Skeletal Radiology

, Volume 48, Issue 1, pp 143–147 | Cite as

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

  • Aleksandr RozenbergEmail author
  • Barry E. Kenneally
  • John A. Abraham
  • Kristin Strogus
  • Johannes B. Roedl
  • William B. Morrison
  • Adam C. Zoga
Scientific Article



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.


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.


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).


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.


Second opinion Oncology Fellowship Discrepancy Musculoskeletal 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Lu MT, Hallett TR, Hemingway J, et al. Secondary interpretation of CT examinations: frequency and payment in the medicine fee-for-service population. J Am Coll Radiol. 2016;13:1096–101.CrossRefPubMedGoogle Scholar
  2. 2.
    Lu MT, Tellis WM, Avrin DE. Providing formal reports for outside imaging and the rate of repeat imaging. AJR Am J Roentgenol. 2014;203:107–10.CrossRefPubMedGoogle Scholar
  3. 3.
    Hunt CH, Wood CP, Diehn FE, et al. Emerging trends in the volume and format of outside examinations submitted for secondary interpretation. AJR Am J Roentgenol. 2012;198:764–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yousem DM. Establishing an outside film reading service/dealing with turf issues: unintended consequences. J Am Coll Radiol. 2010;7:480–1.CrossRefPubMedGoogle Scholar
  5. 5.
    Shaikh S, Bafana R, Halabi S. Concierge and second-opinion radiology: review of current practices. Curr Probl Diagn Radiol. 2016;45:111–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Santhosh Kumar GV, Mahajan A, Desai S, Thakur M. Second opinion by in-house radiologists: present picture and emphasis on standardizing imaging protocol in oncology. Curr Probl Diagn Radiol. 2017;46:356–9.CrossRefGoogle Scholar
  7. 7.
    Duszak R. Another unpaid second opinion. J Am Coll Radiol. 2005;2:793–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255:135–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Chalian M, Del Grande F, Thakkar RS, et al. Second-opinion subspecialty consultations in musculoskeletal radiology. AJR Am J Roentgenol. 2016;206:1217–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Rozenberg A, Kenneally BE, Abraham JA, et al. Clinical impact of second-opinion musculoskeletal subspecialty interpretations during a multidisciplinary orthopedic oncology conference. J Am Coll Radiol. 2017;14:931–6.CrossRefPubMedGoogle Scholar
  11. 11.
    McGuire CM, MacMahon P, Byrne DP, Kavanagh E, Mulhall KJ. Diagnostic accuracy of magnetic resonance imaging and magnetic resonance arthrography of the hip is dependent on specialist training of the radiologist. Skeletal Radiol. 2012;41:659–65.CrossRefPubMedGoogle Scholar
  12. 12.
    Briggs GM, Flynn PA, Worthington M, et al. The role of specialist neuroradiology second-opinion reporting: is there added value? Clin Radiol. 2008;63:791–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Loughrey GJ, Carrington BM, Anderson H, et al. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol. 1999;54:149–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Kalbhen CL, Yetter EM, Olson MC, et al. Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions. AJR Am J Roentgenol. 1998;171:1571–6.CrossRefPubMedGoogle Scholar
  15. 15.
    DiPiro PJ, vanSonnenberg E, Tumeh SS, Ros PR. Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol. 2002;9:1430–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Borgstede JP, Lewis RS, Bhargavan M, Sunshine JH. RADPEER quality assurance program: a multifacility study of interpretive disagreement rates. J Am Coll Radiol. 2004;1:59–65.CrossRefPubMedGoogle Scholar
  17. 17.
    Wibmer A, Vargas HA, Donahue TF, et al. Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol. 2015;205:W73–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Loevner LA, Sonners AI, Schulman BJ, et al. Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center. AJNR Am J Neuroradiol. 2002;23:1622–6.PubMedGoogle Scholar
  19. 19.
    Gollub MJ, Panicek DM, Bach AM, et al. Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center. Radiology. 1999;210:109–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Eakins C, Ellis WD, Pruthi S, et al. Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol. 2012;199:916–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Jordan MJ, Lightfoote JB, Jordan JE. Quality outcomes of reinterpretation of brain CT imaging studies by subspecialty experts in neuroradiology. J Natl Med Assoc. 2006;98:1326–8.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Wechsler RJ, Spettell CM, Kurtz AB, et al. Effects of training and experience in interpretation of emergency body CT scans. Radiology. 1996;199:717–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Cooper VF, Goodhartz LA, Nemcek AA, Ryu RK. Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies. Acad Radiol. 2008;15:1198–204.CrossRefPubMedGoogle Scholar
  24. 24.
    Sistrom C, Deitte L. Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine. Acad Radiol. 2008;15:934–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Stevens KJ, Griffiths KL, Rosenberg J, et al. Discordance rates between preliminary and final radiology reports on cross-sectional imaging studies at a level 1 trauma center. Acad Radiol. 2008;15:1217–26.CrossRefPubMedGoogle Scholar
  26. 26.
    Branstetter BFIV, Morgan MB, Nesbit CE, et al. Preliminary reports in the emergency department: is a subspecialist radiologist more accurate than a radiology resident? Acad Radiol. 2007;14:201–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Carter BW, Erasmus JJ, Truong MT, et al. Quality and value of subspecialty reinterpretation of thoracic CT scans of patients referred to a tertiary Cancer center. J Am Coll Radiol. 2017;14:1109–18.CrossRefPubMedGoogle Scholar
  28. 28.
    Woo S, Kim SY, Choo JY, Kim SH. Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology. Eur Radiol. 2017;5:1877–82.CrossRefGoogle Scholar
  29. 29.
    Centers for Medicare & Medicaid Services Physician and other supplier data CY 2015. Available at: Modified June 15, 2016. Accessed 21 June 2017.
  30. 30.
    Centers for Medicare & Medicaid Services Evaluation of the CMS-HCC Risk Adjustment Model. Available at: Published March 2011. Accessed 21 June 2017.

Copyright information

© ISS 2018

Authors and Affiliations

  • Aleksandr Rozenberg
    • 1
    Email author
  • Barry E. Kenneally
    • 2
  • John A. Abraham
    • 2
  • Kristin Strogus
    • 2
  • Johannes B. Roedl
    • 1
  • William B. Morrison
    • 1
  • Adam C. Zoga
    • 1
  1. 1.Department of RadiologyThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Department of OrthopedicsRothman Institute at Thomas Jefferson UniversityPhiladelphiaUSA

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