Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5030, USA.
Acad Radiol. 2011 Dec;18(12):1500-6. doi: 10.1016/j.acra.2011.08.009. Epub 2011 Oct 1.
To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education.
A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents' answers were compared with "truth," as defined by the best evidence available in the medical literature. Additional questions elicited the respondents' demographics and comfort levels in addressing the findings. Analysis of variance models with a Tukey correction for post hoc comparisons and chi-square tests were used to determine if any demographic factors or comfort levels were predictive of higher correct response rates.
The overall survey response rate was 28% (445/1600). Correct case response rates ranged from 26% (115/442) to 79% (343/445). Only 6% (28/438) of respondents chose the correct answers for all cases. Up to 80% (353/440) of respondents felt comfortable in addressing findings, and only 57% (252/443) of respondents felt that they needed more training in this area. Fellowship training in cardiothoracic radiology, working in a teaching practice, and subspecialization in abdominal or cardiothoracic radiology were predictive of higher correct response rates. Except for one case question, the comfort level was not predictive of correct response rate.
There was considerable variability among radiologists and substantial deviation from best medical practice with regard to the interpretation/evaluation of incidental findings at chest CT, signifying a significant need for further education.
评估在胸部计算机断层扫描（CT）中评估偶然发现的实践模式，以确定是否需要进一步教育。
向 1600 名放射科医生发放了一项调查，提出了四个关于胸部 CT 以下偶然发现的评估/意义的临床病例问题：甲状腺病变；纵隔淋巴结肿大；无症状的小肺栓塞；和小结节。将受访者的答案与医学文献中最佳证据定义的“真相”进行比较。其他问题则引出了受访者的人口统计学数据和解决这些发现的舒适度。使用方差分析模型和 Tukey 校正进行事后比较以及卡方检验，以确定任何人口统计学因素或舒适度是否可以预测更高的正确反应率。
总体调查回复率为 28%（445/1600）。正确病例的反应率从 26%（115/442）到 79%（343/445）不等。只有 6%（28/438）的受访者对所有病例都选择了正确答案。高达 80%（353/440）的受访者对解决发现感到舒适，只有 57%（252/443）的受访者认为他们需要在这方面接受更多培训。心胸放射学的研究员培训、在教学实践中工作以及腹部或心胸放射学的亚专业培训与更高的正确反应率相关。除了一个病例问题外，舒适度与正确反应率无关。
在解释/评估胸部 CT 偶然发现方面，放射科医生之间存在很大差异，且与最佳医疗实践有很大偏差，这表明需要进一步教育。
