title: Interpretation of Emergency Department radiographs: a comparison of emergency medicine physicians with radiologists, residents with faculty, and film with digital display.
abstract: OBJECTIVE
  We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation.
  
  
  METHODS
  A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area.
  
  
  CONCLUSIONS
  We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.
authors.affiliation: Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA.
authors.forename: J
authors.initials: J
authors.lastname: Eng
authors.forename: W K
authors.initials: WK
authors.lastname: Mysko
authors.forename: G E
authors.initials: GE
authors.lastname: Weller
authors.forename: R
authors.initials: R
authors.lastname: Renard
authors.forename: J N
authors.initials: JN
authors.lastname: Gitlin
authors.forename: D A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: D
authors.initials: D
authors.lastname: Magid
authors.forename: G D
authors.initials: GD
authors.lastname: Kelen
authors.forename: W W
authors.initials: WW
authors.lastname: Scott
mesh_terms: D000704:Analysis of Variance; D019540:Area Under Curve; D001842:Bone and Bones / Q000000981:diagnostic imaging; D016001:Confidence Intervals; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency; D015588:Observer Variation; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D011859:Radiography; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D011871:Radiology / Q000193:education; D019112:Teleradiology; D014741:Video Recording / Q000295:instrumentation; D014962:X-Ray Film