title: A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Forty-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.
  
  
  RESULTS
  Per 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%).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: svangrinsven@rijnstate.nl.
authors.forename: Susan
authors.initials: S
authors.lastname: van Grinsven
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: cvanloon@rijstate.nl.
authors.forename: Corné
authors.initials: C
authors.lastname: van Loon
authors.affiliation: Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: mvangorp@rijnstate.nl.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Gorp
authors.affiliation: Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: mvankints@rijnstate.nl.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: van Kints
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands.
authors.forename: Peer
authors.initials: P
authors.lastname: Konings
authors.affiliation: Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6501 HB Nijmegen, The Netherlands. Electronic address: albert.vankampen@radboudumc.nl.
authors.forename: Albert
authors.initials: A
authors.lastname: van Kampen
mesh_terms: D000293:Adolescent; D000328:Adult; D001175:Arthrography; D002983:Clinical Competence; D002985:Clinical Protocols; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000473:pathology*; D055815:Young Adult
keywords: Accuracy; Anterior traumatic shoulder dislocation; Arthroscopy; Magnetic resonance arthrography; Reproducibility; Shoulder joint