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CRITICAL LONGITUDINAL ANALYSIS OF NEUROIMAGING REPORTS FROM GENERAL RADIOLOGISTS (THE CLANGER STUDY)

Critical Longitudinal Analysis of Neuroimaging reports from GEneral Radiologists (The CLANGER study). Background Over the last 15 years neurologists have increasingly been appointed to district general hospitals in an attempt to provide local neurological care. Such a service is highly dependent on a quality–assured neuroimaging service. We have systematically audited the neuroimaging reports over seven years (2003–2009) in our district general hospital and report here the 2007–2009 findings. Methods Patients were selected by general radiologists or a neurologist for a second report from a neuroradiologist. Differences in primary findings, secondary findings or differential diagnoses, and further management advice were recorded. A subgroup analysis was performed for patients who had just a CT brain scan. The results were compared with previous audit results (2003–2006). Results 202 patients (108 men, 94 women, mean age 47.0 (SD 6.5) years) were selected for a neuroradiology report. There were 32 (15.8%) discrepancies in the primary finding/diagnosis. New secondary findings or differential diagnoses were found in 43 (21.3%) patients. Further investigations were recommended in 26 patients (12.9%). Primary finding differences in CT–only patients occurred in 8 of 37 patients (21.6%). Compared with previous results among 539 patients, there was no evidence of improvement in quality: primary finding discrepancy 13.4%, p=NS; secondary findings/differential diagnoses 21.2%, p=NS; further investigations 12.2%, p=NS; and CT brain–only patients (18 of 114 versus 8 of 37, p=NS. Twenty general radiologists reported on the neuroimaging. Conclusions Despite feeding back previous audit results, we failed to demonstrate a secular improvement in any of the neuroimaging report endpoints from our district general hospital. As the accuracy of a diagnostic test often depends on the prevalence of the condition, we speculate that reports from multiple general radiologists may impede the potential for reporting improvement.