title: Residents' performance in the interpretation of on-call "triple-rule-out" CT studies in patients with acute chest pain.
abstract: OBJECTIVE
  To evaluate the performance of radiology residents in the interpretation of on-call, emergency "triple-rule-out" (TRO) computed tomographic (CT) studies in patients with acute chest pain.
  
  
  METHODS
  The study was institutional review board-approved and Health Insurance Portability and Accountability Act compliant. Data from 617 on-call TRO studies were analyzed. Dedicated software enables subspecialty attendings to grade discrepancies in interpretation between preliminary trainee reports and their final interpretation as "unlikely to be significant" (minor discrepancies) or "likely to be significant" for patient management (major discrepancies). The frequency of minor, major and all discrepancies in resident's TRO interpretations was compared to 609 emergent non-electrocardiography (ECG)-synchronized chest CT studies using Pearson χ(2) test.
  
  
  RESULTS
  Minor discrepancies occurred more often in the TRO group (9.1% vs. 3.9%, P < .001), but there was no difference in the frequency of major discrepancies (2.1% vs. 2.8%, P = .55). Minor discrepancies in the TRO group most commonly resulted from missed extrathoracic findings with missed liver lesions being the most frequent. Major discrepancies mostly encompassed cardiac and extracardiac vascular findings but did not result in unnecessary interventions, significant immediate changes in management, or adverse patient outcomes.
  
  
  CONCLUSIONS
  On-call resident interpretation of TRO CT studies in patients with acute chest pain is congruent with final subspecialty attending interpretation in the overwhelming majority of cases. The rate of discrepancies likely to affect patient management in this domain is not different from emergent non-ECG-synchronized chest CT.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: K Gabriel
authors.initials: KG
authors.lastname: Garrett
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Latina, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive, Charleston, SC 29401. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Silverman
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Aleksander W
authors.initials: AW
authors.lastname: Krazinski
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Lucas L
authors.initials: LL
authors.lastname: Geyer
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Lewis
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Headden
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Pal
authors.initials: P
authors.lastname: Suranyi
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Meinel
mesh_terms: D000208:Acute Disease; D039602:After-Hours Care / Q000706:statistics & numerical data*; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000000981:diagnostic imaging*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D015588:Observer Variation; D011655:Pulmonary Embolism; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013022:South Carolina; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: Triple-rule-out CT; acute chest pain; cardiac CT; chest CT; residents; training