title: Can emergency physicians reliably interpret cardiac CT images? A prospective observational study.
abstract: OBJECTIVE
  Cardiac computed tomography (CCT) is useful for evaluation of acute chest pain in the emergency department (ED). Though the test needs proper interpretation by someone with expertise in cardiovascular imaging, the critical nature of the information the test provides frequently lead emergency physicians (EPs) to act on their own interpretation. We performed this study to assess how often EPs' interpretations are in agreement with radiologists'.
  
  
  METHODS
  This study is a prospective observational study. The target population was patients assessed with CCT for acute chest pain or discomfort. EPs with at least one year CCT experience underwent a one-hour training session before study participation. The most significant lesion, if any, in each arterial segment was assessed for coronary stenosis and plaque calcification. The agreement between EPs' and radiologists' interpretation was assessed with Cohen's kappa and Gwet's AC1.
  
  
  RESULTS
  One hundred and three patients were enrolled and 412 segments were analyzed. Stenosis grading was identical in 363 segments (88.1%) and the interrater agreement was good (kappa=0.6439, AC1=0.8810). Similarly, the plaque calcification grading was identical in 354 segments (86.6%) and the kappa and AC1 values were 0.5660 and 0.8501, respectively. EPs classified 6 of the 17 arterial segments with significant stenosis reported by radiologists as non-significant stenosis (n=5) or clear (n=2), all of which were proved to be significant by following subsequent invasive coronary angiography.
  
  
  CONCLUSIONS
  There was substantial discordance of CCT interpretation between EPs and radiologists. For now, EPs need more education prior to independent CCT reading.
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Joon-Myoung
authors.initials: JM
authors.lastname: Kwon
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Joonghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Yun
authors.initials: JY
authors.lastname: Jung
keywords: Atherosclerotic plaque; Cardiac imaging techniques; Chest pain; Multidetector computed tomography