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Objective:
In recent years, there has been an increasing demand in academic medical centers for formal "over-reads" of imaging studies obtained at outside hospitals, a service for which patients and insurers are billed. The rising demand for medical imaging, radiology workforce concerns and associated costs highlights the necessity to explore the value of providing formal over-reads from outside institutions in diagnosis and treatment planning. Previous studies have shown little discordance between original and over-read reports; however, the extent to which a requested over-read influences a patient's care plan, if at all, has not been evaluated. Our study investigates the utilization of over-reads of neuroradiology studies from a single institution and the impact on the plan of care for patients.

Materials and Methods:
A retrospective cohort study was conducted from Penn State Health Radiology Department to analyze and assess 200 head and neck over-reads from external radiology studies. Sixty-five outside studies were excluded due to lack of official outside impressions/reports. Radiological impressions of external and internal reports were compared for discordance. Discordance was categorized by no discordance, minor discordance, and major discordance. The patient care plan was reviewed from the EMR in each case to determine whether the results of the requested over-reads led to any changes being made to the patient’s plan of care.

Results:
Our analysis revealed that there was little discordance between over-reads and the prior outside hospital radiologist’s interpretation: 103 (76.3%) studies showed no discordance, 28 (20.7%) exhibited minor discordance, and four (3.0%) displayed major discordance. Regarding the patients' plans of care, 108 (80%) charts were reviewed which demonstrated no change in the care plan after the over-read. Among the four patients with major discordance between reads, only two experienced a change in care plan. Out of the 27 plans that underwent changes, 24 patients' plans initially relied on the over-read, as these lacked an initial care plan. For those plans that depended on the over-read, 26 (76.5%) showed no discordance with the subsequently retrieved outside reading, six (17.6%) revealed minor discordance, and two (5.9%) displayed major discordance.

Conclusion:
In conclusion, in our series, most over-reads did not substantially contribute any new information or alter management decisions. Considering this, we believe that clinicians may wish to consider the cost-benefit ratio (high cost, little benefit) when requesting such over-reads, in order to avoid obtaining clinically unnecessary over-reads that add costs to patients and tax-limited radiologist resources, yet yield little or no clinical benefit. Future research directions could include approaches such as ordering physician questionnaires to discern patterns of impact, exploration of factors contributing to discrepancies, and implementation of strategies to minimize over-read related costs.