EDITORIAL
Expert Opinion What is the Greatest Challenge or Barrier for Performing Peer Review in Cardiothoracic Imaging? Phillip M. Boiselle, MD, Jannette Collins, MD, MEd, Jacob Sosna, MD, and Richard Woodcock, MD Peer review has become an established part of quality assurance and quality improvement in radiology. However, it can be challenging to effectively implement and successfully maintain a peer review program, especially within subspecialty areas such as cardiothoracic imaging. We thus asked 3 leading experts to share their expert opinions regarding the following question: “What is the greatest challenge or barrier for performing peer review in cardiothoracic imaging?” Peer review of cardiac imaging examinations is challenging when there are a small number of physicians interpreting the exams and they represent different departments (e.g., radiology and cardiology). A larger pool of peer reviewers allows for greater objectivity and a more robust consensus process. One way to increase the number of reviewers is to participate in a multi-institutional peer review program. The University of Cincinnati has partnered with the University of Indiana to start such a program, which is described on the North American Society for Cardiovascular Imaging (NASCI) website: http://www.nasci.org/News/MultiInstitutionalCardiacImagingProject.aspx.
Jannette Collins, MD, MEd Cincinnati, Ohio, USA In radiology, the assessment of reading accuracy is used for quality improvement. Thoracic imaging studies are performed and interpreted by expert chest radiologists and general radiologists; and cardiac studies by radiologists and cardiologists. The challenges of peer review relate to the expectations from physicians with different levels of training. Should peer review be performed solely at the subspecialist level? Should quality standards vary depending on the expertise? How should these differences in interpretation capabilities be measured, defined, and compared? In cardiac imaging, how should differences in interpretation of echocardiography and assessment of extracardiac findings by cardiologists and radiologists be evaluated?
Jacob Sosna, MD Jerusalem, Israel Numerous barriers exist to acceptance and use of peer review. Frequent comments include feeling as though you are a target or are targeting others; fear of professional embarrassment; a sense of unfairness or randomness to the process; concern that the process will be onerous, time consuming and not useful; claims that it is unscientific or unsupported by references (i.e., based on opinion); and concern that increasing complexity and specialization makes true or valid peers harder to find. For a subspecialty such as cardiothoracic radiology, there are often few true or valid peers available to construct an anonymous process. Observations about what is lacking in many practices include that many physicians do not recognize or accept that peer review is part of the total process of providing radiology services; often physicians are slow to accept they make errors; and many providers find it difficult to take constructive criticism or are defensive.
Richard Woodcock, MD Atlanta, Georgia, USA
The authors declare no conflicts of interest. Copyright r 2014 by Lippincott Williams & Wilkins
J Thorac Imaging
Volume 29, Number 5, September 2014
www.thoracicimaging.com |
261
Expert Opinion What is the Greatest Challenge or Barrier for Performing Peer Review in Cardiothoracic Imaging? Phillip M. Boiselle, MD, Jannette Collins, MD, MEd, Jacob Sosna, MD, and Richard Woodcock, MD Peer review has become an established part of quality assurance and quality improvement in radiology. However, it can be challenging to effectively implement and successfully maintain a peer review program, especially within subspecialty areas such as cardiothoracic imaging. We thus asked 3 leading experts to share their expert opinions regarding the following question: “What is the greatest challenge or barrier for performing peer review in cardiothoracic imaging?” Peer review of cardiac imaging examinations is challenging when there are a small number of physicians interpreting the exams and they represent different departments (e.g., radiology and cardiology). A larger pool of peer reviewers allows for greater objectivity and a more robust consensus process. One way to increase the number of reviewers is to participate in a multi-institutional peer review program. The University of Cincinnati has partnered with the University of Indiana to start such a program, which is described on the North American Society for Cardiovascular Imaging (NASCI) website: http://www.nasci.org/News/MultiInstitutionalCardiacImagingProject.aspx.
Jannette Collins, MD, MEd Cincinnati, Ohio, USA In radiology, the assessment of reading accuracy is used for quality improvement. Thoracic imaging studies are performed and interpreted by expert chest radiologists and general radiologists; and cardiac studies by radiologists and cardiologists. The challenges of peer review relate to the expectations from physicians with different levels of training. Should peer review be performed solely at the subspecialist level? Should quality standards vary depending on the expertise? How should these differences in interpretation capabilities be measured, defined, and compared? In cardiac imaging, how should differences in interpretation of echocardiography and assessment of extracardiac findings by cardiologists and radiologists be evaluated?
Jacob Sosna, MD Jerusalem, Israel Numerous barriers exist to acceptance and use of peer review. Frequent comments include feeling as though you are a target or are targeting others; fear of professional embarrassment; a sense of unfairness or randomness to the process; concern that the process will be onerous, time consuming and not useful; claims that it is unscientific or unsupported by references (i.e., based on opinion); and concern that increasing complexity and specialization makes true or valid peers harder to find. For a subspecialty such as cardiothoracic radiology, there are often few true or valid peers available to construct an anonymous process. Observations about what is lacking in many practices include that many physicians do not recognize or accept that peer review is part of the total process of providing radiology services; often physicians are slow to accept they make errors; and many providers find it difficult to take constructive criticism or are defensive.
Richard Woodcock, MD Atlanta, Georgia, USA
The authors declare no conflicts of interest. Copyright r 2014 by Lippincott Williams & Wilkins
J Thorac Imaging
Volume 29, Number 5, September 2014
www.thoracicimaging.com |
261
