What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

Abstract

Background Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied. Questions/purposes (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference? Methods This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists’ patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship–trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference. Results In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows. Conclusion In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310. Clinical Relevance Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.

CORR Insights®: What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

“…A study published by Komarraju et al [3] in this month’s Clinical Orthopaedics and Related Research underscores the inherent value of radiologists in multidisciplinary conferences and the unreimbursed costs for their efforts. The value of this study is, however, its broader message.…”

“…Otherwise, the real value of expert opinion in the context of multidisciplinary conferences is lost on administrators, politicians, and policymakers. It is up to physicians to weigh, benchmark, and publish data demonstrating the value and costs of these services, as was done in this study [3]. We must demonstrate value in a way that everyone understands by doing the things that we do best—focused patient care that brings science, innovation, and compassion to bear on these difficult challenges.…”

Advancements in Standardizing Radiological Reports: A Comprehensive Review

“…In oncology, with increasing multidisciplinary management, comprehensive and universally coherent radiological reports play a pivotal role. A growing amount of information is needed for multidisciplinary discussions and narrative reports have a high degree of variability and may miss essential treatment-choice information; therefore, they are not preferred in multidisciplinary case discussions [ 27 ]. Accordingly, in the last years, many organizations and initiatives have been established to standardize radiological reporting.…”