Musculoskeletal Outside Interpretation (MOI-RADS): an automated quality assurance tool to prospectively track discrepancies in second-opinion interpretations in musculoskeletal imaging

Objective To implement an automated quality assurance tool to prospectively track discrepancies in musculoskeletal (MSK) exams submitted for second-opinion radiology interpretation at a tertiary center. Methods From 2013 to 2020, a standardized template was included in re-interpretation MSK reports, and a concordance assessment compared with primary interpretation was assigned. Analysis of standardized template implementation and discordance rates was performed. Of the re-interpretations that demonstrated likely clinically relevant discordance, a sample was randomly selected and the EMR was reviewed to evaluate the impact on patient care and change in medical management. Results A total of 1052 re-interpretations were identified using the standardized template. Services with higher requests for second-opinion interpretation were oncology ( n = 351, 33%) and orthopedic surgery ( n = 255, 24%). Overall utilization rate of the template was 65% with marked decreased during the last year (22% rate). In comparison to the primary report, there was a 30% discordance rate ( n = 309) with 18% ( n = 184) classified as likely clinically relevant. From the subset of discrepancies that could be clinically relevant, there was a change in management in 63% of the cases (19/30) with the re-interpretation ultimately proving correct in 80% of the cases (24/30). Conclusion Implementation of a quality assurance tool embedded in the radiology workflow of second-opinion interpretations can facilitate the analysis of patient care impact; however, stricter implementation is necessary. Oncologic studies were the most common indication for re-interpretations. Although the primary and second interpretations in the majority of cases were in agreement, subspecialty MSK radiology interpretation was shown to be more accurate than primary interpretations and impacted clinical management in cases of discrepancy.