Implementation of a Structured Peer Learning Program and Missed Critical Findings in a Large Integrated Radiology...

The American College of Radiology (ACR) defines peer learning as nonpunitive, education-centered case review, separated from individual performance evaluation. We describe a program designed against ACR criteria in a large integrated practice and report first-cycle metrics, including missed critical findings-a narrow subset of major misses.

This retrospective analysis spanned 283 radiologists across more than 100 sites between March 30 and May 14, 2026. Cases entered through voluntary worklist submission, risk-event referral, and departmental escalation, and were adjudicated by a fellowship-trained coordinator. A missed critical finding (MCF) required both a finding on the institutional critical results list (provider notification within 30 minutes) and a 4B classification, with agreement between two independent reviewers. Exact (Poisson) 95% confidence intervals (CI) were calculated.

Of 702 submissions, 489 (69.7%) were Learning Opportunities, 187 (26.6%) Great Calls, and 26 (3.7%) Agrees. Of 283 radiologists, 182 (64.3%) submitted at least one case, and 213 (75.3%) received feedback; two conferences were held. Of 17 candidates, reviewers concurred on 7 at initial review; the 10 discordant were resolved by consensus, none meeting criteria. Across 409,122 interpreted studies, the confirmed MCF rate was 0.017 per 1000 (95% CI 0.007-0.035). Seven radiologists (2.5%) had one event; none had more. No confirmed event had been independently filed as a safety event.

The MCF rate reflects a narrow, time-critical subset ascertained with unmeasured sensitivity against a diluted denominator. It is a conservative internal baseline, not a measure of diagnostic accuracy or individual performance.