Disagreements in Chest Roentgen Interpretation

Herman, Peter C.; Gerson, Donald E.; Hessel, Samuel J.; Mayer, Barry S.; Watnick, Murray; Blesser, Barry A.; Ozonoff, David

doi:10.1378/chest.68.3.278

Cited by 114 publications

(39 citation statements)

References 3 publications

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“…Of course, variability in interpretation can also be influenced by other factors than training or experience, such as radiographic quality, and individual radiologist variability (TUDOR; FINLAY; TAUB, 1997;HERMAN et al, 1975;KLINE, 2010). Even amongst experienced and trained radiologists, there is variation in interpretation and diagnostic performance, as we observed and as has been reported (BREALEY; SCALLY; THOMAS, 2002).…”

Section: Discussionsupporting

confidence: 70%

“…Therefore, it is possible that some discrepancies will be associated to simple human error related to cognitive bias (GUNDERMAN, 2009), different emotions or physical tiredness during the interpretation (TUDOR; FINLAY; TAUB, 1997;HERMAN et al, 1975;KLINE, 2010). This can happen to any observers independent of the degree of training and experience.…”

Section: Discussionmentioning

confidence: 99%

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Interobserver agreement in interpretation of radiographic pulmonary changes in dogs in relation to radiology training

Froes¹,

Zwingenberger

Sato

et al. 2014

Sem. Ci. Agr.

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Interpretation of pulmonary radiographs is one of the most difficult aspects of radiology and interobserver variability is high. The aim of this study was to assess variations in interpretation of pulmonary pathology amongst Brazilian veterinarians with different levels of training and experience, using the interpretation by American board-certified radiologists as a reference. We identified areas where interpretation is particularly challenging. Sixty digital canine thoracic radiographic examinations were interpreted by four groups of three Brazilian observers, each group being defined by different levels of training and experience. The radiographic findings of the 4 groups of observers in the study were compared to a reference interpretation established from the findings of three ACVR board-certified radiologists. The degree of discrepancy for each list between each group and the reference interpretation was assessed according to a three-level scoring system: no discrepancy, minor discrepancy, or major discrepancy. Data was analyzed using a Kappa and Cochran-Mantel-Haenszel tests. Brazilian veterinarians with the most training and experience showed the least interobserver variation and best performance when compared to the reference interpretation, followed by those with practical training, but with little work experience in professional practice. The radiographic patterns that were associated with the highest interobserver variability were the vascular, unstructured interstitial and bronchial patterns. Interobserver major discrepancies occurred in all groups, but is more evident in groups with the least training (44.4%) and the general practitioners (26.7%) group. It can be concluded that training positively influences the accuracy of radiographic interpretation and is recommended to reduce erroneous diagnoses. Key words: Training, interobserver agreement, thoracic radiographs, pulmonary patterns ResumoUma das maiores dificuldades na interpretação radiográfica em cães está nas alterações pulmonares sendo a variabilidade interobservador alta. O objetivo desse estudo é detectar as variações de interpretação entre radiologistas brasileiros em diferentes graus de treinamento e experiência, utilizando a interpretação de consenso feito por radiologistas americanos certificados pelo Colégio Americano de Radiologia Veterinária. Na tentativa de identificar os desafios e as particularidades dessa interpretação. Sessenta exames radiográficos digitais do tórax de cães foram interpretados por quatro grupos de observadores com diferentes graus de treinamento em leitura de exames radiográficos. O grau de discrepância entre as observadores foram comparados seguindo um escore com três subclassificações: sem discrepância, discrepância leve e maiores discrepâncias. Para análise dos dados os métodos estatísticos utilizados foram o Kappa e Cochran-Mantel-Haenszel. Os veterinários brasileiros com maior grau de treinamento e experiência foram o que apresentaram menores variações de interpretação quando comparado aos dados d...

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Interobserver agreement in interpretation of radiographic pulmonary changes in dogs in relation to radiology training

Froes¹,

Zwingenberger

Sato

et al. 2014

Sem. Ci. Agr.

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“…Earlier studies have shown that readers do not perform well when interpreting normal chest X-rays, providing false-positive readings mostly due to parenchymal densities. (6,12,18) Accordingly, in our study, we found more false-positives than false-negatives. However, this finding is not in the same range as that reported in one study of the accuracy of chest X-ray interpretation among radiologists and residents.…”

Section: Resultssupporting

confidence: 49%

Competence of senior medical students in diagnosing tuberculosis based on chest X-rays

et al. 2010

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Objective: To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. Methods: In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. Results: The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5%, 90.4% and 94.2%, respectively, and the specificity was 90%, 82% and 42%. The only factor associated with a high score for the overall radiological interpretation was the year of study. Conclusions: In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.Keywords: Tuberculosis, pulmonary; Radiology; Education, medical. ResumoObjetivo: Avaliar a competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose (TB) e determinar fatores associados com altos escores na interpretação de radiografias de tórax em geral. Métodos: Em outubro de 2008, uma amostra de conveniência de estudantes de medicina seniores da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (RJ), que receberam educação formal em radiologia, foi convidada a participar do estudo. Seis radiografias de tórax foram selecionadas, das quais três eram de pacientes com TB. Os participantes escolheram uma entre três possíveis interpretações radiológicas e uma entre quatro condutas clínicas a serem seguidas. Eles também responderam um questionário relativo a dados demográficos, carreira de interesse, tempo de treinamento na emergência e ano de estudo em medicina. A sensibilidade e especificidade para a competência no diagnóstico radiológico da TB, assim como um escore de acertos em radiografia do tórax em geral, foram calculados. Resultados: A sensibilidade para o diagnóstico radiológico provável de TB pulmonar, baseado nas três radiografias de tórax de pacientes com TB (lesões menos extensas, moderadas e mais extensas) foi de 86,5%, 90,4% ...

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“…Subsequently Garland's results have been replicated by other researchers. [7][8][9] Most interesting, comparable rates of "mistakes" were discovered in other specialties. 10,11 In deriving the radiologic error rate, Garland used exclusively abnormal studies-that is, he tested radiologists in environments in which disease prevalence reached 100%.…”

Section: Discussionmentioning

confidence: 56%

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

Babiarz¹,

Yousem²

2011

AJNR Am J Neuroradiol

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SUMMARY:Prior studies have found a 3%-6% clinically significant error rate in radiology practice. We set out to assess discrepancy rates between subspecialty-trained university-based neuroradiologists. Over 17 months, university neuroradiologists randomly reviewed 1000 studies and reports of previously read examinations of patients in whom follow-up studies were read. The discrepancies between the original and "second opinion" reports were scored according to a 5-point scale: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Of the 1000 studies, 876 (87.6%) showed agreements with the original report. The neuroradiology division had a 2.0% (20/1000; 95% CI, 1.1%-2.9%) rate of clinically significant discrepancies involving 8 CTs and 12 MR images. Discrepancies were classified as vascular (n ϭ 7), neoplastic (n ϭ 9), congenital (n ϭ 2), and artifacts (n ϭ 2). Individual neuroradiologist's scores ranged from 0% to 7.7% Ϯ 2.3% (n ϭ 18). Both CT and MR imaging studies had a discrepancy rate of 2.0%. Our quality assessment study could serve as initial data before intervention as part of a PQI project.ABBREVIATIONS: ABR ϭ American Board of Radiology; ACGME ϭ Accreditation Council for Graduate Medical Education; CI ϭ confidence interval; PQI ϭ practice quality improvement R adiologic detection and interpretation errors will not be fully eliminated until the advent of "perfect diagnostic tests" and "perfect observers." 1,2 In the meantime, radiologists, similar to other physicians, struggle with assessing physician performance and reporting quality, to improve and deliver the best care possible.3 L. Henry Garland pioneered the work on radiologic errors more than 60 years ago. [4][5][6] He uncovered a 30% rate of missed radiologic findings in a series of radiographs with abnormal findings among expert reviewers. Subsequently Garland's results have been replicated by other researchers. [7][8][9] Most interesting, comparable rates of "mistakes" were discovered in other specialties. 10,11 In deriving the radiologic error rate, Garland used exclusively abnormal studies-that is, he tested radiologists in environments in which disease prevalence reached 100%. Because in the typical clinical setting, there are a substantial number of examinations with normal findings, Garland hypothesized that the expected radiologic error rate in everyday practice is closer to 5%.Subsequent studies confirmed the radiologic error rate in all-comers radiology practice to be in the 3%-6% range. 3,12-14Soffa et al 14 sampled approximately 7000 cases read by 26 radiologists and uncovered a 3% disagreement rate in general radiology, 3.6% in diagnostic mammography, 5.8% in screening mammography, and 4.1% in sonography, yielding the overall error rate of 3.5%. Robinson et al 13 compared reports for skeletal, chest, and abdominal radiographs completed by 3 radiologists and found ...

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Disagreements in Chest Roentgen Interpretation

Cited by 114 publications

References 3 publications

Interobserver agreement in interpretation of radiographic pulmonary changes in dogs in relation to radiology training

Interobserver agreement in interpretation of radiographic pulmonary changes in dogs in relation to radiology training

Competence of senior medical students in diagnosing tuberculosis based on chest X-rays

Quality Control in Neuroradiology: Discrepancies in Image Interpretation among Academic Neuroradiologists

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