Physician competency is a criticalfactor in the overall quality of medical diagnostics and accuracy ofinterpretation is the key determinant of their competency.
1 Theprocess of quality assurance in the practice of radiology is important toensure high-level patient care and is rapidly recognized at the institutionallevels. From a quality assurance point of view, the report should be the trueright one and discrepancies and errors must be minimized.2 Understanding the baseline discrepancy ratefor interpretation of an imaging examination is necessary for monitoring ofradiologist skills.3 Discrepant reports between initial andsubsequent radiologist interpretations can be due to a variety of factorsincluding inadequate clinical information, poor imaging technique, perceptualerrors and communication errors.
4 There is no consensus on a standard method or protocol for evaluatingerrors and discrepancies in imaging reports.5 Multiple variations in study parametersincluding sampling sources, methods, imaging modalities, specialties,categories, interpreter training levels and degrees of blinding may have contributedto this wide spectrum.2 Computerized(or computed) tomography, and often formerly referred to as computerized axialtomography (CAT) scan, is an X-ray procedure that combines many X-ray imageswith the aid of a computer to generate cross-sectional views and, if needed,three-dimensional images of the internal organs and structures of the body.Computerized tomography is more commonly known by its abbreviated names, CTscan or CAT scan. A CT scan is used to define normal and abnormal structures inthe body and/or assist in procedures by helping to accurately guide theplacement of instruments or treatments. A large donut-shaped X-ray machine orscanner takes X-ray images at many different angles around the body.
Theseimages are processed by a computer to produce cross-sectional pictures of thebody. In each of these pictures the body is seen as an X-ray “slice”of the body, which is recorded on a film. This recorded image is called atomogram. “Computerized axial tomography” refers to the recordedtomogram “sections” at different levels of the body.
3 In recent years, the CT scan hasbecome the diagnostic modality of choice for many clinical situations and isreadily available even in smaller centers with no on-site radiologists. Head CTscan study is one of the common investigations which usually need to beinterpreted by emergency doctors and management plans are initiated before theformal radiologist’s interpretation becomes available.6 While accuracy of interpretation of brain CTscan by emergency physicians is of crucial importance, many EM residencyprograms do not allocate enough time to brain CT scan interpretation training.7Zan et al sampled 4534 neuroradiology cases with an outside report forcomparison and found that 347 (7.7%) had clinically significant discrepanciesbetween the outside study and the interpretation of subspecialty-trainedneuroradiologists.8 Babiarzand Yousem performed a study in which 1000 studies were internally reviewed andthey found a significant discrepancy rate of 2.0% among subspecialty-trained neuroradiologistsat a major university hospital.
2 Viertel VG et al concluded thatthere was a 1.8% rate of clinically significant detection or interpretationdiscrepancy among academic neuroradiologists.9 In a recently published work done by Guérin Get al found that the inter-observer agreement regarding head CT studies withpositive and negative results for clinically pertinent findings was 0.
86(0.77–0.95) but concordance was only 75.6% (67.2%–82.
5%).10 The rationale of our study was todetermine the discrepancy rate and inter-observer agreement in reporting the CTScan of Head in our setting. This will help us in identifying the areas whichneeds to be improved in the training of radiologists to minimize the errors inreporting. This would eventually be helpful for the better management of thesepatients.