and the most common indications were for a suspected appendicitis (16%) or abdominal pain (15%). Radiologists detected no abnormalities in 22% and appendicitis in another 11%. Physicians used free-text reporting in the majority (nearly 78%).
Obayi and colleagues found that their hospital’s outside radiology service was much less likely than in-house rads to report on several important abdominal structures. These included the biliary system (odds ratio = 0.41), mesentery and peritoneum (0.36), vasculature (0.38), bones and soft tissue (0.27), and the lung bases (0.3). Contracted radiologists also were less likely to comment on the pancreas (0.44) and adrenals (0.46), though these differences were not deemed statistically significant. Meanwhile, there was no significant difference in reporting on the liver (0.84) or other incidental findings (1.18).
About 77% of structured CT reports were delivered by local rads versus 23% for outsourced reporters. These evaluations—which used a standard template, rather than a “free text” writing approach—also were significantly more likely to include comments on the spleen, adrenals, mesentery and peritoneum, and bones and soft tissues. The European Society of Radiology has recommended the structured reporting format in its good practice guidelines, the authors noted. That’s because it prompts rads to complete all required fields, is more time efficient, and enables easier retrieval of data for audit and research purposes.
“This study has several limitations. Its retrospective design is a potential source of inherent biases, and being conducted at a single center further increases the risk of these biases,” the authors cautioned. “Additionally, it was limited to abdominal CT scans, which may reduce the generalizability of findings to other imaging modalities. Furthermore, the CT images were not re-evaluated by independent radiologists, which could have helped identify potential omissions in the scan reports. Lastly, the relatively small sample size may also limit the strength of the conclusions drawn.”
U.K. providers made heavy use of outsourcing last year amid high service demand and lack of availability in the local workforce, the authors added. Last year, the combined cost of outsourcing, insourcing and ad hoc locum staffing to meet the National Health Service’s heavy demands was nearly $358 million (USD).
Obayi and colleagues contend that in-house reads offer added benefits, including direct communication between clinical and reporting teams.
“Additionally, locally employed radiologists have direct access to patients' records within the same institution, a resource not available to outsourced reporting services. Consequently, concerns about the quality of outsourced radiology reports have been frequently raised.”
Read more in Cureus, which is part of Springer Nature, below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.