A method and system is provided for optimizing radiology peer review exam selection using artificial intelligence. The system includes an electronic processor configured to: receive a set of candidate medical imaging exams with reading physician data, assign the medical imaging exams to at least one peer reviewer, receive peer reviewer data including scores and/or text for the assigned medical imaging exams, update a machine learning algorithm to optimize the assignment of medical imaging exams to the at least one peer reviewer using the received peer reviewer data.