Radiology resident evaluation of head CT scan orders in the emergency department.
OBJECTIVE
Prior studies have revealed little difference in residents' abilities to interpret cranial CT scans. The purpose of this study was to assess the performance of radiology residents at different levels of training in the interpretation of emergency head CT images.


METHODS
Radiology residents prospectively interpreted 1324 consecutive head CT scans ordered in the emergency department at the University of Arizona Health Science Center. The residents completed a preliminary interpretation form that included their interpretation and confidence in that interpretation. One of five neuroradiologists with a Certificate of Added Qualification subsequently interpreted the images and classified their assessment of the residents' interpretations as follows: "agree," "disagree-insignificant," or "disagree-significant." The data were analyzed by using analysis-of-variance or chi-squared methods.


RESULTS
Overall, the agreement rate was 91%; the insignificant disagreement rate, 7%; and the significant disagreement rate, 2%. The level of training had a significant (P =.032) effect on the rate of agreement; upper-level residents had higher rates of agreement than those of more junior residents. There were 62 false-negative findings. The most commonly missed findings were fractures (n = 18) and chronic ischemic foci (n = 12). The most common false-positive interpretations involved 10 suspected intracranial hemorrhages and suspected fractures.


CONCLUSIONS
The level of resident training has a significant effect on the rate of disagreement between the preliminary interpretations of emergency cranial CT scans by residents and the final interpretations by neuroradiologists. Efforts to reduce residents' errors should focus on the identification of fractures and signs of chronic ischemic change.
Erly
William K
WK
Department of Radiology, University of Arizona Health Sciences Center, 1501 N. Campbell Avenue, Tucson, AZ 85724-5067, USA.
Berger
William G
WG
Krupinski
Elizabeth
E
Seeger
Joachim F
JF
Guisto
John A
JA
D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D003479:Curriculum; D004636:Emergency Service, Hospital; D006801:Humans; D007396:Internship and Residency; D015588:Observer Variation; D011871:Radiology / Q000193:education*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed