Discrepancies between primary and secondary interpretations of pediatric nuclear medicine imaging examinations.
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BACKGROUND: Requests for secondary interpretation of imaging examinations adds clinical work and generates additional charges. OBJECTIVE: To understand the impact of secondary interpretations of pediatric nuclear medicine examinations at a quaternary academic center. MATERIALS AND METHODS: In this IRB approved study, we retrospectively reviewed nuclear medicine examinations submitted for secondary interpretation by a pediatric radiologist with a nuclear medicine focus at our institution between 08/2019 and 08/2024. A single reviewer compared the primary and secondary reports to identify discrepancies that would likely impact clinical management, and discrepancies were confirmed by additional reviewers. Pediatric hematology/oncology faculty (n=29) and fellows (n=18) at our institution were surveyed to understand requests for, and the impact of, secondary interpretations. Results are summarized with descriptive statistics. RESULTS: Three hundred fifty-eight examinations (median patient age=8 years) were included, 237 were 18F-FDG PET body scans, 97 were 123I-MIBG scans, and 24 were other examinations. Secondary interpretations yielded meaningful changes in 17% (60/358). Of these, 20% (12/60) changed from negative/normal to positive, 20% (12/60) changed from positive to negative/normal, and 57% (34/60) included additional positive findings/diagnoses. Sixteen survey responses (34%; n=16/47 response rate) were received, with providers indicating that secondary interpretations were clinically useful even when they agreed with the primary impression. CONCLUSION: Secondary interpretation of pediatric nuclear medicine examinations by pediatric radiologists with nuclear medicine focus resulted in changes that have potential impact on clinical management in 17% of cases. Secondary interpretations completely changed the impression regarding the presence or absence of malignant disease in 40% of these cases. Referring providers identified benefit in secondary interpretations even when they confirmed the primary impression.