Interpretations of diffusion-weighted MR imaging by radiology residents in the emergency department: is diagnostic performance influenced by the level of residency training?
BACKGROUND
To evaluate the diagnostic performance of radiology residents' interpretations for diffusion-weighted MR imaging (DWI) in the emergency department at different levels of residency training.


METHODS
A total of 160 patients who underwent DWI with acute neurologic symptoms were included in this retrospective study with an institutional review board approval. Four radiology residents with different training years and one attending neuroradiologist independently assessed the DWI results. Discordances between the results of residents and attending neuroradiologist were classified as follows: false positive (FP) and false negative (FN). We also evaluated the diagnostic performance of four residents according to the reference standard.


RESULTS
Overall, the concordance rate was 84.8 %, with a 15.2 % overall discordance rate. There were 83 FN results. The most common misses were small vessel disease (n = 55), acute focal infarction (n = 10), diffuse axonal injury (n = 6), solitary mass (n = 5), extraaxial hemorrhages (n = 3), posterior reversible encephalopathy syndrome (n = 2), and postictal change (n = 2). Fourteen FP results were interpreted as hemorrhage and acute infarction. The 4th year resident exhibited the highest diagnostic performance, and the level of training had a significant influence on the rates of concordance (P < 0.05). Interobserver reliability was good between the interpretations of the residents and the final interpretations of the attending neuroradiologists.


CONCLUSIONS
The level of resident training had a significant effect on their diagnostic performance, and good interobserver reliability was noted between the results of the residents and attending neuroradiologist.
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 612-030, Korea.
Sungjae
S
Lee
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea. sartre81@gmail.com.
Hye Jin
HJ
Baek
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 612-030, Korea.
Hyun Kyung
HK
Jung
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea.
Jin Il
JI
Moon
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea.
Soo Buem
SB
Cho
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea.
Bo Hwa
BH
Choi
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea.
Kyungsoo
K
Bae
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Korea.
Kyung Nyeo
KN
Jeon
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Korea.
Dae Seob
DS
Choi
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Korea.
Hwa Seon
HS
Shin
Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
Dong Wook
DW
Kim
D000328:Adult; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D038524:Diffusion Magnetic Resonance Imaging; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D059906:Neuroimaging; D015588:Observer Variation; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D012189:Retrospective Studies
Diagnostic performance; Diffusion-weighted MR imaging; Radiology; Residency training
AJR Am J Roentgenol. 2003 Jun;180(6):1727-30
12760951
AJNR Am J Neuroradiol. 1998 Jun-Jul;19(6):1061-6
9672012
Radiology. 1998 Jul;208(1):125-8
9646802
AJR Am J Roentgenol. 2007 Sep;189(3):523-6
17715095
AJNR Am J Neuroradiol. 2002 Jan;23 (1):103-7
11827881
AJR Am J Roentgenol. 1981 Jul;137(1):129-33
6787863
Radiology. 2002 Aug;224(2):353-60
12147827
Radiology. 2008 Dec;249(3):972-9
19011191
AJNR Am J Neuroradiol. 2000 Jan;21(1):124-9
10669236
Invest Radiol. 1991 Apr;26(4):374-6
2032826
Emerg Radiol. 2007 Oct;14 (5):311-6
17605056
Ann Emerg Med. 1995 Feb;25(2):169-74
7832342
AJR Am J Roentgenol. 2003 Aug;181(2):367-73
12876012