Guide · checked October 2026
Radiology discrepancy meetings (REALM): the RCR standards
Radiology discrepancy meetings are now called radiology events and learning meetings (REALMs); the RCR's 2020 standards ask each trust to hold at least six a year, for every radiologist to attend at least half and contribute at least one case a year, with cases anonymised and kept separate from disciplinary processes.
Why the name changed
The RCR's Standards for radiology events and learning meetings (January 2020) replaced Standards for learning from discrepancies meetings (2014), which followed Standards for radiology discrepancy meetings (2007). The RCR renamed the meetings because discussing excellent diagnoses and teaching cases is as valuable as reviewing discrepancies. Its newsletter and panel on errors were renamed REAL (Radiology Events and Learning) at the same time.
The key standards
- Attendance: every radiologist attends at least 50% of departmental REALMs and contributes at least one case a year.
- Frequency: each trust holds and facilitates at least six REALMs a year, about one every two months.
- Chair: the trust appoints a REALM chair, fairly paid, with the role in the job plan.
- Anonymity and separation: cases are anonymised and discussed for education only, completely separate from candour, serious incident, disciplinary and legal processes.
- Feedback: the radiologists involved are told before discussion, learning points are summarised and shared, and attendance and contributions are recorded for appraisal.
- Culture: respectful knowledge-sharing with no blame or shame, and no scoring of suspected errors.
What's coming
The RCR has published a 2026 working draft for consultation, subtitled Embracing Fallibility. It proposes ten standards, keeps six meetings a year and at least 50% attendance, and adds a REALM lead with protected time, no recording of meetings and a standard on AI. It is a draft, so keep working to the 2020 standards until a final version is published. The Quality Standard for Imaging 2026 (XR-210) also expects reporting radiographers and sonographers to take part and notes that not all discrepancies are errors.
What a REALM is not
- Not a place to score or grade colleagues.
- Not part of a serious incident investigation or disciplinary process.
- Not only about misses: good catches and teaching cases belong there too.
Where RadQA fits
RadQA can surface candidate cases for a REALM chair: peer review discrepancies, possible discrepancies against a prior, and report QA findings, each with the evidence quoted from the report. Analytics and exports (CSV, JSON or HTML) summarise patterns across a period without needing to name individuals.
RadQA does not run the meeting, record attendance or replace the chair's judgement on what to discuss. RadQA is a pilot. It is a quality-assurance assistant, not a diagnostic device, and it does not replace radiologist reporting or clinical judgement.
Questions
How often should REALMs be held?
The RCR's 2020 standards say at least six a year per trust, about one every two months.
Should cases be scored at a REALM?
No. The RCR does not recommend scoring or grading suspected errors in REALMs.
Sources
Official pages, checked October 2026. Guidance changes, so check the current version before you rely on it.
General information for healthcare managers and clinical teams, checked October 2026. It is not legal, regulatory or clinical advice; follow the current official guidance and your organisation's own policies. No patient data is used in these examples. RadQA is a quality-assurance assistant for imaging departments. It is not a diagnostic device and does not replace radiologist reporting or clinical judgement. Validate against your own systems and local governance before production use.