Table 3.

Changes in Clinical Care and Outcomes

Case	Body Area	Clinician Reading	Radiologist Reading	Change in Care	Outcome
1	Foot	Normal	2nd metatarsal stress fracture	Follow-up visit scheduled^*	Continued pain at follow-up visit with normal radiographs 17 months later
2	Hand	Normal	Nondisplaced intra-articular fracture at base of 2nd metacarpal	Cast applied^*	Continued to have pain 9 months later despite appropriate care
3	Left ribs and PA chest	Normal	Nondisplaced 5th, 6th and 7th rib fractures	New prescription for pain medication^*	Pain improved at 5-week follow-up visit
4	Foot	Normal	Nondisplaced 5th proximal phalangeal shaft fracture	Gym excuse for 3 weeks^*	No further follow up documented
5	Ankle	Normal	Impacted calcaneus fracture	Repeat radiographs^*	No calcaneal pain 9 weeks later
6	Hand	Normal	Possible fracture of DIP dorsal spur	Additional office visit repeat radiographs^*	Although patient free of pain or swelling, repeat radiographs were obtained.
7	PA and lateral chest	Lung infiltrate	No acute pulmonary disease	Cancelled possible CT^*	Cough resolved
8	Lumbar spine, AP and lateral	′No acute disease′	Possible spondylolysis recommended additional radiographs	Additional radiographs^†	No change in care for back pain
9	Abdomen	Normal	6-mm nodule, base of lung	Additional radiographs^†	′Nodule′ not seen on repeat radiographs
10	PA and lateral chest	Normal	Bilateral lung nodules	Additional radiographs^†	One nodule was nipple, other was not identified
11	PA and lateral chest	Normal	1-cm lung nodule	Additional radiographs^†	No further evaluation
12	Shoulder	Normal	Possible mild acromioclavicular subluxation, recommended additional radiographs	Additional radiographs^†	Complete resolution of muscular shoulder strain, no change in care of shoulder
13	PA and lateral chest	Normal	Possible parenchymal opacity	Administrative effort to obtain old radiographs for comparison^‡	Possible parenchymal opacity was second rib
14	PA and lateral chest	Normal	Possible lung nodule	Administrative effort to obtain old radiographs for comparison^‡	Nodule stable for more than 2 years
15	Hand^§	Normal	Fracture at base of 5th proximal phalanx	None documented	Unknown
16	Thumb^§	Normal	Possible nondisplaced Salter-Harris type II fracture of distal phalanx	None documented	Unknown
17	Ankle^§	Normal	Possible medial malleolar avulsion fracture	None documented	Unknown
18	Thumb^§	Normal	Possible nondisplaced Salter-Harris type II fracture of distal phalanx	None documented	Unknown

PA, posteroanterior.
* Presumed or documented 1 telephone contact for each case.
† Presumed or documented 2 telephone contacts for each case.
‡ Presumed or documented 3 telephone contacts for each case.
§ No follow up documented.