Referring clinicians follow second opinion radiology reports about half the time

Radiologists often recommend additional diagnostic imaging or other tests in their second opinion reports, but there has been some debate over how often referring clinicians actually follow these conclusions.

Research out of the Netherlands found those opinions are followed more often than not. In fact, when it comes to second opinion reports of abdominal imaging exams, referrers adhered to radiologists’ recommendations about 53% of the time. 

The findings, published Dec. 11 in the American Journal of Roentgenology, may help radiology in its transition from volume- to value-based care, Sabine A. Heinz, with University Medical Center Groningen’s Medical Imaging Center, and colleagues wrote.

“Because the number of secondary interpretations and associated cumulative healthcare costs have risen considerably, insight into the practice and value of recommendations in second opinion radiology reports has become increasingly important,” Heinz and colleagues added. “This information may be useful to improve communication between the referring clinician and the radiologist who performs the secondary interpretation and to verify the hypothesis that these recommendations by subspecialty radiologists add clinical value.”

With this in mind, Heinz et al. retrospectively analyzed 2,225 second-opinion radiology reports of abdominal imaging tests performed at institutions outside of their own. Overall, referring clinicians followed slightly more than half of the recommendations within these reports.

The team then turned to another, more complex question: Why are some recommendations followed, while others are not?

They didn’t find many conclusive answers; none of the determinants they investigated—including patient age, sex, hospitalization status and experience of the radiologists who completed the second interpretation, among other things—proved to be significant.

“Overall, the reasons why recommendations in secondary reports are followed by referring clinicians remain somewhat elusive,” the authors wrote. “In light of these findings…we hypothesize that many requested secondary interpretations are redundant and do not add to clinical decision making, regardless of any recommendation given by the subspecialty radiologist in the report.”

Heinz and co-authors did note that 20% of the recommendations that were followed led to a malignant diagnosis, a proportion much higher than the 3% of second opinions that were not followed. This suggests recommendations may add value in certain instances, potentially because a radiologist's second reading is improved with additional clinical information from the referring physician, they noted.