Clinical Audit–Ready Imaging Reporting: A Validator-Governed Deterministic Architecture

Background: Radiographic reporting in musculoskeletal imaging remains vulnerable to reproducibility challenges that undermine clinical audit programs. Inter-reader variability, inconsistent projection handling, incomplete descriptor capture, and absent audit trails propagate uncertainty into longitudinal monitoring and clinical trial endpoints. Objective: To describe and validate a governance-first, disease-agnostic radiographic platform in which reproducibility and audit-readiness are treated as primary design constraints. Methods: RheumaView™ was evaluated using three validation protocols: (1) repeat-run determinism testing across 8-week interval on identical inputs; (2) cross-modality concordance assessment comparing structured radiograph-derived descriptors against independently dictated MRI reports; (3) longitudinal structural stability documentation across 4.5-year serial imaging. Validation employed manual field-by-field comparison with predefined evaluation criteria. Results: Repeat-run testing demonstrated no observed differences in evaluated fields (structural burden grades, phenotype classification) across independent executions. Cross-modality concordance indices ranged from 0.78–0.95 across evaluated domains. Longitudinal delta tables documented stable erosive burden and joint space metrics across 4.5-year interval. Conclusions: A validator-governed deterministic architecture demonstrates governance properties suitable for clinical audit programs: repeat-run reproducibility, structured cross-modality concordance assessment, and longitudinal stability documentation. These findings demonstrate workflow governance capabilities on shared artifacts. Clinical effectiveness, diagnostic performance, and outcome impact are not evaluated in this study.