How Do American Radiology Institutions Deal With Second Opinion Consultations on Outside Studies?

OBJECTIVE. Policies regarding how to handle the review of imaging studies performed at another institution (second opinion consultations) have not been uniform in academic radiology. Departments must decide whether to simply store outside studies in the PACS, report the studies officially, bill third-party payers, repeat such studies, or take a combination of these steps. The purpose of this study was to determine the current state of practice in dealing with second opinion consultations in academic radiology departments. SUBJECTS AND METHODS. A survey was conducted of the members of the Society of Chairs of Academic Radiology Departments (SCARD) and the Association of Administration in Academic Radiology (AAARAD) for their practices with respect to outside studies. RESULTS. Completed surveys were received from 91 of 160 (56.9%) SCARD and 35 of 106 (33.0%) AAARAD members. Of the 91 SCARD respondents, 70 (76.9%) added outside studies to their PACS, and 34 (37.4%) required formal internal reports on all outside studies. By contrast, 74 (81.3%) allowed at least some outside studies into their PACS without requiring an internal report. Many respondents interpreted outside studies only if specifically requested. Most (67/91 [73.6%]) billed insurers but not patients (61/91 [67.0%]) for the second opinion consultations. Fifteen (16.5%) preferred repeating studies rather than including outside studies in the PACS. With minimal exceptions, the AAARAD results paralleled the SCARD results. CONCLUSION. The survey showed that common practices in academic radiology are to add outside studies to the institutional PACS without mandating an internal report and to bill insurers but not patients for second opinion consultations.

Ethical Dilemmas in Radiology: Survey of Opinions and Experiences.

OBJECTIVE. The aim of this study was to assess trainees' and practicing radiologists' perceptions and experiences in handling ethical situations. We sought to identify frequently encountered ethical dilemmas and how they are addressed in daily practice. MATERIALS AND METHODS. A questionnaire on ethics was sent by email invitation to 1569 radiologists and radiology trainees in an institutional database maintained for continuing medical education purposes on three separate occasions between September 17, 2016, and October 31, 2016. The link to the survey was also posted on social media sites via the authors' and institutional accounts on Facebook, Twitter, Instagram, and Aunt Minnie as well as on American College of Radiology and Radiological Society of North America web blogs. RESULTS. A total of 424 radiologists and trainees responded to the survey, for a response rate of 27% (424/1569). Of them, 363 responded to a question asking whether they had witnessed an ethical dilemma; 203 (56%) had. The wording of reports when a miss was discovered was not handled in a consistent fashion. Regarding disclosure, trainees were more likely than practicing radiologists to report theirs and others' errors to the patient. Of the 362 respondents who responded to a question about whether they would report a negligent act by a colleague to the group director, 292 (81%) stated that they would, but trainees were less likely than practicing radiologists to do so. CONCLUSION. This study found many common ethical dilemmas in radiology practices remain without an appropriate, objective, and unified approach to effectively guide the radiologist's actions. These results highlight a need to provide more uniform recommendations to assist radiologists in addressing ethical issues in an appropriate manner.

Expert witnesses: neuroradiologists' perspectives.

PURPOSE: Physician malpractice expert witnesses may testify on behalf of physicians or patients. The goal of the study was to assess the experience of neuroradiologists as expert witnesses and their attitudes about such testimony. METHODS: A survey was distributed to the 4,357 e-mail addresses of the members of the American Society of Neuroradiology with questions about expert witnesses. RESULTS: The survey found that 1,301 of 4,357 answered at least one survey question. Five hundred twenty seven of 1194 (44.1%) of respondents had experience as expert witnesses. Most offer to testify on behalf of both plaintiffs and defendant physicians (324 of 465; 69.7%). Some do not testify/review cases on behalf of a plaintiff because they do not think that physicians should testify against other physicians, even if negligence is a factor (40 of 198; 20.2%). This reason was the most common for not agreeing to be an expert witness for a plaintiff, for all age groups. Of those expressing an opinion, 312 of 874 (35.7%) of neuroradiologists feel negatively about expert witnesses, whereas 434 of 874 (49.6%) say they serve a purpose, and 105 of 874 (12.0%) feel they should be commended for their work on behalf of the justice system. CONCLUSIONS: Of neuroradiologists answering the survey, nearly half have served as expert witnesses, and most feel comfortable testifying for both plaintiffs and defendants. Substantive negative perceptions (35.7%) of expert witnesses were found.