title: Volumetric CT-images improve testing of radiological image interpretation skills.
abstract: OBJECTIVE
  Current radiology practice increasingly involves interpretation of volumetric data sets. In contrast, most radiology tests still contain only 2D images. We introduced a new testing tool that allows for stack viewing of volumetric images in our undergraduate radiology program. We hypothesized that tests with volumetric CT-images enhance test quality, in comparison with traditional completely 2D image-based tests, because they might better reflect required skills for clinical practice.
  
  
  METHODS
  Two groups of medical students (n=139; n=143), trained with 2D and volumetric CT-images, took a digital radiology test in two versions (A and B), each containing both 2D and volumetric CT-image questions. In a questionnaire, they were asked to comment on the representativeness for clinical practice, difficulty and user-friendliness of the test questions and testing program. Students' test scores and reliabilities, measured with Cronbach's alpha, of 2D and volumetric CT-image tests were compared.
  
  
  RESULTS
  Estimated reliabilities (Cronbach's alphas) were higher for volumetric CT-image scores (version A: .51 and version B: .54), than for 2D CT-image scores (version A: .24 and version B: .37). Participants found volumetric CT-image tests more representative of clinical practice, and considered them to be less difficult than volumetric CT-image questions. However, in one version (A), volumetric CT-image scores (M 80.9, SD 14.8) were significantly lower than 2D CT-image scores (M 88.4, SD 10.4) (p<.001). The volumetric CT-image testing program was considered user-friendly.
  
  
  CONCLUSIONS
  This study shows that volumetric image questions can be successfully integrated in students' radiology testing. Results suggests that the inclusion of volumetric CT-images might improve the quality of radiology tests by positively impacting perceived representativeness for clinical practice and increasing reliability of the test.
authors: Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands. Electronic address: C.J.Ravesloot@umcutrecht.nl.
authors: Cécile J
authors: CJ
authors: Ravesloot
authors: Department of Pedagogical and Educational Sciences at Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands. Electronic address: M.F.vanderSchaaf@uu.nl.
authors: Marieke F
authors: MF
authors: van der Schaaf
authors: Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands. Electronic address: J.P.J.vanSchaik@umcutrecht.nl.
authors: Jan P J
authors: JP
authors: van Schaik
authors: Center for Research and Development of Education at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Electronic address: T.J.tenCate@umcutrecht.nl.
authors: Olle Th J
authors: OT
authors: ten Cate
authors: Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands. Electronic address: A.vanderGijp-2@umcutrecht.nl.
authors: Anouk
authors: A
authors: van der Gijp
authors: Image Sciences Institute at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Electronic address: C.Mol@umcutrecht.nl.
authors: Christian P
authors: CP
authors: Mol
authors: Image Sciences Institute at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Electronic address: K.Vincken@umcutrecht.nl.
authors: Koen L
authors: KL
authors: Vincken
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D054893:Cone-Beam Computed Tomography; D004502:Education, Medical, Continuing; D004521:Educational Measurement / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011856:Radiographic Image Enhancement / Q000592:standards; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D013337:Students, Medical / Q000706:statistics & numerical data*
keywords: Education; Radiology test; Test quality; Volumetric images