Peer learning in breast imaging

Published:February 28, 2022DOI:


      • Traditional peer review is increasingly being replaced by peer learning.
      • Strengths of peer learning include learning, practice improvement, and cultivation of interpersonal relationships.
      • Challenges to peer learning are adaptation and transition from peer review, informatics support, and practice buy-in.
      • Peer learning may especially benefit breast imaging due to its common association with errors in medical malpractice cases.


      With the increasing focus on quality and safety in medicine, radiology practices are increasingly transitioning from traditional score-based peer review to peer learning. Participation in a peer learning program can increase learning, practice improvement, and cultivation of interpersonal relationships in a non-punitive environment. As breast imaging errors are the most cited in medical malpractice cases, learning and attention to and reduction of these errors in breast imaging are especially important. We describe the strengths of a peer learning program, implementation process in a breast imaging program, challenges to overcome, and strategies to support success.


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        • Chetlen A.L.
        • Petscavage-Thomas J.
        • Cherian R.A.
        • Ulano A.
        • Nandwana S.B.
        • Curci N.E.
        • et al.
        Collaborative learning in radiology: from peer review to peer learning and peer coaching.
        Acad Radiol. 2020; 27: 1261-1267
        • Larson D.B.
        • Donnelly L.F.
        • Podberesky D.J.
        • Merrow A.C.
        • Sharpe Jr., R.E.
        • Kruskal J.B.
        Peer feedback, learning, and improvement: answering the call of the Institute of Medicine Report on diagnostic error.
        Radiology. 2017; 283: 231-241
        • Institute of Medicine Committee on Quality of Health Care in A
        Kohn L.T. Corrigan J.M. Donaldson M.S. To err is human: building a safer health system. National Academies Press (US) Copyright 2000 by the National Academy of Sciences, Washington (DC)2000 (All rights reserved)
        • Borgstede J.P.
        • Lewis R.S.
        • Bhargavan M.
        • Sunshine J.H.
        RADPEER quality assurance program: a multifacility study of interpretive disagreement rates.
        J Am Coll Radiol. 2004; 1: 59-65
        • Jackson V.P.
        • Cushing T.
        • Abujudeh H.H.
        • Borgstede J.P.
        • Chin K.W.
        • Grimes C.K.
        • et al.
        RADPEER scoring white paper.
        J Am Coll Radiol. 2009; 6: 21-25
        • Itri J.N.
        • Tappouni R.R.
        • McEachern R.O.
        • Pesch A.J.
        • Patel S.H.
        Fundamentals of diagnostic error in imaging.
        Radiographics. 2018; 38: 1845-1865
        • Moriarty A.K.
        • Cedeno-Kelly K.
        • Hioe T.
        Private practice Radiologists’ perceptions of peer learning.
        J Am Coll Radiol. 2020; 17: 1509-1514
        • Goldberg-Stein S.
        • Frigini L.A.
        • Long S.
        • Metwalli Z.
        • Nguyen X.V.
        • Parker M.
        • et al.
        ACR RADPEER committee white paper with 2016 updates: revised scoring system, new classifications, self-review, and subspecialized reports.
        J Am Coll Radiol. 2017; 14: 1080-1086
        • Soffa D.J.
        • Lewis R.S.
        • Sunshine J.H.
        • Bhargavan M.
        Disagreement in interpretation: a method for the development of benchmarks for quality assurance in imaging.
        J Am Coll Radiol. 2004; 1: 212-217
        • Larson D.B.
        • Broder J.C.
        • Bhargavan-Chatfield M.
        • Donnelly L.F.
        • Kadom N.
        • Khorasani R.
        • et al.
        Transitioning from peer review to peer learning: report of the 2020 peer learning summit.
        J Am Coll Radiol. 2020; 17: 1499-1508
        • Eisenberg R.L.
        • Cunningham M.L.
        • Siewert B.
        • Kruskal J.B.
        Survey of faculty perceptions regarding a peer review system.
        J Am Coll Radiol. 2014; 11: 397-401
        • Abujudeh H.
        • Pyatt Jr., R.S.
        • Bruno M.A.
        • Chetlen A.L.
        • Buck D.
        • Hobbs S.K.
        • et al.
        RADPEER peer review: relevance, use, concerns, challenges, and direction forward.
        J Am Coll Radiol. 2014; 11: 899-904
        • Committee on Diagnostic Error in Health C
        • Board on Health Care S
        • Institute of M
        • The National Academies of Sciences E
        Medicine Balogh E.P. Miller B.T. Ball J.R. Improving Diagnosis in Health Care. National Academies Press (US) Copyright 2015 by the National Academy of Sciences, Washington (DC)2015 (All rights reserved)
        • Larson D.B.
        • Nance J.J.
        Rethinking peer review: what aviation can teach radiology about performance improvement.
        Radiology. 2011; 259: 626-632
      1. American College of Radiology. Peer learning physician quality assurance pathway for accreditation: American College of Radiology,; [Available from: 2 Learning-Webinar_Recording.html?_ga=2.234206302.1376884319.1642084964-943305776.1640886301.

        • Whang J.S.
        • Baker S.R.
        • Patel R.
        • Luk L.
        • Castro III, A.
        The causes of medical malpractice suits against radiologists in the United States.
        Radiology. 2013; 266: 548-554
        • Arleo E.K.
        • Saleh M.
        • Rosenblatt R.
        Lessons learned from reviewing breast imaging malpractice cases.
        J Am Coll Radiol. 2016; 13: R58-r60
        • Dick III, J.F.
        • Gallagher T.H.
        • Brenner R.J.
        • Yi J.P.
        • Reisch L.M.
        • Abraham L.
        • et al.
        Predictors of radiologists' perceived risk of malpractice lawsuits in breast imaging.
        AJR Am J Roentgenol. 2009; 192: 327-333
        • Lee M.V.
        • Konstantinoff K.
        • Gegios A.
        • Miles K.
        • Appleton C.
        • Hui D.
        Breast cancer malpractice litigation: a 10-year analysis and update in trends.
        Clin Imaging. 2020; 60: 26-32
        • Baker S.R.
        • Pentakota S.R.
        • Hubbi B.
        Breast radiology malpractice suits: characteristics of frequency and outcomes- national and statewide distinctions.
        Breast J. 2018; 24: 360-364
        • Sivarajah R.
        • Dinh M.L.
        • Chetlen A.
        Errors in breast imaging: how to reduce errors and promote a safety environment.
        J Breast Imaging. 2021; 3: 221-230
        • Majid A.S.
        • de Paredes E.S.
        • Doherty R.D.
        • Sharma N.R.
        • Salvador X.
        Missed breast carcinoma: pitfalls and pearls.
        Radiographics. 2003; 23: 881-895
        • Lamb L.R.
        • Mohallem Fonseca M.
        • Verma R.
        • Seely J.M.
        Missed breast cancer: effects of subconscious bias and lesion characteristics.
        Radiographics. 2020; 40: 941-960
        • Lewis R.S.
        • Sunshine J.H.
        • Bhargavan M.
        A portrait of breast imaging specialists and of the interpretation of mammography in the United States.
        AJR Am J Roentgenol. 2006; 187: W456-W468
        • Parikh J.R.
        • Sun J.
        • Mainiero M.B.
        What causes the Most stress in breast radiology Practice? A survey of members of the Society of Breast Imaging.
        J Breast Imaging. 2021; 3: 332-342
        • Strickland N.H.
        Quality assurance in radiology: peer review and peer feedback.
        Clin Radiol. 2015; 70: 1158-1164
        • Trinh T.W.
        • Boland G.W.
        • Khorasani R.
        Improving radiology peer learning: comparing a novel electronic peer learning tool and a traditional score-based peer review system.
        AJR Am J Roentgenol. 2019; 212: 135-141
        • Armstrong V.
        • Tan N.
        • Sekhar A.
        • Richardson M.L.
        • Kanne J.P.
        • Sai V.
        • et al.
        Peer learning through multi-institutional web-based case conferences: perceived value (and Challenges) from abdominal, cardiothoracic, and musculoskeletal radiology case conference participants.
        Acad Radiol. 2020; 27: 1641-1646
        • Harvey H.B.
        • Alkasab T.K.
        • Prabhakar A.M.
        • Halpern E.F.
        • Rosenthal D.I.
        • Pandharipande P.V.
        • et al.
        Radiologist peer review by group consensus.
        J Am Coll Radiol. 2016; 13: 656-662
        • Alkasab T.K.
        • Harvey H.B.
        • Gowda V.
        • Thrall J.H.
        • Rosenthal D.I.
        • Gazelle G.S.
        Consensus-oriented group peer review: a new process to review radiologist work output.
        J Am Coll Radiol. 2014; 11: 131-138
        • Haas B.M.
        • Mogel G.T.
        • Attaya H.N.
        Peer learning on a shoe string: success of a distributive model for peer learning in a community radiology practice.
        Clin Imaging. 2020; 59: 114-118
        • Donnelly L.F.
        • Dorfman S.R.
        • Jones J.
        • Bisset III, G.S.
        Transition from peer review to peer learning: experience in a radiology department.
        J Am Coll Radiol. 2018; 15 (3): 1143-1149
        • Sharpe Jr., R.E.
        • Huffman R.I.
        • Congdon R.G.
        • Plunkett L.A.
        • Tschumper B.A.
        • Stewart D.T.
        • et al.
        Implementation of a peer learning program replacing score-based peer review in a multispecialty integrated practice.
        AJR Am J Roentgenol. 2018; 211: 949-956
        • Johnson D.
        • Johnson R.
        Cooperative learning: improving university instruction by basing practice on validated theory.
        J Excell Coll Teach. 2015; 25: 85-118
        • Donnelly L.F.
        • Larson D.B.
        • Heller III, R.E.
        • Kruskal J.B.
        Practical suggestions on how to move from peer review to peer learning.
        AJR Am J Roentgenol. 2018; 210: 578-582
        • Lee R.K.
        • Cohen M.
        • David N.
        • Matalon T.
        Transitioning to peer learning: lessons learned.
        J Am Coll Radiol. 2021; 18: 499-506
        • Harvey H.B.
        • Sotardi S.T.
        Peer learning and preserving the physician's right to learn.
        J Am Coll Radiol. 2018; 15: 444-445
        • Burns J.
        • Miller T.
        • Weiss J.M.
        • Erdfarb A.
        • Silber D.
        • Goldberg-Stein S.
        Just culture: practical implementation for radiologist peer review.
        J Am Coll Radiol. 2019; 16: 384-388
        • Broder J.C.
        • Cameron S.F.
        • Korn W.T.
        • Baccei S.J.
        Creating a radiology quality and safety program: principles and pitfalls.
        Radiographics. 2018; 38: 1786-1798
        • Schafer L.E.
        • Perry H.
        • Fishman M.D.
        • Jakomin B.V.
        • Slanetz P.J.
        Incorporating peer learning into your breast imaging practice.
        J. Breast Imaging. 2021; 3: 491-497
        • Parikh J.R.
        • Kalambo M.
        Integration of the community-based academic radiologist with the academic radiology department: a strategic imperative.
        J Am Coll Radiol. 2020; 17: 304-308