The Nuances of Peer Review in Radiology
Jan 7, 2026
Peer review at its core is intended to improve the diagnostic performance of imaging healthcare professionals via feedback and continuous education. Individual physicians should ideally receive feedback related to exams they read and also learn from broader group experiences. Over the past forty years, I have been involved in many peer review programs and have some lessons to share:
Peer review must be incorporated into the normal workflow or it becomes an onerous additional task, burdening already overstressed physicians. Radiologists read thousands of prior reports in their normal course of practice, creating a natural and convenient means of providing peer review.
Peer review must include a means of surveillance of randomly selected exams.
The grading system that is applied to rating exams should be linear. Numerical scores that are linear can be tracked over time, just like a grade point average. Non-linear measures are more difficult to manage and compare over time.
Peer review should involve more than measuring reporting errors. Radiologists communicate with referring doctors, supervise technologists, attend committee meetings, and participate in technology decisions. Each of these activities merits peer review and upward evaluation.
Assessment of the frequency and type of follow-up recommendations is a form of peer review that is generally overlooked. Similarly, while technical quality is often measured, the relative participation of physicians in enforcing technical standards is often unmeasured.
Participants in any peer review program must be confident that the program is confidential, fair, and effective.
When a professional performs outside of the group standard, either positively or negatively, it should be recognized. Outstanding reports and behavior should be encouraged and replicated. Problems should lead to focused review to assess and correct the root causes.
Input should be solicited from outside resources. For example, an emergency department may report problems back to the radiology department and have those problems systematically evaluated. Results may be routinely obtained from pathology departments to close the loop on biopsy recommendations.
When disagreements occur, there must be a system for adjudication by an appointed peer review supervisor.
When peer review is done well, it can be efficient, educational, and lead to measurable improvements. As with all human processes, the activities can be supported by technology that is ideally integrated into the daily workflow of all imaging healthcare professionals.
