Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Orthopedics, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Clin Orthop Relat Res. 2023 Oct 1;481(10):2005-2013. doi: 10.1097/CORR.0000000000002626. Epub 2023 Mar 17.
Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied.
QUESTIONS/PURPOSES: (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference?
This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists' patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship-trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference.
In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows.
In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310.
Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.
多学科骨科肿瘤会议对于制定疑似骨科骨与软组织肿瘤患者的治疗计划非常重要，涉及来自多个科室的医生。过去的研究表明了这些会议的临床价值；然而，放射科在管理计划中的投入以及放射科为这些会议配备人员的时间成本尚未得到充分研究。
问题/目的：（1）放射科在多学科会议上的投入是否有助于指导临床管理并提高临床医生的信心？（2）放射科投入多学科会议的时间成本是多少？
这项前瞻性研究于 2020 年 10 月至 2022 年 3 月在一家拥有肉瘤中心的三级学术中心进行。在每周的多学科会议上进行放射学讨论后，将一份单一数据问卷发送给三位治疗骨科肿瘤医生中的一位，每位医生各有 41、19 和 5 年的经验。三位骨科肿瘤医生的患者中有 48%（322 例中的 196 例）完成了治疗骨科肿瘤医生的数据问卷，这是指捕获到的这些医生的患者比例。一名肌肉骨骼放射科住院医师和一名肌肉骨骼放射科 fellowship培训的放射科医生在每次多学科会议上提供放射学投入。记录了临床计划（单独留下、随访影像学、随访临床、建议不同的影像学检查、核心针活检、手术切除或活检或固定、或其他）和放射学投入前后临床信心的变化。每周还向放射科住院医师发送第二份数据问卷，以估算放射科投入多学科会议的时间成本。
在 29%（322 例中的 93 例）的患者中，放射学投入后临床计划发生了变化。在最初计划进行活检的 80 例患者中，有 30%（24 例）取消了活检，在最初计划进行手术切除的 72 例患者中，有 24%（17 例）取消了手术切除。在 21%（322 例中的 68 例）的患者中，存在未报告的影像学发现，这些发现影响了临床管理；13%（43 例中的 322 例）的患者存在漏诊，8%（25 例中的 322 例）的患者存在影像学解释错误。对于最终治疗计划的信心，在多学科会议后，78%（322 例中的 251 例）的患者的治疗骨科肿瘤医生的临床信心有所增加。放射科住院医师和主治医生每周分别花费 4.2 和 1.5 小时进行审查和演示。根据主治医生的国家中位数薪资数据和住院医师的内部薪资数据，放射科主治医生和住院医师的年度合并按比例计算的时间成本估计为 24310 美元。
在一项针对三级肿瘤治疗计划的研究中，放射科主治医生和住院医师在多学科会议中的投入有助于指导最终的治疗计划，减少程序，并提高临床医生对最终治疗计划的信心，其年度时间成本为 24310 美元。
多学科骨科肿瘤会议可能会改变管理计划，放射科的时间成本应由放射科或其所属机构进行预算。
