Factors influencing the detection of abnormalities in barium enemas performed by junior radiologists.
OBJECTIVE
To study the effects of patient variability, technical examination and radiologist-related factors on the radiological diagnosis of barium enema studies.


METHODS
Twenty-one residents (12 women and nine men, age 26-39 years) performed 523 double contrast barium enemas in a university hospital. Diagnoses were classified as normal (n = 203), diverticulosis (n = 224), polyps (n = 25), tumours (n = 20) and other (n = 46); five were missing diagnoses. Binary and multinomial logistic regressions were used to study the relations between the independent variables and the radiological diagnoses.


RESULTS
Patients' advanced age (p < 0.001) and obesity (p = 0.041) were significant positive predictors for the detection of any abnormalities, as was good or moderate study quality (p = 0.023). However, patients' obesity was negatively associated with the detection of polyps (p = 0.037). Pathological findings were associated with higher dose-area products (p = 0.047) than normal cases. Residents' advanced age (p = 0.029) and experience (a high number of previously performed barium enemas; p = 0.009) were negative predictors for the detection of pathological findings.


CONCLUSIONS
Patients' obesity hampers polyp detection, possibly due to decreased image quality or coexisting diverticula. The most experienced and oldest residents missed positive findings, possibly due to insufficient consultation of supervising radiologists, emphasizing the need for their optimal cooperation.
Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland. tapio.vehmas@ttl.fi
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D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D015992:Body Mass Index; D002983:Clinical Competence; D003287:Contrast Media; D004733:Enema / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007417:Intestinal Polyps / Q000000981:diagnostic imaging; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity
D003287:Contrast Media; D001466:Barium Sulfate