What is radiology peer review?
The short answer
Peer review is a second radiologist looking at a first radiologist’s report and recording whether they agree. It exists because some disagreement is unavoidable: a widely cited review puts the day-to-day error and discrepancy rate in radiology at an estimated 3% to 5% of reported studies (Brady, Insights into Imaging, 2017). The goal is to find patterns and improve, not to punish single misses.
- 3–5%estimated day-to-day discrepancy rate (Brady, 2017)
- 7ACR accreditation modalities requiring peer review
- 2models: score-based review and peer learning
The 3% to 5% figure comes from Adrian Brady’s review, “Error and discrepancy in radiology: inevitable or avoidable?” (Insights into Imaging, 2017). It also stresses that a discrepancy is not automatically an error, and an error is not automatically negligence. That framing is why modern programs focus on learning from discrepancies rather than scoring individuals.
What is RADPEER and how does it work?
RADPEER is the American College of Radiology’s peer review program. The ACR describes it as a process that lets peer review happen during routine image interpretation: when a radiologist reads a new exam and the patient has a prior study of the same area, they score the accuracy of the earlier report on a standardized scale, with no extra interpretive work. Scores go through a secure website, and group leaders can see summary statistics by physician and modality (ACR accreditation support, RADPEER).
The ACR does not set a minimum number of reviews per physician; groups may set their own targets. RADPEER is one option, not the only one: other peer review methods also meet ACR accreditation requirements.
What is peer learning, and why are groups switching?
Score-based peer review
- Random or opportunistic cases are scored for agreement
- Scores roll up to individual physicians
- Often seen as punitive, so few cases are submitted
- Measures agreement more than it teaches
Peer learning
- Radiologists submit cases worth learning from: misses, great calls, near-misses
- Cases are discussed as a group, without blame
- Tracks participation, submissions and improvement projects
- Aims to change practice, not just record scores
The ACR now offers an accreditation pathway for programs that use peer learning, as described in a 2022 program report in the American Journal of Neuroradiology (AJNR, 2022); a 2024 JACR case study explains how the ACR designed that pathway (JACR, 2024). Programs on the pathway report metrics such as the number of cases submitted, the share of radiologists meeting submission targets, conference attendance and improvement projects.
Is radiology peer review required?
| Who asks | What they require | Source |
|---|---|---|
| ACR accreditation | Active participation in a peer review program for CT, MR, NM, PET, ultrasound, breast ultrasound and breast MRI accreditation | ACR accreditation support |
| Your medical staff | Ongoing evaluation of every privileged practitioner’s performance, under your bylaws and accreditor’s standards | Your medical staff bylaws |
| CMS, for telemedicine readers | If you rely on a distant site’s credentialing, you review the remote practitioner’s performance and send it back, including all adverse events and complaints | 42 CFR 482.22, 485.616 |
Mammography and some breast and radiation oncology programs are excluded from the ACR peer review requirement, per the same ACR page. Your accreditor and medical staff office are the final word on what your hospital must do.
How should teleradiologists be included in peer review?
- Same program, same rules. Remote readers’ reports go into the same review pool as your own group’s, so you can compare like with like.
- Two-way sharing. Under a credentialing-by-proxy agreement, your hospital sends adverse events and complaints about remote readers back to the distant site, per CMS. Agree who sends what, and when.
- Review the night shift on purpose. Overnight ED studies are often seen again by your day group the next morning. That is where peer review is easiest and most useful.
- Close the loop. When a discrepancy matters clinically, the reading radiologist should hear about it quickly, and the case should feed a learning conference.
- Report it monthly. Ask for quality data on the same monthly report as turnaround and critical calls, by priority and by hour.
For the other half of the quality picture, see radiology turnaround benchmarks and critical results communication.
What should you ask a teleradiology provider about quality?
- Are your reads signed finals, or preliminaries your day group must re-read?
- How are your radiologists’ reads included in our peer review or peer learning program?
- Will you share discrepancy findings with us, and how fast?
- How do you handle a clinically significant discrepancy found the next morning?
- What goes on the monthly report: turnaround by priority, critical calls, anything else?
- Who is the backup reader, and are they credentialed at our hospital already?
How TeleRads answers. Every TeleRads report is a signed final; we read finals only, never preliminaries. Board-certified radiologists, licensed in your state and approved by your medical staff office before they read a single study for you. Stroke studies are read first and critical results are called within 15 minutes. You get a scorecard you can hold us to, every month, with turnaround and every critical call. A named backup, already credentialed at your hospital, is on every night. Our 12-question buyer checklist covers the rest.
Questions
What is peer review in radiology?
A process in which one radiologist reviews another’s earlier interpretation and records agreement or disagreement, usually while reading a new study of the same patient. It is used to find patterns, support learning and meet accreditation and medical staff requirements.
What is RADPEER?
The American College of Radiology’s peer review program. Radiologists score the accuracy of a prior report during routine reading on a standardized scale, and leaders see summaries by physician and modality. Other peer review methods can also meet ACR accreditation requirements.
What is peer learning in radiology?
A non-punitive model in which radiologists submit cases worth learning from and discuss them as a group, tracking participation and improvement projects. The ACR now offers an accreditation pathway for programs that use peer learning.
Is peer review required for ACR accreditation?
Yes, for CT, MR, nuclear medicine, PET, ultrasound, breast ultrasound and breast MRI accreditation, per the ACR’s accreditation support page. RADPEER is optional; other compliant methods, including the peer learning pathway, can be used.
How common are errors in radiology?
A widely cited 2017 review (Brady, Insights into Imaging) estimates a day-to-day error and discrepancy rate of 3% to 5% of reported studies, and notes that a discrepancy is not automatically an error or negligence.
Should teleradiologists be in our peer review program?
Yes. Remote readers’ reports should be reviewed under the same program as your own radiologists’. If you rely on a distant site’s credentialing, CMS also requires you to send adverse events and complaints about remote readers back to that site.