Trainee misinterpretations on pediatric neuroimaging studies: classification, imaging analysis, and outcome assessment

Overnight radiology resident discrepancies at a large pediatric hospital: categorization by year of training, program, imaging modality, and report type

BACKGROUND

Overnight radiology resident discrepancies have been described in multiple studies; however, study of resident discrepancies specific to pediatric radiology is limited.

PURPOSE

To examine radiology resident discrepancies as they pertain to a large pediatric hospital system.

MATERIAL AND METHODS

A total of 21,560 preliminary reports issued by 39 residents over a one-year period were scored as agreement, minor discrepancy, or major discrepancy by faculty members using a modification of the 2009 RADPEER scoring system. Residents were trainees of three different diagnostic radiology programs: large university-based, medium-sized community-based, or small community-based. Discrepancy rates were evaluated based on resident postgraduate year, program, and imaging modality. The effect of a general pediatric radiology report versus pediatric neuroradiology report of a CT scan was also tested. CT was the only modality in which there were comparable numbers of studies scored by both general pediatric radiologists and neuroradiologists.

RESULTS

The rate of major resident to faculty assessment discrepancies was 1.01%, and the rate of minor resident to faculty assessment discrepancies was 4.47%. Major discrepancy rates by postgraduate years 3-5 were 1.08%, 0.75%, and 1.59%, respectively. Major discrepancy rates were highest for MR (11.22%), followed by CT (1.82%), radiographs (0.91%), and ultrasound (0.56%). There was no significant difference in discrepancy rate between residency programs and general pediatric radiology report of a CT versus pediatric neuroradiology report of a CT.

CONCLUSION

Radiology discrepancy rates for residents issuing preliminary reports at a large children's hospital system are similar to those reported for adult procedures.

After-hours radiology coverage in children's hospitals: a multi-center survey

BACKGROUND

Although the provision of pediatric emergency and trauma radiology has become increasingly prevalent in North America over the last few years, many hospitals differ in their models of providing after-hours coverage.

OBJECTIVE

To describe the scope of after-hours radiology services provided in children's hospitals in North America, and the means by which different radiology departments deliver this coverage.

MATERIALS AND METHODS

The Society for Pediatric Radiology Emergency and Trauma Imaging Committee developed a survey that we electronically distributed to a single representative from each of the 79 hospitals represented in the Society of Chiefs of Radiology at Children's Hospitals (SCORCH).

RESULTS

Completed questionnaires were submitted between Aug. 2, 2017, and Sept. 29, 2017, by 44/79 (56%) SCORCH representatives. Contemporaneous after-hours interpretation of radiographs (81%), ultrasounds (81%), body CT (79%) and neurologic CT (75%) with preliminary or final reports was common. Coverage was accomplished most commonly by a combination of evening and overnight shifts 17/44 (39%). Eleven of 44 (25%) hospitals used a model in which radiologists rotate working blocks of overnight service followed by blocks off service. Only 2/44 (5%) hospitals exclusively provided pager coverage after hours. Attending pediatric radiologists were assigned to the majority of after-hours shifts 110/175 (63%), but radiology trainees provided interpretations independently for varying periods of time at 19/44 (43%) surveyed hospitals. Incentives to work after hours included the option to work remotely, as well as additional income, time off, and academic time.

CONCLUSION

The model for delivering after-hours pediatric radiology coverage varies. Most hospitals, however, provide contemporaneous interpretations of radiographs, US, body CT and neurologic CT. Most institutions use evening shifts to extend coverage later, with many providing subsequent overnight coverage. Although most shifts are staffed by attending pediatric radiologists, radiology trainees commonly interpret studies independently for varying durations of time after hours.

Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology

BACKGROUND AND PURPOSE

Diagnostic errors in radiology are classified as perception or interpretation errors. This study determined whether specific conditions differed when perception or interpretation errors occurred during neuroradiology image interpretation.

MATERIALS AND METHODS

In a sample of 254 clinical error cases in diagnostic neuroradiology, we classified errors as perception or interpretation errors, then characterized imaging technique, interpreting radiologist's experience, anatomic location of the abnormality, disease etiology, time of day, and day of the week. Interpretation and perception errors were compared with hours worked per shift, cases read per shift, average cases read per shift hour, and the order of case during the shift when the error occurred.

RESULTS

Perception and interpretation errors were 74.8% (n = 190) and 25.2% (n = 64) of errors, respectively. Logistic regression analyses showed that the odds of an interpretation error were 2 times greater (OR, 2.09; 95% CI, 1.05-4.15; P = .04) for neuroradiology attending physicians with ≤5 years of experience. Interpretation errors were more likely with MR imaging compared with CT (OR, 2.10; 95% CI, 1.09-4.01; P = .03). Infectious/inflammatory/autoimmune diseases were more frequently associated with interpretation errors (P = .04). Perception errors were associated with faster reading rates (6.01 versus 5.03 cases read per hour; P = .004) and occurred later during the shift (24th-versus-18th case; P = .04).

CONCLUSIONS

Among diagnostic neuroradiology error cases, interpretation-versus-perception errors are affected by the neuroradiologist's experience, technique, and the volume and rate of cases read. Recognition of these risk factors may help guide programs for error reduction in clinical neuroradiology services.

CTRead-A Revolutionary Approach to Training Residents in Computed Tomography Facial Bone Interpretation

PURPOSE

The purpose of our study was to create an online, web-based training module that would instruct a group of residents in the interpretation of a computed tomography (CT) facial bone scan in a logical, stepwise manner to locate and identify all relevant facial fractures. Our hypothesis was that implementing the CTRead facial bones training module would improve residents' competency in the interpretation of CT facial bone scans.

MATERIALS AND METHODS

We designed and implemented a prospective quasi-experimental trial. The population for the present study included medical and dental residents. The primary outcome variable was the difference between the pre- and post-test scores of the participants and the frequency of missing fractures before and after the course. The secondary outcomes of interest were subjective data gathered from the course, including participants' feedback and subjective evaluation of the training module and perceived benefit. Another secondary outcome measured was the residents' self-reported confidence level in interpreting the CT facial bone scans on their own before and after completion of the course. Descriptive and bivariate statistics were used.

RESULTS

The population sample included 38 residents from North America, aged 25 to 34 years (mean, 28.2 years). When comparing the results from before and after the course, the overall frequency of missed fractures had decreased from 20.7 to 6.4 (P < .001), and the total score overall had increased from 32.7 to 74.7% (P < .001). Regarding the secondary outcomes, most participants indicated that they agreed or strongly agreed with a number of positive subjective queries. In addition, we found a statistically significant increase in the participants' comfort level in the interpretation of CT facial bone scans.

CONCLUSIONS

The results of the present study have confirmed the hypothesis that completing the CTRead training module (available at: www.CTRead.ca) improves competency among residents in the interpretation of CT facial bone scans and their correctly identification of facial fractures.

Pitfalls in pediatric radiology

This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves.

Systematic method for initial rapid analysis of maxillofacial computed tomography scans for surgeons in training

BACKGROUND

Reading maxillofacial computed tomography (CT) scans is a basic skill for any surgeon who operates on the face. A standard systematic approach for how to read a maxillofacial CT scan from a surgeon's perspective is lacking in literature, particularly for those in the early stages of training. We present a method of initial rapid analysis which our residents in training have responded to and report to be conceptually simple to apply.

METHODS

The senior author reviewed over 250 consults for face trauma and performed a detailed composite of the most common elements of each consult as well as the clinically relevant decision points. These elements were then bundled into a conceptual sketch of the skull-face-mandible with an accompanying standardized clinical data list. The new residents were then guided through a systematic approach to reading the scans while sketching the injuries identified. The authors then performed a survey to establish if the new method was helpful to early learners prior to and after adoption of the method. The survey consisted of five questions regarding the utility of the method for analysis of reading maxillofacial CT.

RESULTS

In total, seven residents were surveyed; 100% thought the technique made reading facial CT easier, 100% thought this method was easy to teach to junior residents and 86% found the analysis of facial CT easier and helped their surgical decision making.

CONCLUSION

We present a systematic method for surgeons to evaluate facial CT scans. This is the first published account of methodology for maxillofacial CT analysis for surgeons.