Implementation of a Structured Peer Learning Program and Missed Critical Findings in a Large Integrated Radiology Practice: A Baseline Retrospective Analysis.

Authors

Zachary Ballenger, Thomas J Ward, Jason C Theadore, Ibrahim F Koury, Asif Bhimani, RoyLynn Taylor, Vanessa Loriga, Aramis Segarra, Felix M Gonzalez

Published in

Academic radiology. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

The American College of Radiology (ACR) defines peer learning as nonpunitive, education-centered case review, separated from individual performance evaluation. We describe a program designed against ACR criteria in a large integrated practice and report first-cycle metrics, including missed critical findings-a narrow subset of major misses.
This retrospective analysis spanned 283 radiologists across more than 100 sites between March 30 and May 14, 2026. Cases entered through voluntary worklist submission, risk-event referral, and departmental escalation, and were adjudicated by a fellowship-trained coordinator. A missed critical finding (MCF) required both a finding on the institutional critical results list (provider notification within 30 minutes) and a 4B classification, with agreement between two independent reviewers. Exact (Poisson) 95% confidence intervals (CI) were calculated.
Of 702 submissions, 489 (69.7%) were Learning Opportunities, 187 (26.6%) Great Calls, and 26 (3.7%) Agrees. Of 283 radiologists, 182 (64.3%) submitted at least one case, and 213 (75.3%) received feedback; two conferences were held. Of 17 candidates, reviewers concurred on 7 at initial review; the 10 discordant were resolved by consensus, none meeting criteria. Across 409,122 interpreted studies, the confirmed MCF rate was 0.017 per 1000 (95% CI 0.007-0.035). Seven radiologists (2.5%) had one event; none had more. No confirmed event had been independently filed as a safety event.
The MCF rate reflects a narrow, time-critical subset ascertained with unmeasured sensitivity against a diluted denominator. It is a conservative internal baseline, not a measure of diagnostic accuracy or individual performance.

PMID:
42864179
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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