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Second opinion services from specialist neuroradiologists have 'clear added value' in complex cases, radiologists say. "Second opinion services from specialist neuroradiologists have "clear added value" in complex cases," radiologists say.

Researchers from Northern Ireland assessed the impact of formalized neuroradiology second opinions on patient management by comparing the discrepancy rate with general radiologist reports.

They looked at 506 second opinion CT and MRI reports during 2004 given by three consultant neuroradiologists. Most had been requested by neurologists.

They reported a 13 per cent major discrepancy rate, in which the second opinion substantially altered patient management, and a 21 per cent minor discrepancy rate. The remainder were in agreement.

The authors said: "There is a significant major discrepancy rate between specialist neuroradiology second opinion and general radiologists. The benefit of a formal specialist second opinion service is clearly demonstrated; however, it is time-consuming."

Dr Gavin Briggs, Consultant Radiologist at Craigavon Area Hospital in Northern Ireland and one of the study researchers, explained: "The driver for the study was to determine if there was a role for a second opinion service for complex/unusual abnormalities or where the clinical and radiological findings differed.

"The number of scans which are sent for second opinions is only a fraction of the overall workload of a district general hospital so there was obviously selection bias."

He pointed out that "there is often discrepancy even between expert opinion," but noted that the findings suggested there might be a role for "dedicated generalists with a subspecialist neuro interest."

Dr David Yousem, Director of Neuroradiology at The Johns Hopkins Medical Institution in Baltimore, US, agreed that "a second opinion service for difficult cases is warranted."

He added: "We have a policy at Johns Hopkins where we provide second opinions officially for any cases referred, in a similar manner to reviewing pathology slides via the Department of Pathology. The value is clear and we have an ongoing project also looking at discrepancy rates."


The role of specialist neuroradiology second opinion reporting: is there added value?
Clin Radiol 2008; Articles in press