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

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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.

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Authors and Affiliations

  1. Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA

    Aleksandr Rozenberg, Johannes B. Roedl, William B. Morrison & Adam C. Zoga

  2. Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Barry E. Kenneally, John A. Abraham & Kristin Strogus

Authors
  1. Aleksandr Rozenberg
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  2. Barry E. Kenneally
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  3. John A. Abraham
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  4. Kristin Strogus
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  5. Johannes B. Roedl
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  6. William B. Morrison
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  7. Adam C. Zoga
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Corresponding author

Correspondence to Aleksandr Rozenberg.

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Rozenberg, A., Kenneally, B.E., Abraham, J.A. et al. Second opinions in orthopedic oncology imaging: can fellowship training reduce clinically significant discrepancies?. Skeletal Radiol 48, 143–147 (2019). https://doi.org/10.1007/s00256-018-3024-3

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  • DOI: https://doi.org/10.1007/s00256-018-3024-3

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