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Erschienen in: Skeletal Radiology 1/2019

12.07.2018 | Scientific Article

Second opinions in orthopedic oncology imaging: can fellowship training reduce clinically significant discrepancies?

verfasst von: Aleksandr Rozenberg, Barry E. Kenneally, John A. Abraham, Kristin Strogus, Johannes B. Roedl, William B. Morrison, Adam C. Zoga

Erschienen in: Skeletal Radiology | Ausgabe 1/2019

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Abstract

Objective

To determine factors that lead to significant discrepancies in second-opinion consultation of orthopedic oncology patients, and particularly if musculoskeletal fellowship training can decrease clinically significant discrepancies.

Methods

A PACS database was queried for secondary reads on outside cross-sectional imaging studies, as requested by orthopedic oncology from 2014 to 2017. Comparison of original and secondary reports was performed using a published seven-point scale that defines clinically significant discrepancies. An online search was performed for each original radiologist to record if a fellowship in musculoskeletal imaging was completed. Additionally, years of post-residency experience, number of Medicare part B patients billed per year (marker of practice volume), and average hierarchical condition category for each radiologist (marker of practice complexity) was recorded.

Results

A total of 571 patients met the inclusion criteria, with 184 cases initially interpreted by an outside fellowship trained musculoskeletal (MSK) radiologist and 387 cases initially interpreted by a non-MSK trained radiologist. The rate of clinically significant discrepancy was 9.2% when initially interpreted by MSK radiologists compared with 27.9% when initially performed by non-MSK radiologists (p < 0.05). After adjustment by both patient characteristics and radiologist characteristics, the likelihood of clinically significant discrepancies was greater for initial interpretations by non-MSK radiologists compared with MSK radiologists (OR = 1.36; 95% CI = 1.23–2.49).

Conclusion

In orthopedic oncology patients, the rate of clinically significant discrepancies was significantly higher when initially interpreted by non-MSK radiologists compared with MSK radiologists. The lower rate of clinically significant discrepancies demonstrates that subspecialty training may direct more appropriate diagnosis and treatment.
Literatur
1.
Zurück zum Zitat Lu MT, Hallett TR, Hemingway J, et al. Secondary interpretation of CT examinations: frequency and payment in the medicine fee-for-service population. J Am Coll Radiol. 2016;13:1096–101.CrossRefPubMed Lu MT, Hallett TR, Hemingway J, et al. Secondary interpretation of CT examinations: frequency and payment in the medicine fee-for-service population. J Am Coll Radiol. 2016;13:1096–101.CrossRefPubMed
2.
Zurück zum Zitat Lu MT, Tellis WM, Avrin DE. Providing formal reports for outside imaging and the rate of repeat imaging. AJR Am J Roentgenol. 2014;203:107–10.CrossRefPubMed Lu MT, Tellis WM, Avrin DE. Providing formal reports for outside imaging and the rate of repeat imaging. AJR Am J Roentgenol. 2014;203:107–10.CrossRefPubMed
3.
Zurück zum Zitat Hunt CH, Wood CP, Diehn FE, et al. Emerging trends in the volume and format of outside examinations submitted for secondary interpretation. AJR Am J Roentgenol. 2012;198:764–8.CrossRefPubMedPubMedCentral Hunt CH, Wood CP, Diehn FE, et al. Emerging trends in the volume and format of outside examinations submitted for secondary interpretation. AJR Am J Roentgenol. 2012;198:764–8.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Yousem DM. Establishing an outside film reading service/dealing with turf issues: unintended consequences. J Am Coll Radiol. 2010;7:480–1.CrossRefPubMed Yousem DM. Establishing an outside film reading service/dealing with turf issues: unintended consequences. J Am Coll Radiol. 2010;7:480–1.CrossRefPubMed
5.
Zurück zum Zitat Shaikh S, Bafana R, Halabi S. Concierge and second-opinion radiology: review of current practices. Curr Probl Diagn Radiol. 2016;45:111–4.CrossRefPubMed Shaikh S, Bafana R, Halabi S. Concierge and second-opinion radiology: review of current practices. Curr Probl Diagn Radiol. 2016;45:111–4.CrossRefPubMed
6.
Zurück zum Zitat Santhosh Kumar GV, Mahajan A, Desai S, Thakur M. Second opinion by in-house radiologists: present picture and emphasis on standardizing imaging protocol in oncology. Curr Probl Diagn Radiol. 2017;46:356–9.CrossRef Santhosh Kumar GV, Mahajan A, Desai S, Thakur M. Second opinion by in-house radiologists: present picture and emphasis on standardizing imaging protocol in oncology. Curr Probl Diagn Radiol. 2017;46:356–9.CrossRef
8.
Zurück zum Zitat Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255:135–41.CrossRefPubMed Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255:135–41.CrossRefPubMed
9.
Zurück zum Zitat Chalian M, Del Grande F, Thakkar RS, et al. Second-opinion subspecialty consultations in musculoskeletal radiology. AJR Am J Roentgenol. 2016;206:1217–21.CrossRefPubMed Chalian M, Del Grande F, Thakkar RS, et al. Second-opinion subspecialty consultations in musculoskeletal radiology. AJR Am J Roentgenol. 2016;206:1217–21.CrossRefPubMed
10.
Zurück zum Zitat Rozenberg A, Kenneally BE, Abraham JA, et al. Clinical impact of second-opinion musculoskeletal subspecialty interpretations during a multidisciplinary orthopedic oncology conference. J Am Coll Radiol. 2017;14:931–6.CrossRefPubMed Rozenberg A, Kenneally BE, Abraham JA, et al. Clinical impact of second-opinion musculoskeletal subspecialty interpretations during a multidisciplinary orthopedic oncology conference. J Am Coll Radiol. 2017;14:931–6.CrossRefPubMed
11.
Zurück zum Zitat McGuire CM, MacMahon P, Byrne DP, Kavanagh E, Mulhall KJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography of the hip is dependent on specialist training of the radiologist. Skeletal Radiol. 2012;41:659–65.CrossRefPubMed McGuire CM, MacMahon P, Byrne DP, Kavanagh E, Mulhall KJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography of the hip is dependent on specialist training of the radiologist. Skeletal Radiol. 2012;41:659–65.CrossRefPubMed
12.
Zurück zum Zitat Briggs GM, Flynn PA, Worthington M, et al. The role of specialist neuroradiology second-opinion reporting: is there added value? Clin Radiol. 2008;63:791–5.CrossRefPubMed Briggs GM, Flynn PA, Worthington M, et al. The role of specialist neuroradiology second-opinion reporting: is there added value? Clin Radiol. 2008;63:791–5.CrossRefPubMed
13.
Zurück zum Zitat Loughrey GJ, Carrington BM, Anderson H, et al. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol. 1999;54:149–54.CrossRefPubMed Loughrey GJ, Carrington BM, Anderson H, et al. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol. 1999;54:149–54.CrossRefPubMed
14.
Zurück zum Zitat Kalbhen CL, Yetter EM, Olson MC, et al. Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions. AJR Am J Roentgenol. 1998;171:1571–6.CrossRefPubMed Kalbhen CL, Yetter EM, Olson MC, et al. Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions. AJR Am J Roentgenol. 1998;171:1571–6.CrossRefPubMed
15.
Zurück zum Zitat DiPiro PJ, vanSonnenberg E, Tumeh SS, Ros PR. Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol. 2002;9:1430–3.CrossRefPubMed DiPiro PJ, vanSonnenberg E, Tumeh SS, Ros PR. Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol. 2002;9:1430–3.CrossRefPubMed
16.
Zurück zum Zitat Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH. RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol. 2004;1:59–65.CrossRefPubMed Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH. RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol. 2004;1:59–65.CrossRefPubMed
17.
Zurück zum Zitat Wibmer A, Vargas HA, Donahue TF, et al. Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol. 2015;205:W73–8.CrossRefPubMed Wibmer A, Vargas HA, Donahue TF, et al. Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol. 2015;205:W73–8.CrossRefPubMed
18.
Zurück zum Zitat Loevner LA, Sonners AI, Schulman BJ, et al. Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center. AJNR Am J Neuroradiol. 2002;23:1622–6.PubMed Loevner LA, Sonners AI, Schulman BJ, et al. Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center. AJNR Am J Neuroradiol. 2002;23:1622–6.PubMed
19.
Zurück zum Zitat Gollub MJ, Panicek DM, Bach AM, et al. Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology. 1999;210:109–12.CrossRefPubMed Gollub MJ, Panicek DM, Bach AM, et al. Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology. 1999;210:109–12.CrossRefPubMed
20.
Zurück zum Zitat Eakins C, Ellis WD, Pruthi S, et al. Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol. 2012;199:916–20.CrossRefPubMed Eakins C, Ellis WD, Pruthi S, et al. Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol. 2012;199:916–20.CrossRefPubMed
21.
Zurück zum Zitat Jordan MJ, Lightfoote JB, Jordan JE. Quality outcomes of reinterpretation of brain CT imaging studies by subspecialty experts in neuroradiology. J Natl Med Assoc. 2006;98:1326–8.PubMedPubMedCentral Jordan MJ, Lightfoote JB, Jordan JE. Quality outcomes of reinterpretation of brain CT imaging studies by subspecialty experts in neuroradiology. J Natl Med Assoc. 2006;98:1326–8.PubMedPubMedCentral
22.
Zurück zum Zitat Wechsler RJ, Spettell CM, Kurtz AB, et al. Effects of training and experience in interpretation of emergency body CT scans. Radiology. 1996;199:717–20.CrossRefPubMed Wechsler RJ, Spettell CM, Kurtz AB, et al. Effects of training and experience in interpretation of emergency body CT scans. Radiology. 1996;199:717–20.CrossRefPubMed
23.
Zurück zum Zitat Cooper VF, Goodhartz LA, Nemcek AA, Ryu RK. Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies. Acad Radiol. 2008;15:1198–204.CrossRefPubMed Cooper VF, Goodhartz LA, Nemcek AA, Ryu RK. Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies. Acad Radiol. 2008;15:1198–204.CrossRefPubMed
24.
Zurück zum Zitat Sistrom C, Deitte L. Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine. Acad Radiol. 2008;15:934–41.CrossRefPubMed Sistrom C, Deitte L. Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine. Acad Radiol. 2008;15:934–41.CrossRefPubMed
25.
Zurück zum Zitat Stevens KJ, Griffiths KL, Rosenberg J, et al. Discordance rates between preliminary and final radiology reports on cross-sectional imaging studies at a level 1 trauma center. Acad Radiol. 2008;15:1217–26.CrossRefPubMed Stevens KJ, Griffiths KL, Rosenberg J, et al. Discordance rates between preliminary and final radiology reports on cross-sectional imaging studies at a level 1 trauma center. Acad Radiol. 2008;15:1217–26.CrossRefPubMed
26.
Zurück zum Zitat Branstetter BFIV, Morgan MB, Nesbit CE, et al. Preliminary reports in the emergency department: is a subspecialist radiologist more accurate than a radiology resident? Acad Radiol. 2007;14:201–6.CrossRefPubMed Branstetter BFIV, Morgan MB, Nesbit CE, et al. Preliminary reports in the emergency department: is a subspecialist radiologist more accurate than a radiology resident? Acad Radiol. 2007;14:201–6.CrossRefPubMed
27.
Zurück zum Zitat Carter BW, Erasmus JJ, Truong MT, et al. Quality and value of subspecialty reinterpretation of thoracic CT scans of patients referred to a tertiary Cancer center. J Am Coll Radiol. 2017;14:1109–18.CrossRefPubMed Carter BW, Erasmus JJ, Truong MT, et al. Quality and value of subspecialty reinterpretation of thoracic CT scans of patients referred to a tertiary Cancer center. J Am Coll Radiol. 2017;14:1109–18.CrossRefPubMed
28.
Zurück zum Zitat Woo S, Kim SY, Choo JY, Kim SH. Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology. Eur Radiol. 2017;5:1877–82.CrossRef Woo S, Kim SY, Choo JY, Kim SH. Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology. Eur Radiol. 2017;5:1877–82.CrossRef
Metadaten
Titel
Second opinions in orthopedic oncology imaging: can fellowship training reduce clinically significant discrepancies?
verfasst von
Aleksandr Rozenberg
Barry E. Kenneally
John A. Abraham
Kristin Strogus
Johannes B. Roedl
William B. Morrison
Adam C. Zoga
Publikationsdatum
12.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 1/2019
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-018-3024-3

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