A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

•Feedback improves the radiologic diagnostic reproducibility of TASI related MRA.•Feedback also improves the radiologic diagnostic accuracy of TASI related MRA.•Feedback enables radiologists and orthopaedic surgeons to discuss discrepancies.•Feedback enables fine-tuning of TASI related definition interpretation agreement.•Feedback increases congruent interdisciplinary professional development.

PurposeTo prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution.Materials and methodsForty-five surgically confirmed MRA’s were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. After execution of the feedback protocol 20 new, surgically confirmed, MRA’s were assessed by 2 experienced musculoskeletal radiologists using a seven-lesion standardized scoring form. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemar’s test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved.ResultsPer 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k = 0.81 versus k = 0.48 and 90.7% versus 78.2%, respectively). The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%).ConclusionThe implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability.