Preliminary Interpretations of After-Hours CT and Sonography by Radiology Residents Versus Final Interpretations by Body Imaging Radiologists at a Level 1 Trauma Center

Carney, E. Thomas; Kempf, Jeffrey; Decarvalho, Victor L.; Yudd, Anthony P.; Nosher, John L.

doi:10.2214/ajr.181.2.1810367

Cited by 117 publications

(70 citation statements)

References 15 publications

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“…These circumstances may well suit certain individuals more than others. Indeed, previous studies comparing resident CT performance have shown very good agreement with experienced specialist radiologists for studies as diverse as abdominal trauma [20], appendicitis [21] and CT pulmonary angiography [22]. Seemingly, the same cannot be assumed for CTC.…”

Section: Discussionmentioning

confidence: 99%

Reader error during CT colonography: causes and implications for training

et al. 2006

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This study investigated the variability in baseline computed tomography colonography (CTC) performance using untrained readers by documenting sources of error to guide future training requirements. Twenty CTC endoscopically validated data sets containing 32 polyps were consensus read by three unblinded radiologists experienced in CTC, creating a reference standard. Six readers without prior CTC training [four residents and two board-certified subspecialty gastrointestinal (GI) radiologists] read the 20 cases. Readers drew a region of interest (ROI) around every area they considered a potential colonic lesion, even if subsequently dismissed, before creating a final report. Using this final report, reader ROIs were classified as true positive detections, true negatives correctly dismissed, true detections incorrectly dismissed (i.e., classification error), or perceptual errors. Detection of polyps 1-5 mm, 6-9 mm, and > or =10 mm ranged from 7.1% to 28.6%, 16.7% to 41.7%, and 16.7% to 83.3%, respectively. There was no significant difference between polyp detection or false positives for the GI radiologists compared with residents (p=0.67, p=0.4 respectively). Most missed polyps were due to failure of detection rather than characterization (range 82-95%). Untrained reader performance is variable but generally poor. Most missed polyps are due perceptual error rather than characterization, suggesting basic training should focus heavily on lesion detection.

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Section: Discussionmentioning

confidence: 99%

Reader error during CT colonography: causes and implications for training

et al. 2006

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“…[1][2][3] An argument for providing continuous in-house attending coverage is the presence of errors in preliminary interpretation of examinations by residents; however, the error rate for overnight preliminary interpretations by residents has been shown to be quite low. [4][5][6][7][8] CT examination of the head is the most frequently requested after-hours study and can account for up to 57% of all CT examinations performed on call. 9 The fear of being unable to detect intracranial hemorrhage among radiology residents at our institution was the impetus for our study.…”

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confidence: 99%

Overnight Preliminary Head CT Interpretations Provided by Residents: Locations of Misidentified Intracranial Hemorrhage

Strub¹,

Leach²,

Tomsick³

et al. 2007

American Journal of Neuroradiology

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“…Differences between initial emergency CT reports by general radiologists or residents and secondary interpretation by specialists revealed discrepancy rates of 6-27% but change in patient management in only 1-5% [10][11][12]. In studies looking at specialist oncological radiology review of external cross-sectional imaging, radiological staging was changed or major disagreements found in 12-19% of patients but actual change in management in only 3-9% [13][14][15].…”

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confidence: 99%

Radiological error: analysis, standard setting, targeted instruction and teamworking

Fitzgerald

2005

Eur Radiol

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Diagnostic radiology does not have objective benchmarks for acceptable levels of missed diagnoses. Until now, data collection of radiological discrepancies has been very time consuming. The culture within the specialty did not encourage it. However, public concern about patient safety is increasing. There have been recent innovations in compiling radiological interpretive discrepancy rates which may facilitate radiological standard setting. However standard setting alone will not optimise radiologists' performance or patient safety. We must use these new techniques in radiological discrepancy detection to stimulate greater knowledge sharing, targeted instruction and teamworking among radiologists. Not all radiological discrepancies are errors. Radiological discrepancy programmes must not be abused as an instrument for discrediting individual radiologists. Discrepancy rates must not be distorted as a weapon in turf battles. Radiological errors may be due to many causes and are often multifactorial. A systems approach to radiological error is required. Meaningful analysis of radiological discrepancies and errors is challenging. Valid standard setting will take time. Meanwhile, we need to develop top-up training, mentoring and rehabilitation programmes.

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Preliminary Interpretations of After-Hours CT and Sonography by Radiology Residents Versus Final Interpretations by Body Imaging Radiologists at a Level 1 Trauma Center

Cited by 117 publications

References 15 publications

Reader error during CT colonography: causes and implications for training

Reader error during CT colonography: causes and implications for training

Overnight Preliminary Head CT Interpretations Provided by Residents: Locations of Misidentified Intracranial Hemorrhage

Radiological error: analysis, standard setting, targeted instruction and teamworking

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