Four experienced coronary angiographers (two radiologists and two cardiologists) independently assessed the location and degree of coronary artery stenosis, and the location and degree of left ventricular wall motion abnormalities in 20 coronary angiograms. Marked interobserver variability was noted in quantifying percent coronary artery stenosis and degree of left ventricular wall motion abnormalities. For example, in only 13/20 (65%) of the coronary angiograms did all observers agree about the significance of a stenosis (defined as greater than 50% in diameter luminal narrowing) in the proximal or mid left anterior descending coronary artery. In 3/20 (15%) angiograms there was disagreement by at least one observer about the significance of lesions noted in the main left coronary artery. The ventricle was divided into five segments and the degree of wall motion abnormality graded into six categories of increasing severity from normal to dyskinesis. There was a 42% mean disagreement among all four observers where a disagreement between observers was defined as any difference in grading wall motion abnormalities. Interobserver variability reveals a significant limitation of coronary angiography.

Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.

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To compare the accuracy of interpretation of digitized radiographs with that of plain films, the authors prospectively evaluated the first 685 plain film cases (530 adult and 155 pediatric cases, each of which consisted of one or more images) transmitted from an outpatient center 18 miles (approximately 29 km) to a hospital radiology department by means of a high-speed teleradiology system. Plain films were digitized and transmitted via a T-1 (1.544 Mbit/sec) data link for display on high-resolution (2,560 x 2,048-pixel) workstations. Radiologists at the hospital used a copy of the radiology requisition that had been faxed from the remote center. Interpretation of the digital images was followed by review of the original plain radiographs within 1 working day. Discrepant interpretations occurred in 18 cases (2.6%) (sensitivity, 96%; specificity, 99%); an arbitration panel decided that they were associated with observer performance more than with the fidelity of the digital display. It is concluded that primary diagnosis without review of the original plain radiographs is feasible with state-of-the-art teleradiology systems.

Phase-contrast cine MR images acquired in the plane of an ASD define the defect shape by the cross section of the shunt flow stream and allow noninvasive determination of defect size with sufficient accuracy to permit stratification of patients to closure of the defect by catheter-based techniques versus surgery. Spin-echo images, on the other hand, are not adequate for defining ASD size, because septal thinning adjacent to a secundum ASD may appear to be part of the defect.