Second‐opinion interpretations of neuroimaging studies by oncologic neuroradiologists can help reduce errors in cancer care

Hatzoglou, Vaios; Omuro, Antonio; Haque, Sofia; Khakoo, Yasmin; Ganly, Ian; Oh, Jung Hun; Shukla–Dave, Amita; Fatovic, Robin; Gaal, Joshua; Holodny, Andrei I.

doi:10.1002/cncr.30083

Cited by 44 publications

(18 citation statements)

References 21 publications

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“…By 2012, that number had increased to 1,157, and in 2015, 2,053 second opinion reviews of FDG PET/CT scans were performed. Several studies have suggested that subspecialty review of body CT, neuroradiology, and mammography exams have varying levels of benefit, with discrepancy rates between the initial report and the specialist reassessment ranging between 1 and 19% [1–8]. The value of subspecialist review of FDG PET/CT scans is unknown.…”

Section: Introductionmentioning

confidence: 99%

Value of second-opinion review of outside institution PET-CT examinations

Ulaner

Mannelli

Dunphy

2017

Nuclear Medicine Communications

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Objective Determine if second opinion reviews of PET/CT examinations by subspecialists alters reporting of malignant findings. Methods This IRB-approved study compared 240 FDG PET/CT consecutively dictated reports by two nuclear medicine subspecialists against the original outside institution reports. Subspecialist reviews documented if malignant findings on the outside report were malignant, and noted additional malignant findings not described on the outside report. Final diagnosis of malignancy or benignity was determined by pathology when available, otherwise by imaging follow-up. Results 22 findings (in 20 reports) called suspicious/malignant on the outside reports were deemed benign by subspecialist review. A final diagnosis was available for 20 of 22 findings by pathology (3) or follow-up imaging (17). The subspecialist review was accurate in 20 of 20 (100%) cases where a final diagnosis was available. The subspecialist review called 11 findings (in 11 reports) suspicious/malignant that were not described or deemed benign on the outside reports. Definitive diagnosis was available for 10 of 11 findings by pathology (7) or follow-up imaging (3). The second opinion report was accurate in 7 of 10 (70%) cases where a final diagnosis was available. Conclusions In 31 of 240 (13%) FDG PET/CT examinations performed at an outside institution, subspecialist review resulted in at least one discordant opinion of malignancy. For 28 discrepant cases where a final diagnosis was available, the subspecialist review defined malignancy or benignity correctly in 25 of 28 (89%) cases. This provides evidence for cost and effort invested in performing second opinion reviews of PET/CT studies.

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Section: Introductionmentioning

confidence: 99%

Value of second-opinion review of outside institution PET-CT examinations

Ulaner

Mannelli

Dunphy

2017

Nuclear Medicine Communications

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“…Therefore, we set out to expand on this prior scholarship to develop methodology for measuring not just a radiologist's area of work focus, but also whether advanced imaging is interpreted by a high-volume reader in the field. We present here this methodology and apply it to neurological MRI and musculoskeletal MRI, two areas in which specialist interpretations have been demonstrated to add value [3,4,6,9].…”

Section: Prior Work By Rosenkrantz Et Al Uses This Cms Data To Classimentioning

confidence: 99%

“…Specialization within radiology can take the form of either advanced training, or a increased focus or volume of one's work within a subfield. Both of these forms of specialization have been shown to result in increased diagnostic performance [3][4][5][6][7][8][9][10][11][12][13][14]. While the value of specialization has been demonstrated across a variety of radiology subfields, including musculoskeletal, neurologic, abdominopelvic, thoracic, and breast imaging, the greatest impact has been largely for more complex imaging tasks, such as MRI or oncologic imaging.…”

Section: Introductionmentioning

confidence: 99%

Low-Volume and High-Volume Readers of Neurological and Musculoskeletal MRI: Achieving Subspecialization in Radiology

Trinh

Calabrese

et al. 2020

Journal of the American College of Radiology

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Differentiate high versus low-volume radiologists who interpret neurological(Neuro) MRI or musculoskeletal(MSK) MRI, and measure the proportion of Neuro/MSK MRI read by low-volume radiologists. Methods: We queried the 2015 Medicare Physician and Other Supplier Public Use File for radiologists who submitted claims for Neuro or MSK MRI. Radiologists were classified as high-volume versus low-volume based on their work RVU(wRVU) focus and/or volume of studies interpreted using three different methodologies: (Method1) percentage of wRVU in Neuro/MSK MRI, (Method2) absolute number of Neuro/MSK MRI interpreted, and (Method3) both percentage and absolute number. Multiple thresholds with each methodology were tested, and the percent of Neuro/MSK MRI interpreted by low-volume radiologists was calculated for each threshold. Results: For Neuro(MSK) MRI 33%(50%) of studies were interpreted by a radiologist whose wRVU in Neuro/MSK MRI is less than 20% (Method1). With Method2, 22%(37%) of Neuro(MSK) MRI was interpreted by radiologists who read fewer than the mean number of Neuro/MSK MRI interpreted by an "average fulltime radiologist" whose wRVU in Neuro/MSK MRI is approximately 20%. With 1 Method3, 38%(57%) of Neuro(MSK) MRI was interpreted by "low-volume" radiologists. If instead, 50% wRVU threshold is used for Methods 1/2/3, 70%/ 58%/77% (86%/80%/90%) of Neuro(MSK) MRI is read by low-volume radiologists. Discussion: A large number of radiologists read a low volume of Neuro or MSK MRI; these low-volume Neuro/MSK MRI radiologists read a substantial portion of Neuro/MSK MRI. It is unknown which of the methods for distinguishing lowvolume radiologists, combined with which threshold may best correlate with high performing or low-performing radiologists.

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“…radiologists specializing in cancer imaging, with secondopinion reports indicating the need for changes in patient management in as many as 13% to 53.5% of cases. [7][8][9][10][11][12][13][14][15][16][17][18][19] Second-opinion review can prevent unnecessary biopsies while improving cancer detection, as was shown by a recent study that included 147 patients who self-referred for second-opinion readings of breast images. 20 On secondary review, 24 (25%) of 96 lesions originally reported as suspicious were downgraded to benign or probably benign, preventing biopsy in 21 patients, all of whom remained disease free on follow-up imaging.…”

confidence: 99%