(P 087) RATING THE EFFICACY OF DIAGNOSTIC IMAGING STUDIES PERFORMED FOR THE WORK-UP OF MUSCULOSKELETAL MASSES

Objective: Concerns for missed diagnosis and the practice of defensive medicine has led to a recent increase in excessive imaging. Patients with suspected musculoskeletal tumors may have undergone non-diagnostic and unnecessary invasive imaging studies prior to being referred to a musculoskeletal oncologist. This can result in patients receiving extra radiation or being unable to obtain appropriate diagnostic imaging. The purposes of this study are as follows: 1. To Internally rate the usefulness of imaging tests received for a patient based on a proprietary scoring system and 2. To determine the interrater reliability of providers who rated our scores.

Methods: This is a single-center, retrospective study of 112 patients who presented to our musculoskeletal oncology clinic for work-up of a suspected mass from February to May 2021. After IRB approval, Information on all radiographic images pertinent to the patient’s work-up was collected and recorded by research personnel via a manual chart review. Patient information and images were sent to six fellowship-trained physicians (two musculoskeletal radiologists, two surgical pathologists, and two orthopaedic oncologists) for their review. Providers then graded the appropriateness of each imaging diagnostic test using the five-point scale shown in Table 1. Final diagnoses of our patients were split into three categories: Bone lesions, soft tissue lesions, and metastatic bone lesions. Interrater reliability was performed using Interclass correlation coefficient (ICC) tests.

Results: There were 291 Images for 112 patients in the study. For bone lesions, highly rated diagnostic studies included plain films and MRI with and without contrast, while bone scans received the lowest ratings. The invasive procedure that had the highest percentage of 2+ scores was the core needle biopsy. For Soft tissue lesions, MRIs and CT without contrast were the highest rated diagnostic studies and core needle biopsy was the highest rated invasive study. For metastatic bone lesions, highly rated diagnostic studies include PET/CT and MRI with and without contrast. Core needle biopsy once again was the highest rated invasive study (Table 2). the overall ICC between all providers was 0.33.

Conclusion: Our study was performed to internally rate the usefulness of imaging tests ordered for a patient who initially presents to the musculoskeletal oncology clinic. For bone, tissue and metastatic bone lesions, MRI, CT and Plain films were frequently rated as helpful studies. A core needle biopsy was the highest rated invasive study. Bone scans were considered inappropriate for some bony lesions. Limitations of our study include low inter-provider correlation and broad diagnosis categories. Our study demonstrates the complexity in ordering the right image for diagnosis of musculoskeletal tumors. In order to minimize patient harm and decrease the financial burden to the healthcare system, providers should exercise discretion prior to ordering more invasive tests for the work up of suspected musculoskeletal masses.

Study Study Table 1_CTOS.docx

Study Study Table 2_CTOS.docx