Peer review in clinical radiology practice.

Summary statistics and comparison of per-formance measures generated for each physi-cian by modality should be collated [13]. Radi -ologists should be compared with peers in their own facilities in terms of major difference in image interpretation. This comparison needs to take into account the volume of cases in-terpreted by an individual radiologist to avoid bias. Radiologists who have more clinical days than others may have a higher number of cases with discrepant results on peer review; there-fore, error numbers tallied and normalized to the number of clinical days worked would bet-ter represent the work. Because there are dif-ferences in misinterpretation and difficult-case disagreement rates among imaging modalities, comparison needs to be specific to imaging modality as well [14]. Limitations Radiologist commitment to continuous peer review is relatively limited. Increased workload, radiologist shortage, substantial-ly decreased payments per service, and resis -tance of radiologists to anything that increas -es workloads or costs even by a small amount have been quoted as causes of reduced com-pliance in the RADPEER program [14]. In addition, reviewing radiologists may be re-luctant to perform peer review because of a potential negative influence on their relation -ship with their colleagues. Unclear policies and procedures of peer review, negative at-titudes toward peer review (seeing it as con-trolling rather than educating or learning for improvement), disbelief that peer review would lead to worthwhile results, and fear of information being made public through the legal system contribute to diminished com-mitment and effort [5].Methods, such as reactive or proactive re-views of cases without a reference standard or definitive diagnosis, may simply represent opinions because they are not verified by pa-thology or clinical follow-up. In such cases, initial findings may not be proof of error in performance and should be used only as a trigger for further evaluation [14].