Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period

• Published in: The spine journal 2017-04, Vol.17 (4), p.554-561
• Main Authors: Herzog, Richard, Elgort, Daniel R., Flanders, Adam E., Moley, Peter J.
• Format: Article
• Language: English
• Subjects: Aged; Diagnostic Errors; Female; Humans; Low Back Pain - diagnosis; Low Back Pain - diagnostic imaging; Lumbar Vertebrae - diagnostic imaging; Magnetic Resonance Imaging - standards; MRI diagnostic accuracy; MRI diagnostic error rates; MRI diagnostic variability; MRI impact on patient outcome; MRI interpretive accuracy; MRI interpretive error rates; MRI interpretive variability; MRI lumbar spine; MRI quality; MRI value
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2016.11.009

In today's health-care climate, magnetic resonance imaging (MRI) is often perceived as a commodity—a service where there are no meaningful differences in quality and thus an area in which patients can be advised to select a provider based on price and convenience alone. If this prevailing view is correct, then a patient should expect to receive the same radiological diagnosis regardless of which imaging center he or she visits, or which radiologist reviews the examination. Based on their extensive clinical experience, the authors believe that this assumption is not correct and that it can negatively impact patient care, outcomes, and costs. This study is designed to test the authors' hypothesis that radiologists' reports from multiple imaging centers performing a lumbar MRI examination on the same patient over a short period of time will have (1) marked variability in interpretive findings and (2) a broad range of interpretive errors. This is a prospective observational study comparing the interpretive findings reported for one patient scanned at 10 different MRI centers over a period of 3 weeks to each other and to reference MRI examinations performed immediately preceding and following the 10 MRI examinations. The sample is a 63-year-old woman with a history of low back pain and right L5 radicular symptoms. Variability was quantified using percent agreement rates and Fleiss kappa statistic. Interpretive errors were quantified using true-positive counts, false-positive counts, false-negative counts, true-positive rate (sensitivity), and false-negative rate (miss rate). Interpretive findings from 10 study MRI examinations were tabulated and compared for variability and errors. Two of the authors, both subspecialist spine radiologists from different institutions, independently reviewed the reference examinations and then came to a final diagnosis by consensus. Errors of interpretation in the study examinations were considered present if a finding present or not present in the study examination's report was not present in the reference examinations. Across all 10 study examinations, there were 49 distinct findings reported related to the presence of a distinct pathology at a specific motion segment. Zero interpretive findings were reported in all 10 study examinations and only one finding was reported in nine out of 10 study examinations. Of the interpretive findings, 32.7% appeared only once across all 10 of the study examinations' reports. A global Fleiss