Meyer Russell E, Nickerson Joshua P, Burbank Heather N, Alsofrom Gary F, Linnell Grant J, Filippi Christopher G
Department of Radiology, Fletcher Allen Health Care, University of Vermont School of Medicine, 111 Colchester Ave., Burlington, VT 05401, USA.
AJR Am J Roentgenol. 2009 Aug;193(2):527-32. doi: 10.2214/AJR.08.2169.
The purpose of our study was to determine the discrepancy rates of radiology residents' interpretations of emergent CT angiography (CTA) studies of the neck and circle of Willis and to assess any adverse clinical outcomes.
Five hundred thirty-eight CTA studies (287 circle of Willis and 251 neck) ordered emergently after hours and given preliminary readings by radiology residents from January 1, 2006, through December 31, 2007, were retrospectively reviewed. Discrepancies between the interpretations of radiology residents and the final reports of neuroradiology attending physicians were classified as either false-negatives (failure to recognize abnormalities) or false-positives (misinterpreting normal scans as abnormal). Discrepancies that could affect patient care or clinical care were considered major.
Overall, the discrepancy rate was 13.6% for circle of Willis CTA and 13.5% for neck CTA. The misinterpretation rate of first-year residents was 19.5%, which was statistically significant compared with more senior-level residents (p = 0.05). There were 57 false-negative interpretations. The most common misses were stenosis greater than 50% (n = 16) and aneurysm (n = 15), and the most common false-positive was overcalling a potential intracranial aneurysm (n = 7). No adverse clinical outcomes were detected.
The discrepancy rate between interpretations by on-call radiology residents and attending physicians of neuroradiology CTA studies was higher than expected at 13.6%, with a statistically significant greater miss rate among the most junior residents, which may be mitigated by recent changes with respect to the radiology residents' overnight call. No adverse clinical outcome was detected.
我们研究的目的是确定放射科住院医师对颈部和 Willis 环急诊 CT 血管造影（CTA）检查结果解读的差异率，并评估任何不良临床结局。
回顾性分析了 2006 年 1 月 1 日至 2007 年 12 月 31 日期间下班后紧急安排的 538 例 CTA 检查（287 例 Willis 环和 251 例颈部），这些检查由放射科住院医师进行了初步解读。放射科住院医师的解读与神经放射科主治医师的最终报告之间的差异被分类为假阴性（未识别出异常）或假阳性（将正常扫描误判为异常）。可能影响患者护理或临床治疗的差异被视为主要差异。
总体而言，Willis 环 CTA 的差异率为 13.6%，颈部 CTA 的差异率为 13.5%。第一年住院医师的误判率为 19.5%，与更高级别的住院医师相比具有统计学意义（p = 0.05）。有 57 例假阴性解读。最常见的漏诊是狭窄大于 50%（n = 16）和动脉瘤（n = 15），最常见的假阳性是过度诊断潜在的颅内动脉瘤（n = 7）。未检测到不良临床结局。
值班放射科住院医师与神经放射科 CTA 检查主治医师之间的解读差异率高于预期，为 13.6%，最年轻住院医师的漏诊率在统计学上显著更高，近期放射科住院医师夜间值班的变化可能会缓解这种情况。未检测到不良临床结局。
