Variability in diagnostic error rates of 10 MRI centers: The Spine Journal

Filed Under: Costs, Patients, Providers

“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,” write Richard Herzog M.D., Daniel R. Elgort, PhD, Adam E. Flanders M.D., and Peter J. Moley, M.D., in a paper in The Spine Journal.

I was interested in it because of the debate over whether more expensive procedures deliver better results, and also because Dr. Moley was once my orthopedist. And everybody knows I like a good quality conversation — especially since the issue of quality is most often raised by providers whose services are the most expensive, as they point out that people looking to save money might be led astray by the need to pay $300 for an MRI rather than $6,000. (I had an MRI of the lower back about 10 years ago at the Hospital for Special Surgery, where Dr. Moley practices; my insurance company paid around $2,400.)

The writers go on: “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. Purpose 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….” They go on to describe the “secret shopper” methodology, in which a 63-year-old woman had 10 MRI exams over the space of a few weeks. And then they deliver the results.

“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. …

“This study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists’ reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors conclude that where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome.” Richard Herzog M.D., Daniel R. Elgort, PhD, Adam E. Flanders M.D., and Peter J. Moley, M.D., “Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period,” The Spine Journal.