Evaluating our data,
we can conclude that the first 3-4 months can be referred as the learning period (for both first and second readers) that caused the moderately lower grades during the 2nd-4th month period,
comparing with the first month's or later results.
A slight increase in performance follwed,
but some changes happened among both first and second readers meanwhile (some stopped,
some newcomers joined).
At the end of 2018 some "senior" first readers left the project and some other newcomers joined that can caused the slight decrease in performance generally.
The ratio of addenda (14.8%) is very similar to the overall clinical relevance results,
while a bit different than the ratio of image reading accuracy.
Lingusitics has stabilized its performance on a very high level,
highlighting communication is an essential part of such a project (see Fig.
2.).
A database based on addenda data is under development on typical problems that can support newcomers (and senoirs) to the project.
Fig. 2: Peer-review grade 5 percentage (09.2017-12.2018)
References: Department of Central Radiology Diagnostics, University of Debrecen, Kenézy University Hospital, Debrecen, Hungary, 2019
Training centres should consider to implement more and more quality assurance tools into their clinical services and training programs.
Radiology is an excellent field of medicine to develop such projects: plenty of quantitative data is available,
almost fully digital and can be well documented.
Peer-review has a learning curve,
not only for the first readers,
but for the second readers,
too and this should be considered if such a system is implemented,
while support needs from management,
seniors and juniors,
either.
Peer review should be carried out in a supportive way,
focusing on learning and increasing quality,
not on punishment.
And it really needs sacrifice (2.5-3 hours daily) from all participants.
Departments can not only benefit from statistics and increasing grades of trainees.
It has a direct impact on image reading and radiology reporting skills,
moreover it opens new communication channels between first and second readers (generally between juniors and seniors) that can have a positive effect on the everyday life within the department.
Giving feedback is an essential part of the department workdays for now in a safe environment,
that can be beneficial not only for co-workers,
but for patients,
too.
It should be clarified,
that participating in this project does not give any legal possibilities to overcome the postgraduate training or gather legally acknowledged competencies for radiologists-in-training - but can make them more confident for specialty exam and develop image reading and reporting skills during training in a safe environment.
Atlhough the authors are aware,
that the presented project has its own limitations and possibly does not meet all the criteria that is available in the literature and is not the ultimate way to learn radiology (3-4).
As the participants opinion stated,
it is highly recommended to perform peer-review at teaching hospitals.
And if department leaders does not feel its importance in the aspect of postgraduate training,
its clinical impact - 85% agreed that better quality reports are resulted due to double reading and peer-review - can convince all department leaders.
Such a project can make a step towards value based imaging.