Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients

Abstract Introduction As PET/CT’s role in oncology expands, with increasing demands for staging, restaging, and therapy monitoring across a range of malignancies, and with the rise of theranostics, PET facilities are experiencing higher workloads, raising concerns about the accuracy of reports. This...

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Main Authors: Fabrice Gutman, Didier Poncin, Renaud Guedec-Ghelfi, Rémi Génin, Pierre-Maxime David, Amélie Cuif, Geoffrey Popinat, Vincent Nogueira, Nicolas Aide
Format: Article
Language:English
Published: Springer 2025-06-01
Series:EJNMMI Reports
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Online Access:https://doi.org/10.1186/s41824-025-00253-9
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author Fabrice Gutman
Didier Poncin
Renaud Guedec-Ghelfi
Rémi Génin
Pierre-Maxime David
Amélie Cuif
Geoffrey Popinat
Vincent Nogueira
Nicolas Aide
author_facet Fabrice Gutman
Didier Poncin
Renaud Guedec-Ghelfi
Rémi Génin
Pierre-Maxime David
Amélie Cuif
Geoffrey Popinat
Vincent Nogueira
Nicolas Aide
author_sort Fabrice Gutman
collection DOAJ
description Abstract Introduction As PET/CT’s role in oncology expands, with increasing demands for staging, restaging, and therapy monitoring across a range of malignancies, and with the rise of theranostics, PET facilities are experiencing higher workloads, raising concerns about the accuracy of reports. This prospective study evaluates the frequency and nature of errors identified through a double-reading protocol. Materials and methods Patients scheduled for baseline or follow-up PET/CT scans were prospectively included in the study between May and June 2024. PET scans included [18 F]FDG, [18 F]Choline, [18 F]Dopa, and [18 F]PSMA. Each scan was independently reviewed by a second reader before finalizing the report. Significant changes were discussed before validation, and a third reader’s input was sought if consensus was needed. Data collection focused on potential factors influencing PET report errors, using a survey completed by second readers evaluating report changes (minor versus impactful), reader confidence, modified diagnostic hypotheses, and whether the initial reader was a permanent doctor or a locum doctor. Information regarding the indication, the number of previous scans for comparison, and the timing (period of the day) of PET readings was also recorded. Results Two-thirds of second readings were completed within 2–5 min. Changes were reported in 17% of PET reports (117/678), although impactful changes were rare. In therapy monitoring, only 5 out of 20 changes were significant. In staging and restaging, two major changes were noted. Most changes involved phrasing or formatting (59%), laterality (10%), and target lesions that did not affect TNM staging (29%). Regarding the degree of certainty, 18 changes were observed: 8 cases shifted from doubtful to certain, and 10 from certain to doubtful, necessitating follow-up scans. Factors such as the timing of the first reading, indication for PET, number of previous comparative PET scans, PET request clarity, first reader’s experience, type of PET tracer, and patient BMI, as a surrogate of image quality, showed no significant correlation with changes in PET reports. Conclusion Systematic double reading effectively identifies and corrects both rare impactful and minor errors in PET reports, though no specific predictive factors for error occurrence were identified, indicating that double reading, if performed, must be systematic.
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spelling doaj-art-ba1a6fbdbe9c4490af9d7ee5bc63e1622025-08-20T03:20:59ZengSpringerEJNMMI Reports3005-074X2025-06-019111410.1186/s41824-025-00253-9Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patientsFabrice Gutman0Didier Poncin1Renaud Guedec-Ghelfi2Rémi Génin3Pierre-Maxime David4Amélie Cuif5Geoffrey Popinat6Vincent Nogueira7Nicolas Aide8Hôpital Paul D’EgineHôpital Paul D’EgineClinique Saint-Jean l’HermitageClinique Saint-Jean l’HermitageGrand Hôpital de l’Est FrancilienGrand Hôpital de l’Est FrancilienHôpital Paul GallienGrand Hôpital de l’Est FrancilienCentre Havrais d’imagerie NucléaireAbstract Introduction As PET/CT’s role in oncology expands, with increasing demands for staging, restaging, and therapy monitoring across a range of malignancies, and with the rise of theranostics, PET facilities are experiencing higher workloads, raising concerns about the accuracy of reports. This prospective study evaluates the frequency and nature of errors identified through a double-reading protocol. Materials and methods Patients scheduled for baseline or follow-up PET/CT scans were prospectively included in the study between May and June 2024. PET scans included [18 F]FDG, [18 F]Choline, [18 F]Dopa, and [18 F]PSMA. Each scan was independently reviewed by a second reader before finalizing the report. Significant changes were discussed before validation, and a third reader’s input was sought if consensus was needed. Data collection focused on potential factors influencing PET report errors, using a survey completed by second readers evaluating report changes (minor versus impactful), reader confidence, modified diagnostic hypotheses, and whether the initial reader was a permanent doctor or a locum doctor. Information regarding the indication, the number of previous scans for comparison, and the timing (period of the day) of PET readings was also recorded. Results Two-thirds of second readings were completed within 2–5 min. Changes were reported in 17% of PET reports (117/678), although impactful changes were rare. In therapy monitoring, only 5 out of 20 changes were significant. In staging and restaging, two major changes were noted. Most changes involved phrasing or formatting (59%), laterality (10%), and target lesions that did not affect TNM staging (29%). Regarding the degree of certainty, 18 changes were observed: 8 cases shifted from doubtful to certain, and 10 from certain to doubtful, necessitating follow-up scans. Factors such as the timing of the first reading, indication for PET, number of previous comparative PET scans, PET request clarity, first reader’s experience, type of PET tracer, and patient BMI, as a surrogate of image quality, showed no significant correlation with changes in PET reports. Conclusion Systematic double reading effectively identifies and corrects both rare impactful and minor errors in PET reports, though no specific predictive factors for error occurrence were identified, indicating that double reading, if performed, must be systematic.https://doi.org/10.1186/s41824-025-00253-9PET/CTOncologyDiagnostic errorsDouble reading
spellingShingle Fabrice Gutman
Didier Poncin
Renaud Guedec-Ghelfi
Rémi Génin
Pierre-Maxime David
Amélie Cuif
Geoffrey Popinat
Vincent Nogueira
Nicolas Aide
Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
EJNMMI Reports
PET/CT
Oncology
Diagnostic errors
Double reading
title Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
title_full Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
title_fullStr Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
title_full_unstemmed Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
title_short Systematic double reading for oncological PET/CT scans: insights from a prospective multicentre study in 678 patients
title_sort systematic double reading for oncological pet ct scans insights from a prospective multicentre study in 678 patients
topic PET/CT
Oncology
Diagnostic errors
Double reading
url https://doi.org/10.1186/s41824-025-00253-9
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