What should be done if a radiologist is unqualified to interpret a study?

Managing a Radiologist Unqualified to Interpret a Study

When a radiologist is unqualified to interpret a study, the appropriate action is to arrange for interpretation by a qualified physician with the necessary training and experience in that specific imaging modality, while ensuring proper documentation and communication of findings to maintain patient safety and comply with legal requirements. 1

Identifying Qualification Issues

• Qualification for interpreting imaging studies is based on:

  • Appropriate training and experience with the specific imaging modality
  • Familiarity with the anatomical area being imaged
  • Knowledge of the clinical context and patient history
  • Maintenance of ongoing practical experience with the modality 1

• Warning signs of insufficient qualification:

  • Lack of specific training in the imaging modality
  • Insufficient case volume to maintain competency
  • Unfamiliarity with the anatomical area or pathology in question
  • Absence of proper credentialing for the specific type of study 1, 2

Immediate Actions to Take

1. Arrange for qualified interpretation:

   • Identify a radiologist with appropriate training and experience for the specific study
   • Ensure the qualified radiologist has access to all relevant images and clinical information 1

2. Document the situation:

   • Record why the original radiologist was deemed unqualified
   • Document the transfer of interpretation responsibility
   • Maintain clear records of all communications 1, 3

3. Communicate with all stakeholders:

   • Inform the ordering physician about the need for reinterpretation
   • Establish closed-loop communication for critical findings
   • Ensure the patient is informed appropriately about any delays 1

Proper Interpretation Arrangements

Option 1: Complete Reinterpretation

• Have a qualified radiologist perform a complete interpretation of the study
• The qualified radiologist should document and sign their own report
• This is the preferred approach for patient safety 1, 3

Option 2: Split Interpretation (when appropriate)

• May be appropriate in specific scenarios (e.g., CT colonography where a gastroenterologist interprets colonic images and a radiologist interprets extracolonic findings)
• Each physician should sign separate reports clearly indicating which portions they interpreted
• Patient must be informed that multiple physicians will be interpreting different aspects of the study 1

Option 3: Overread Arrangement

• The qualified radiologist reviews and confirms/corrects the initial interpretation
• Both the initial interpretation and overread should be documented
• Clear documentation of any discrepancies is essential 1, 3

Legal and Billing Considerations

• Billing integrity:

  • Only physicians who personally perform the complete interpretation can bill for the service
  • Falsely certifying interpretation of images not personally reviewed is fraudulent 1, 3
  • "Ghost reading" (signing reports for studies interpreted by others) is unethical and fraudulent 1

• Liability concerns:

  • All physicians involved in interpreting images may be named in malpractice actions
  • State laws determine how liability is apportioned between physicians
  • Consultation with malpractice carriers is recommended when establishing interpretation arrangements 1

• Documentation requirements:

  • Reports should clearly state which physician interpreted which aspects of the study
  • Any limitations in the interpretation should be documented
  • Changes between preliminary and final interpretations must be communicated promptly 1

Quality and Safety Measures

• Ensuring access to clinical information:

  • The interpreting radiologist must have access to relevant clinical history, prior studies, and electronic medical records
  • Lack of access to this information should be documented as a limitation 1, 4

• Communication protocols:

  • Establish reliable methods for communicating critical findings
  • Ensure bidirectional communication between radiologists and referring providers
  • Document all communications regarding interpretation changes 1

• Ongoing quality assessment:

  • Implement peer review processes to evaluate interpretation quality
  • Monitor error rates and address systematic issues
  • Provide feedback to improve performance 5, 6

Prevention Strategies

• Training and credentialing:

  • Ensure radiologists maintain appropriate training and case volume for their areas of practice
  • Implement credentialing processes that verify competency in specific imaging modalities 1, 7

• Workload management:

  • Avoid excessive interpretation volumes that may compromise quality
  • Ensure appropriate time for thorough review of complex studies 7

• Specialty-specific considerations:

  • Recognize that non-radiologists (except cardiologists for cardiac imaging) generally lack sufficient training to independently interpret advanced imaging studies 2
  • Establish clear protocols for when specialist consultation is required 1, 2