British Radiologist Addresses Peer Review Issues In Radiology

New scholarship out of England is attempting to address issues plaguing the peer-review process in radiology. Dr. N.H. Strickland, a radiologist at Hammersmith College in London, authored the piece, which was published in the November issue of "Clinical Radiology."

Addressing Peer-Review Reluctance
According to Strickland, medical-imaging professionals are reluctant to attend multidisciplinary team meetings, or the peer-review sessions convened in order to evaluate imaging studies. Strickland attributes this reluctance to the technological deficiencies present in the current peer-to-peer feedback system. If reviewing radiologists discover discrepancies or issues in a study during MDTMs, they create an electronic record noting the problem and attach an addendum. However, radiologists rarely receive direct, peer-to-peer feedback regarding their technique which, if improved, could prevent these kinds of mistakes in the first place.

This sort of circular, non-remedial process engenders doubt within the medical-imaging community regarding the usefulness of peer-review.

Technological Blind Spots
Strickland concluded that faulty technology is to blame. Currently, radiologists use a number of disparate radiological information systems and picture archiving and communication systems during the the peer-review process. This creates inter-institutional technology gaps and makes streamline peer-to-peer feedback almost impossible, he argued.

Currently, most radiologists use RADPEER, an online peer-review software with which reviewers assign each study a numerical score. However, the scores are not made available to study authors, only to those in leadership positions. Additionally, many within the field believe RADPEER increases the likelihood of what Strickland refers to as "hindsight bias," as reviewers can view previous report scores before submitting their own evaluations.

A New Professional Development Solution
Strickland suggested a field-wide reform of peer-review software.

"Radiologists need to work with imaging industry software developers to design the kind of integrated peer review and feedback software needed by radiologists," he wrote.

For his article, Strickland evaluated peer-review feedback systems in anaesthetics and aviation. Both industries used highly-connected, technologically-advanced feedback systems that cultivated higher rates of peer-review compliance and improved overall service quality.

Earlier studies support the validity of Strickland's proposed solution. A 2012 study published by the National Center for Biotechnology Information found that a streamlined, comment-based peer-review system with peer-to-peer communication features improved peer-review compliance and care over the course of a year at Seattle Children's Hospital. The system also reduced the number of discrepancies, the study reported.

Dr. David Larson, a radiologist at Cincinnati Children's Hospital Medical Center, conducted a study on peer-review effectiveness in radiology. In his study, which was published in the journal Radiology, Larson argued that radiology should look to the aviation industry for guidance regarding professional development. Following this research, Larson went on to implement a new review system at Cincinnati Children's Hospital Medical Center. Larson's system emphasized peer-to-peer discussion and omitted numerical ratings, reported Radiology Business.

"What is the purpose of peer review?" Larson asked during an interview with the publication. "From our perspective, the purpose of peer review is to improve care. Let's stop trying to identify the bad radiologists; instead, let's create an environment that is conducive to lifelong learning.

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