The clinical value of second-opinion reporting by subspecialist musculoskeletal radiologists

This systematic review aims to evaluate the added clinical value of secondary interpretations produced by specialist musculoskeletal radiologists. Additional aims are to identify clinical settings producing more discrepant cases between the initial and secondary interpreters.

A systematic search of the MEDLINE and Scopus databases was performed for original research studies, which included a discrepancy rate or a number of discordant reports between a primary interpreter of any training level and a secondary subspecialist musculoskeletal radiologist. Full texts included were screened by two reviewers to determine inclusion. A modified version of the QUADAS-2 tool was used to evaluate the risk of bias for each study.

Eight studies with 11,186 initial imaging examinations reinterpreted by a specialist musculoskeletal radiologist met the inclusion criteria. Across the studies, clinically significant discrepancies were generally defined as discrepant cases impacting a patient's management. Most initial reports were produced by radiologists of varying experience without musculoskeletal specialisation. The secondary reports were produced mainly by multiple experienced subspecialised musculoskeletal radiologists. The range of clinically significant discrepancies reported across the eight studies was between 1.4-27.9%. High discrepancy rates were seen in musculoskeletal oncologic cases, and lower discrepancy rates were seen in appendicular radiographs; however, it was concluded that both areas require greater awareness of the potential discrepancies.

Second opinion reports initially interpreted by a non-musculoskeletal radiologist and reinterpreted by a specialist musculoskeletal radiologist were established as beneficial for patients and impacted their management, especially in musculoskeletal oncology cases, fractures within the appendicular extremities and multiple myeloma focal lesion detection. Greater attention to these clinical settings can potentially advise policymaking to formalise second opinion reinterpretations, which could reduce the risk of misdiagnosis and enhance patient safety and survival. Findings highlight areas requiring greater focus in radiology education, guiding resource allocation to address knowledge gaps and enhance diagnostic accuracy.