Radiologist Quality Assurance by Nonradiologists at Tumor Board

To explore the use of nonradiologists as a method to efficiently reduce bias in the assessment of radiologist performance using a hepatobiliary tumor board as a case study.

Institutional review board approval was obtained for this HIPAA-compliant prospective quality assurance (QA) effort. Consecutive patients with CT or MR imaging reviewed at one hepatobiliary tumor board between February 2016 and October 2016 (n = 265) were included. All presentations were assigned prospective anonymous QA scores by an experienced nonradiologist hepatobiliary provider based on contemporaneous comparison of the imaging interpretation at a tumor board and the original interpretation(s): concordant, minor discordance, major discordance. Major discordance was defined as a discrepancy that may affect clinical management. Minor discordance was defined as a discrepancy unlikely to affect clinical management. All discordances and predicted management changes were retrospectively confirmed by the liver tumor program medical director. Logistic regression analyses were performed to determine what factors best predict discordant reporting.

Approximately one-third (30% [79 of 265]) of reports were assigned a discordance, including 51 (19%) minor and 28 (11%) major discordances. The most common related to mass size (41% [32 of 79]), tumor stage and extent (24% [19 of 79]), and assigned LI-RADS v2014 score (22% [17 of 79]). One radiologist had 11.8-fold greater odds of discordance (P = .002). Nine other radiologists were similar (P = .10-.99). Radiologists presenting their own studies had 4.5-fold less odds of discordance (P = .006).

QA conducted in line with tumor board workflow can enable efficient assessment of radiologist performance. Discordant interpretations are commonly (30%) reported by nonradiologist providers.