Cervini Patrick, Bell Chaim M, Roberts Heidi C, Provost Yves L, Chung Tae-Bong, Paul Narinder S
Department of Diagnostic Imaging, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 2N2.
Acad Radiol. 2008 May;15(5):556-62. doi: 10.1016/j.acra.2007.12.007.
To evaluate the interpretation of computed tomographic pulmonary angiograms performed outside of regular reporting hours, comparing the initial interpretation by the radiology resident to the attending radiologist.
Records for 840 consecutive computed tomographic pulmonary angiograms (CTPA) performed outside of regular reporting hours at two tertiary referral centers from January 1, 2004-December 31, 2005 were reviewed. The preliminary interpretation by the on-call radiology resident was compared to the subsequent final report issued by a subspecialty trained chest radiologist. Studies were stratified as positive, negative, or equivocal for pulmonary embolus. Cases with discordant interpretations or negative CTPA were reviewed to determine impact on clinical outcome. Patients were followed up to 12 months after CTPA to document any subsequent thromboembolic event.
Sixteen percent (131/840) of CTPAs were reported positive by the staff radiologist. There was agreement in 90% (752/840) of studies (P = .76, 95% confidence interval, 0.71-0.81) with 86% (114/133) agreement for studies interpreted as positive by residents, 95% (582/612) for studies interpreted as negative by residents, and 63% (60/95) for studies interpreted as equivocal by residents. Studies of optimal quality had higher interobserver agreement than studies of suboptimal quality (P < .0001). In-patient studies were more likely to be positive than emergency room patients (20% vs. 13%) (P = .004). No adverse clinical outcomes were attributed to discordant interpretations.
Radiology residents provide a high level interpretation of on-call CTPA studies, achieving good concordance with the attending radiologists' assessment.
为评估在常规报告时间之外进行的计算机断层扫描肺血管造影的解读情况，比较放射科住院医师的初步解读与主治放射科医生的解读。
回顾了2004年1月1日至2005年12月31日期间在两个三级转诊中心常规报告时间之外进行的840例连续计算机断层扫描肺血管造影（CTPA）记录。将值班放射科住院医师的初步解读与随后由经过专科培训的胸部放射科医生出具的最终报告进行比较。研究被分为肺栓塞阳性、阴性或可疑。对解读不一致或CTPA为阴性的病例进行审查，以确定对临床结果的影响。对患者进行CTPA后长达12个月的随访，以记录任何后续的血栓栓塞事件。
放射科工作人员报告16%（131/840）的CTPA为阳性。90%（752/840）的研究结果一致（P = 0.76，95%置信区间，0.71 - 0.81），住院医师解读为阳性的研究中86%（114/133）结果一致，住院医师解读为阴性的研究中95%（582/612）结果一致，住院医师解读为可疑的研究中63%（60/95）结果一致。质量最佳的研究观察者间一致性高于质量欠佳的研究（P < 0.0001）。住院患者的研究比急诊室患者更可能为阳性（20%对13%）（P = 0.004）。解读不一致未导致不良临床后果。
放射科住院医师对值班CTPA研究提供了高水平解读，与主治放射科医生的评估具有良好的一致性。
