Second-opinion subspecialty consultations in musculoskeletal radiology

Majid Chalian, Filippo Del Grande, Rashmi S. Thakkar, Sahar F. Jalali, Avneesh Chhabra, John A. Carrino

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this article is to evaluate the significance of subspecialty second- opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology. MATERIALS AND METHODS. All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement. RESULTS. Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants. CONCLUSION. The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.

Original languageEnglish (US)
Pages (from-to)1217-1221
Number of pages5
JournalAmerican Journal of Roentgenology
Volume206
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Radiology
Referral and Consultation
Chi-Square Distribution
Consultants
Reading
Pathology

Keywords

  • Consultation
  • Discrepancy
  • Imaging
  • Musculoskeletal
  • Second opinion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Chalian, M., Del Grande, F., Thakkar, R. S., Jalali, S. F., Chhabra, A., & Carrino, J. A. (2016). Second-opinion subspecialty consultations in musculoskeletal radiology. American Journal of Roentgenology, 206(6), 1217-1221. https://doi.org/10.2214/AJR.15.14540

Second-opinion subspecialty consultations in musculoskeletal radiology. / Chalian, Majid; Del Grande, Filippo; Thakkar, Rashmi S.; Jalali, Sahar F.; Chhabra, Avneesh; Carrino, John A.

In: American Journal of Roentgenology, Vol. 206, No. 6, 01.06.2016, p. 1217-1221.

Research output: Contribution to journalArticle

Chalian, M, Del Grande, F, Thakkar, RS, Jalali, SF, Chhabra, A & Carrino, JA 2016, 'Second-opinion subspecialty consultations in musculoskeletal radiology', American Journal of Roentgenology, vol. 206, no. 6, pp. 1217-1221. https://doi.org/10.2214/AJR.15.14540
Chalian, Majid ; Del Grande, Filippo ; Thakkar, Rashmi S. ; Jalali, Sahar F. ; Chhabra, Avneesh ; Carrino, John A. / Second-opinion subspecialty consultations in musculoskeletal radiology. In: American Journal of Roentgenology. 2016 ; Vol. 206, No. 6. pp. 1217-1221.
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AB - OBJECTIVE. The purpose of this article is to evaluate the significance of subspecialty second- opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology. MATERIALS AND METHODS. All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement. RESULTS. Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants. CONCLUSION. The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.

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