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Neuroradiology MRI Second Opinion Interpretations
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C. Hostage MD, Y. Chang MD, PhD
Results and Discussion
Introduction
• Neuroimaging MRI studies performed at outside facilities for patients who are subsequently
transferred to BIDMC are often submitted to the Radiology department for second opinion
interpretation.
• Through discussion with BIDMC referrers and review of reports from other centers, the ostensible
benefits of this practice are several-fold, but appear to primarily revolve around 1) perceived increase
in sophistication and accuracy of the read received, which may alter the management of the patient 2)
documentation of imaging findings in BIDMC’s electronic medical record, for purposes of justifying
subsequent management and care decisions made here.
• Problems perceived from the neuroradiologist perspective is that the volume of these cases has been
subjectively increasing over time, the quality of the MRI studies received is variable, and the actual
versus perceived benefit to the patient/referrer is unclear.
• The scope of this project was to collect and describe recent data on second opinion MRI read requests
and results in the department of Radiology’s Neuroradiology division.
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Over a 6-month period from September 2018 – March 2018, sixty-six (66) total neuroradiology
second opinion interpretations were performed for MRI studies
Of these 5 were excluded due to lack of availability of the original report
Of the remaining 61, 13 reads (21%) were discrepant
Of 13 discrepant reads, 4 (6.5%) were considered “major”, and 9 (15%) were considered ”minor”
Of the 4 discrepant reads, one was a “misdiagnosis”, the other 3 were “missed diagnoses”
The rates of discrepancy seen in our review of recent data were similar to previously reported data at
other centers (3, 4)
Prior studies of more extensive data sets at other facilities utilizing confirmatory follow-up data, either
imaging and/or pathologic data, have suggested that the second opinion subspecialty reads are of
higher accuracy than original general radiology (non-subspeciality) reports (2, 3)
Aim and Methods
• Collect preliminary data on the departmental PACS on recent second opinion MRI requests in the
division of Neuroradiology, including details such as the origin of the original interpretation
• Analyze rates of discrepancy of the initial interpretation as compared to the second interpretation
performed at BIDMC
• Categorize any such discrepancies as “major” or “minor”, and additionally note if there was a “missed
diagnosis” or ”misdiagnosis” on the initial interpretation
• Examples of major discrepancies included missed tumors or fractures, other missed diagnosis,
misdiagnosis, missed incidental findings that would change management (e.g. large AAA which was
unknown to care team seen on lumbar spine MRI). Examples of minor discrepancies include small
(e.g. <5 mm) pulmonary nodules, adrenal adenomas (or other similar non-emergent but notmentioned incidental findings) and clearly chronic findings that were not mentioned in original report
(e.g. chronic lacunar infarcts).
References:
1) Torok CM, Lee C, Nagy P, Yousem DM, Lewin JS. Neuroradiology second opinion consultation service: assessment of duplicative imaging. AJR Am J
Roentgenol. 2013;201(5):1096-100.
2) Lysack JT, Hoy M, Hudon ME, et al. Impact of neuroradiologist second opinion on staging and management of head and neck cancer. J Otolaryngol
Head Neck Surg. 2013;42:39.
3) Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255(1):135-41.
4) Briggs GM, Flynn PA, Worthington M, Rennie I, Mckinstry CS. The role of specialist neuroradiology second opinion reporting: is there added value?.
Clin Radiol. 2008;63(7):791-5.
Future Interventions
• These results suggest that as has been found at other centers, there is a similar level of benefit to be
derived from subspecialist re-interpretation here of neuroimaging studies performed elsewhere,
however further study including confirmation with follow-up imaging and pathologic data may be of
utility at our own center
• Data should also be collected on larger time-frames than the small initial sampling here, in order to
confirm the findings of this small sample
• In addition, data on CT could be obtained and analyzed for similar trends
• Further sub-analysis of the CAQ (Neuroradiology sub-specialization certification) status of the original
outside reader could be performed to explore the intuitive hypothesis that it is the subspeciality
training, or lack thereof, of the reader that specifically correlates with the accuracy of the read as
assessed by follow-up imaging and/or pathologic data
For more information, contact:
C. Hostage MD, BIDMC Neuroradiology Fellow/chostage@bidmc.harvard.edu
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Silverman Symposium
Description
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Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Christopher Hostage (<a href="mailto:chostage@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">chostage@bidmc.harvard.edu</a>)
Department
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Neuroradiology
BIDMC Location
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BIDMC
Project Team
Christopher Hostage
Yu-Ming Chang
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Neuroradiology MRI Second Opinion Interpretations
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
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pdf
Effectiveness
Safety