Overnight resident preliminary interpretations on CT Examinations: should the process continue?

We report our experience with resident preliminary interpretations given at night on both abdominal and neurological CT scans to quantify the discrepancy rate when compared to the final report. An attempt was also made to document any adverse clinical outcomes as a result of the preliminary interpretation. From January 1, 2004 to December 31, 2004, adult CT examinations were prospectively interpreted by residents at night at a level I trauma center. Both the neurological and body CT scans were reviewed beginning at 7:00 a.m. the following morning by the respective subspecialty staff and discrepancies were noted. Adult CT examinations (6,858) were prospectively interpreted by residents: 5,206 cranial spinal CT examinations and 1,652 body CT examinations. Among the neurological studies, there were six cases identified as major discrepancies (0.1%) and 185 minor discrepancies (3.5%). Among the body CT cases, there were seven cases identified as major discrepancies (0.4%) and 23 cases of minor discrepancies (1.4%). There is a low discrepancy rate (0.2% major and 3.1% minor) in the preliminary resident interpretations from the final report. The process of overnight preliminary CT interpretations should continue as it is not substandard care.Presented at the American Society of Emergency Radiology 2005 Annual Meeting, Tucson, Arizona.     

Preliminary interpretations of after-hours CT and sonography by radiology residents versus final interpretations by body imaging radiologists at a level 1 trauma center

OBJECTIVE: At many academic institutions, preliminary interpretations of CT scans and sonograms obtained after regular hours of operation are performed by radiology residents, with attending radiologists reviewing the interpretations the next morning. We sought to determine the rate of discrepancy between residents' interpretations of imaging studies and the final interpretations performed by an attending body imaging radiologist as well as any resulting clinical consequences stemming from the discrepancies. Therefore, we reviewed 928 CT and sonographic images that had been obtained after hours at a level 1 trauma center during a 6-month period. MATERIALS AND METHODS: Any discrepancies between the preliminary and final interpretations were judged as either major (i.e., necessitating an urgent change in treatment) or minor errors. We conducted patient follow-up via a retrospective review of the medical charts to determine whether any of the discrepancies led to additional imaging, an increase in patient morbidity, an extension of a hospital stay, or a change in treatment. RESULTS: The overall discrepancy rate in interpretations rendered by the residents and those performed by the attending radiologist was 3.8%, with most of these discrepancies (86%) judged to be minor. If we combined the data for body CT scans and sonograms, the rate of minor discrepancies was 3.2%, and the rate of major discrepancies was 0.5%. If we considered only body CT data in the evaluation, the overall discrepancy rate increased to 6.4%, with a 5.4% rate of minor discrepancies and a 1.0% rate of major discrepancies. CONCLUSION: Our evaluation of discrepancy rates was unusual in that we included interpretations of sonograms, on which residents and the attending radiologist had a higher rate of agreement (99.5%). Because of the high agreement in the interpretation of sonograms, the overall discrepancy rate was 3.8%. However, if only body CT scan interpretations were evaluated, our results were closer to the rates reported in previously published studies. Major discrepancies led to a change in patient treatment but did not lead to any increase in patient morbidity or to any quantifiable increase in the length of the hospital stay.     

The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff

At many academic hospitals, radiology residents provide preliminary interpretations of CT studies performed outside of regular working hours. We examined the rate of discrepancies between resident interpretations and final reports issued by staff. We prospectively obtained 1,756 preliminary reports and corresponding final reports for computed tomography (CT) scans performed on call between November 2006 and March 2007. The overall rate of clinically significant discrepancies (those that would potentially alter the patient’s clinical course prior to issue of the final report) was 2.0%. Major discrepancy rates for abdominal/pelvic, chest, cervical spine and head CT were 4.1%, 2.5%, 1.0% and 0.7%, respectively. Senior residents had fewer major discrepancies compared to their junior colleagues. Time of interpretation was also evaluated, but a statistically significant relationship was not observed. In summary, this study demonstrates a low discrepancy rate between residents and staff radiologists and identifies areas where after-hours service may be further improved.     

Resident vs. attending interpretation of on-call studies: clinical impact

Purpose: This study was performed to determine whether significant changes to patient treatment plan or outcome result from discrepancies between on-call radiology residents and follow-up attending radiologists in their interpretation of examinations. Methods: For 70 days we recorded on-call radiology residents' readings of all computed tomography and ultrasound examinations performed in our institution and the follow-up attending radiologists' readings of these same examinations. A chart review was performed to determine whether interpretation discrepancies changed the treatment plan and clinical outcome. Results: Eight-hundred thirty-four examinations met the study guidelines. The overall discrepancy rate was 5.16 %. Of these discrepancies, 6.98 % affected the treatment plan (0.36 % of all 834 studies) and none affected the clinical outcome. Conclusion: Where there is a discrepancy between interpretation of computed tomography and ultrasound after hours by on-call radiology residents and follow-up readings by attending radiologists, this discrepancy has no significant effect on the immediate or long-term care of patients.     

Overnight shift work: factors contributing to diagnostic discrepancies

The aims of the study are to identify factors contributing to preliminary interpretive discrepancies on overnight radiology resident shifts and apply this data in the context of known literature to draw parallels to attending overnight shift work schedules. Residents in one university-based training program provided preliminary interpretations of 18,488 overnight (11 pm–8 am) studies at a level 1 trauma center between July 1, 2013 and December 31, 2014. As part of their normal workflow and feedback, attendings scored the reports as major discrepancy, minor discrepancy, agree, and agree—good job. We retrospectively obtained the preliminary interpretation scores for each study. Total relative value units (RVUs) per shift were calculated as an indicator of overnight workload. The dataset was supplemented with information on trainee level, number of consecutive nights on night float, hour, modality, and per-shift RVU. The data were analyzed with proportional logistic regression and Fisher’s exact test. There were 233 major discrepancies (1.26 %). Trainee level (senior vs. junior residents; 1.08 vs. 1.38 %; p?<?0.05) and modality were significantly associated with performance. Increased workload affected more junior residents’ performance, with R3 residents performing significantly worse on busier nights. Hour of the night was not significantly associated with performance, but there was a trend toward best performance at 2 am, with subsequent decreased accuracy throughout the remaining shift hours. Improved performance occurred after the first six night float shifts, presumably as residents acclimated to a night schedule. As overnight shift work schedules increase in popularity for residents and attendings, focused attention to factors impacting interpretative accuracy is warranted.     

Radiology Resident Preliminary Reporting in an Independent Call Environment: Multiyear Assessment of Volume,Timeliness, and Accuracy

PurposeThe objective of this paper is to assess the volume, accuracy, and timeliness of radiology resident preliminary reports as part of an independent call system. This study seeks to understand the relationship between resident year in training, study modality, and discrepancy rate.MethodsResident preliminary interpretations on radiographs, ultrasound, CT, and MRI from October 2009 through December 2013 were prospectively scored by faculty on a modified RADPEER scoring system. Discrepancy rates were evaluated based on postgraduate year of the resident and the study modality. Turnaround times for reports were also reviewed. Differences between groups were compared with a chi-square test with a significance level of 0.05. Institutional review board approval was waived as only deidentified data were used in the study.ResultsA total of 416,413 studies were reported by 93 residents, yielding 135,902 resident scores. The rate of major resident–faculty assessment discrepancies was 1.7%. Discrepancy rates improved with increasing experience, both overall (PGY-3: 1.8%, PGY-4: 1.7%, PGY-5: 1.5%) and for each individual modality. Discrepancy rates were highest for MR (3.7%), followed by CT (2.4%), radiographs (1.4%), and ultrasound (0.6%). Emergency department report turnaround time averaged 31.7 min. The average graduating resident has been scored on 2,746 ± 267 reports during residency.ConclusionsResident preliminary reports have a low rate of major discrepancies, which improves over 3 years of call-taking experience. Although more complex cross-sectional studies have slightly higher discrepancy rates, discrepancies were still within the range of faculty report variation.     

On-Call Radiology Resident Discrepancies: Categorization by Patient Location and Severity

PurposeTo report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results.MethodsA HIPAA-compliant, institutional review board–exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded.ResultsRadiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up.ConclusionsOur resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.     

Clinical trial of digital teleradiology in the practice of emergency room radiology

The application of digital teleradiology (DTR) to radiologic examinations performed in the emergency room was evaluated. A total of 919 examinations (ten computed tomographic; the rest, radiographic) were transmitted to a radiology resident at another hospital emergency room. The 512 X 512 images were reviewed by an attending radiologist and compared with another attending radiologist's interpretation of the original films. Cases with discrepant interpretations were analyzed. Inadequate DTR image quality was responsible for clinically significant discrepancies in 14 of 897 cases (1.6%) available for follow up. Problem areas such as the detection of pneumothorax and abdominal calcifications were identified. Retransmission of optically zoomed images of areas of concern and repeat radiographs of overpenetrated films are suggested to improve DTR performance.     

First year radiology residents not taking call: will there be a difference?

Currently, there is a debate in the academic radiology community about whether or not first year residents should take overnight call. The purpose of this study was to track discrepancies on overnight resident preliminary reads on radiographs from the emergency department to see if the experience level of the resident makes a difference. From October 1, 2005 to September 22, 2006, 13,213 radiographs were prospectively interpreted by residents at night at a Level I Trauma Center. Discrepancies were documented after review of the films with the staff radiologist in the morning. The patient’s medical record was then examined to determine if there was any adverse clinical outcome as a result of the reading. Of the 13,184 radiographs interpreted, 120 total discrepancies were identified (overall discrepancy rate 0.9%). First year residents showed a discrepancy rate of 1.59%, higher than other residents, which were ranged from 0.39 to 0.56%. Of the 54 patients with follow-up imaging, the abnormality that was felt to be present by staff persisted on follow-up imaging in 22 cases; however, the abnormality was not present on follow up of the other 32 patients (59.2% of discrepancies with follow-up imaging). Although there is higher rate of discrepancy among reports generated by first year residents, the difference compared to the other levels of experience is small, and its overall significance can be debated. Follow-up imaging often showed that staff interpretations were false positives when there was a discrepancy reported.     

Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists

Objective

To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists.

Methods

Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated.

Results

CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19–88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation.

Conclusions

Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations.     

Resident interpretation of emergency computed tomographic scans

Our busy, urban emergency room is staffed by radiology residents after working hours. To determine the accuracy of our residents' interpretations of emergency cranial computed tomographic (CT) scans, the authors reviewed the preliminary reports of our residents for a two-month period. A total of 289 cranial CT scans were retrospectively reviewed and the resident interpretation judged acceptable, minor error, moderate error, or major error. Six of 289 neurologic examinations (2%) had moderate (4) or major (2) errors. The mistakes all involved misinterpretation of cerebral hemorrhage. The 98% accuracy in interpretation of cranial CT is higher than the accuracy reported with emergency plain film (PF) interpretation.     

Nonenhanced limited CT in children suspected of having appendicitis: prospective comparison of attending and resident interpretations.

PURPOSE: To prospectively compare resident and attending radiologic interpretations of nonenhanced limited computed tomographic (CT) scans obtained in children suspected of having appendicitis. MATERIALS AND METHODS: Seventy-five consecutive children underwent nonenhanced limited CT for suspected appendicitis. The scans were prospectively interpreted by a resident and an attending radiologist, each unaware of the other's interpretation. The probability that the findings indicated a diagnosis of appendicitis, level of certainty in the interpretation, and presence of an alternate diagnosis were statistically analyzed. RESULTS: Nineteen children (25%) had appendicitis. The area under the receiver operating characteristic curve was not significantly different between residents (0.97 +/- 0.02) and attendings (0.95 +/- 0.04). The percentage agreement between residents and attendings was 91% (kappa = 0.73 +/- 0.095). The average level of certainty tended to be higher for attendings (93% +/- 15) than residents (89% +/- 12). The sensitivity, specificity, and accuracy of resident interpretations were 63%, 96%, and 88%, respectively, compared with those of attending interpretations--95%, 98%, and 97%, respectively. Residents and attendings noted alternate diagnoses in 30% of children without appendicitis. CONCLUSION: A high level of agreement exists between resident and attending radiologists in the interpretation of nonenhanced limited CT scans in children suspected of having appendicitis. Residents, however, tend to be less confident in their interpretations.     

Ensuring Appropriateness of Pediatric Second Opinion Consultations

PurposeWe sought to evaluate discrepancy rates between outside interpretations, radiology trainee preliminary reports, and subspecialist attending final interpretations for pediatric second opinion consultations on plain film and computed tomography imaging and to evaluate the impact of a process improvement for second opinion consultations.MethodsOf a total of 572 requests for second opinion consultations during 1-year preintervention period, we utilized RADPEER to score concurrence of 158 requests which occurred overnight and included outside radiologist interpretations and resident preliminary reports. In consultation with clinician committees, we developed new guidelines for requesting second opinion consultations. We evaluated the impact on the number of consultations for the 1-year period following implementation of this process improvement.ResultsThere was concurrence between the outside interpretation and pediatric subspecialist second opinion in 146 of 158 cases (92%). There was concurrence between the radiology resident and pediatric subspecialist second opinion in 145 of 158 cases (92%). During the 1-year period following our process improvement implementation, the total number of second opinion consultations decreased to 185 (from 572, a decrease of 68%) and the number of overnight requests for resident preliminary reports decreased to 11 (from 158, a decrease of 93%).ConclusionsThere was a high degree of concurrence between interpretations provided by outside radiologists, overnight radiology residents, and attending pediatric radiologists at our institution. Analyzing institutional-specific discrepancy rates is a valuable first step in partnering with clinicians to develop appropriate guidelines for second opinion consultations.     

Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine

RATIONALE AND OBJECTIVES: This study examines the joint effect of several factors on radiology resident performance in the task of interpreting after-hours neuroradiology examinations. MATERIALS AND METHODS: As part of a quality assessment process, we conducted a prospective evaluation of all (N = 21,796) after-hours preliminary readings of neuroradiology examinations performed by radiology residents over a 62-month period at our academic medical center. Each reading was scored by the interpreting neuroradiologist as "agree," "disagree with minimal clinical impact," and "disagree with significant clinical impact." Coded resident and attending identities were also recorded for each case along with modality, body area studied, and the date of examination. These raw data were used to create an analytic data set with level of resident/attending agreement as the outcome and six predictors, including two date-derived variables: months 1-62 representing when the case occurred during the study and quartiles 1-4 accounting for the timing of the case in each resident's own experience. Cross tabulations, plots, bivariate statistics, and logistic regression were used to examine the relationships between study variables and the outcome (level of agreement). RESULTS: Over about 5 years of the study, the absolute number of significant disagreements remained stable at about three per month. The total caseload increased at a rate of 4.1 per month with most of the increase falling into the agree category, whereas the minimal disagreements actually decreased slightly (0.2 per month). In the logistic model for disagreement, three of the factors accounted for most of the variance: attending (61%), resident (15%), and month (15%). Study type (modality and area examined) accounted for another 10%. There was no significant contribution from the variable (quartile) constructed to test for individual resident learning during the on-call experience. CONCLUSION: Although residents differ somewhat in the extent of attending agreement with their on-call work, evaluation or remediation made on the basis of simple comparison of these rates should be done with caution. Improved agreement over time seems to be a collective experience shared by residents.     

Radiology resident interpretation of on-call CT pulmonary angiograms

RATIONALE AND OBJECTIVES: To evaluate the interpretation of computed tomographic pulmonary angiograms performed outside of regular reporting hours, comparing the initial interpretation by the radiology resident to the attending radiologist. MATERIALS AND METHODS: Records for 840 consecutive computed tomographic pulmonary angiograms (CTPA) performed outside of regular reporting hours at two tertiary referral centers from January 1, 2004-December 31, 2005 were reviewed. The preliminary interpretation by the on-call radiology resident was compared to the subsequent final report issued by a subspecialty trained chest radiologist. Studies were stratified as positive, negative, or equivocal for pulmonary embolus. Cases with discordant interpretations or negative CTPA were reviewed to determine impact on clinical outcome. Patients were followed up to 12 months after CTPA to document any subsequent thromboembolic event. RESULTS: Sixteen percent (131/840) of CTPAs were reported positive by the staff radiologist. There was agreement in 90% (752/840) of studies (P = .76, 95% confidence interval, 0.71-0.81) with 86% (114/133) agreement for studies interpreted as positive by residents, 95% (582/612) for studies interpreted as negative by residents, and 63% (60/95) for studies interpreted as equivocal by residents. Studies of optimal quality had higher interobserver agreement than studies of suboptimal quality (P < .0001). In-patient studies were more likely to be positive than emergency room patients (20% vs. 13%) (P = .004). No adverse clinical outcomes were attributed to discordant interpretations. CONCLUSIONS: Radiology residents provide a high level interpretation of on-call CTPA studies, achieving good concordance with the attending radiologists' assessment.     

In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making

PurposeThe aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making.MethodsInformed consent was waived for this institutional review board-exempt, HIPAA-compliant, prospective quality improvement study. From January 29, 2015 to December 10, 2015, semiweekly rounds lasting approximately 60 min were held between the on-call acute care surgery team (attending surgeon, chief resident, and residents) and one of three expert abdominal radiologists. A comprehensive imaging review was performed of recent and comparison examinations for cases selected by the surgeons in which medical and/or surgical decision making was pending. All reviewed examinations had available finalized reports known to the surgical team. RADPEER interradiologist concordance scores were assigned to all reviewed examinations. The impression and plan of the attending surgeon were recorded before and after each in-person review.ResultsOne hundred patients were reviewed with 11 attending surgeons. The in-person meetings led to changes in surgeons’ diagnostic impressions in 43% (43 of 100) and changes in medical and/or surgical planning in 43% (43 of 100; 20 acute changes, 23 nonacute changes, 19 changes in operative management) of cases. There were major discrepancies (RADPEER score ≥3) between the impression of the reviewing radiologist and the written report in 11% of cases (11 of 100).ConclusionsTargeted in-person collaboration between radiologists and acute care surgeons is associated with substantial and frequent changes in patient management, even when the original written report contains all necessary data. The primary mechanism seems to be promotion of a shared mental model that facilitates the exchange of complex information.     

Radiology residents' on-call interpretation of chest radiographs for congestive heart failure

RATIONALE AND OBJECTIVES: This study was designed to evaluate the performance of radiology residents in interpreting emergency department (ED) chest radiographs for congestive heart failure and to characterize the factors associated with a subsequent amended interpretation by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for ED chest radiographs between January 2004 and July 2005 and identified those with discrepant interpretations regarding the diagnosis of congestive heart failure. A total of 1.9% (476 of 24,600) of chest radiographs were amended over the study period. Forty-eight patients (75% female, mean age 66 years) whose chest radiograph was amended for the diagnosis of congestive heart failure and were available for review formed the study population. A control group of 35 patients (69% female, mean age 67 years) were individually matched to a convenience subset of patients by age, gender, clinical indication, and radiographic projection. Chest radiographs were in the anteroposterior projection in 62% (30 of 48) of study patients and 60% (21 of 35) of controls. A blinded expert panel of three board-certified cardiothoracic radiologists jointly reviewed each chest radiograph for the presence or absence of congestive heart failure and its specific radiographic findings. RESULTS: The expert panel diagnosed congestive heart failure in 19% (9 of 48) of study patients and in 23% (8 of 35) of controls (P = .65). When present, congestive heart failure was mild to moderate in severity in both the study and control groups (P = 1.00). There was a significant difference in the expert panel agreement between the attending versus the resident interpretation (65% versus 35%, P = .008), for the study group. This resulted in fair agreement (kappa = 0.29) between the expert panel and the attending interpretation and no agreement (kappa = -0.29) between the expert panel and the resident interpretation. In contrast, the expert panel agreed with the joint resident/attending interpretation in 83% (29 of 35) of controls, yielding substantial agreement (kappa = 0.72). CONCLUSION: Interpretation of chest radiographs for congestive heart failure by radiology residents has a low error rate. The majority of chest radiographs with discrepant resident and attending interpretations were portable films of female patients with subtle radiographic findings of congestive heart failure, and were inherently difficult to interpret.     

Quality control in neuroradiology: discrepancies in image interpretation among academic neuroradiologists

Prior studies have found a 3%-6% clinically significant error rate in radiology practice. We set out to assess discrepancy rates between subspecialty-trained university-based neuroradiologists. Over 17 months, university neuroradiologists randomly reviewed 1000 studies and reports of previously read examinations of patients in whom follow-up studies were read. The discrepancies between the original and "second opinion" reports were scored according to a 5-point scale: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Of the 1000 studies, 876 (87.6%) showed agreements with the original report. The neuroradiology division had a 2.0% (20/1000; 95% CI, 1.1%-2.9%) rate of clinically significant discrepancies involving 8 CTs and 12 MR images. Discrepancies were classified as vascular (n = 7), neoplastic (n = 9), congenital (n = 2), and artifacts (n = 2). Individual neuroradiologist's scores ranged from 0% to 7.7% ± 2.3% (n = 18). Both CT and MR imaging studies had a discrepancy rate of 2.0%. Our quality assessment study could serve as initial data before intervention as part of a PQI project.     

Comparison of on-call radiology resident and faculty interpretation of 4- and 16-row multidetector CT pulmonary angiography with indirect CT venography

RATIONALE AND OBJECTIVES: On-call radiology residents frequently interpret computed tomography (CT) pulmonary angiography and CT venography studies outside of routine working hours. The purpose of this study was to compare resident and faculty interpretation concordance rates and to see if concordance rates differed depending on the number of CT detectors used. MATERIALS AND METHODS: The study population included 122 consecutive CT pulmonary angiography (CTPA) and CT venography (CTV) examinations performed on a four-row multidetector CT (MDCT) and 125 consecutive CTPA examinations performed using a 16-row MDCT scanner with CTV performed in 124 patients. Preliminary resident reports and final faculty reports were compared. Discrepant cases were independently reviewed by three cardiothoracic radiologists who were unaware of the initial interpretations. Interpretation concordance rates were calculated for both 4- and 16- row MDCT studies and compared using Fisher's exact test. RESULTS: Resident and faculty CTPA and CTV interpretations were concordant in 80% of the 4-row cases and 94% of the 16-row cases. When comparing resident interpretation to the final expert reference standard, the corrected resident error rate was 11% and 2% for 4-row CTPA and CTV, respectively and 4% and 2% for 16-row CTPA and CTV, respectively. Overall CTPA and CTV concordance was significantly lower for 4-row MDCT (80% versus 94%, P < .001 [two-sided] by Fisher's exact test). CONCLUSIONS: Radiology resident interpretation of CTPA and CTV studies demonstrates a high level of agreement with radiology faculty interpretation. Concordance rates are significantly higher for 16-row MDCT than 4-row MDCT which may be due to improved image quality.     

Preliminary Reports in the Emergency Department: Is a Subspecialist Radiologist More Accurate Than a Radiology Resident?

RATIONALE AND OBJECTIVES: To determine whether emergency department (ED) preliminary reports rendered by subspecialist attending radiologists who are reading outside their field of expertise are more accurate than reports rendered by radiology residents, and to compare error rates between radiologists and nonradiologists in the ED setting. MATERIALS AND METHODS: The study was performed at a large academic medical center with a busy ED. An electronic preliminary report generator was used in the ED to capture preliminary interpretations rendered in a clinical setting by radiology residents, junior attendings (within 2 years of taking their oral boards), senior attendings, and ED clinicians between August 1999 and November 2004. Each preliminary report was later reviewed by a final interpreting radiologist, and the preliminary interpretation was adjudicated for the presence of substantial discordances, defined as a difference in interpretation that might immediately impact the care of the patient. Of the 612,890 preliminary reports in the database, 65,780 (11%) met inclusion criteria for this study. A log-linear analysis was used to assess the effects of modality and type of author on preliminary report error rates. RESULTS: ED clinicians had significantly higher error rates when compared with any type of radiologist, regardless of modality. Within the radiologists, residents and junior attendings had lower error rates than did senior attendings, but the differences were not statistically significant. CONCLUSION: Subspecialized attending radiologists who interpret ED examinations outside their area of expertise have error rates similar to those of radiology residents. Nonradiologists have significantly higher error rates than radiologists and radiology residents when interpreting examinations in the ED.