Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA.
Eur J Radiol. 2013 Aug;82(8):1240-7. doi: 10.1016/j.ejrad.2013.02.037. Epub 2013 Apr 17.
To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience.
Nine radiologist and cardiologist observers with varying prior CCTA experience ranging from novice to expert independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50-74%, 75-99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series. Diagnostic accuracy on a per-segment basis was compared for all readers and both case series, respectively.
Correlation coefficients between CCTA and catheter angiography initially ranged between good (r=0.87) and poor (r=0.26), depending on reader experience, and significantly (p<0.05) improved in the second case series (range: r=0.42 to r=0.91). Diagnostic accuracy was significantly (p<0.05) higher for more experienced readers (range: 96.5-97.8%) as compared to less experienced observers (range: 90.7-93.6%). After completion of the second case series for less experienced readers sensitivity and PPV significantly (p<0.05) improved (range: 62.7-67.8%/51.4-84.1%), but still remained significantly (p<0.05) lower as compared to more experienced observers (range: 89.8-93.3%/80.6-93.3%).
The level of experience appears to be a strong determinant of proficiency in CCTA interpretation. Limited one-time training improves proficiency in novice readers, but not to clinically satisfactory levels.
评估经验和培训对不同经验水平的从业者进行冠状动脉 CT 血管造影（CCTA）解读能力的影响。
9 名放射科医生和心脏病专家观察者具有不同的 CCTA 经验，从新手到专家不等，他们独立分析了两个系列的 50 例与导管相关的 CCTA 研究，用于评估冠状动脉狭窄程度（0%、≤49%、50-74%、75-99%或 100%）。第一组病例的结果是不设盲的，并在每个读者进行第二组病例分析之前，与导管血管造影结果一起呈现给他们。分别比较了所有读者和两个病例系列的每一节段的诊断准确性。
根据读者的经验，CCTA 与导管血管造影之间的相关系数最初在良好（r=0.87）和较差（r=0.26）之间变化，在第二组病例中显著（p<0.05）提高（范围：r=0.42 至 r=0.91）。经验丰富的读者的诊断准确性明显（p<0.05）更高（范围：96.5-97.8%），而经验较少的观察者（范围：90.7-93.6%）则较低。对于经验较少的观察者，在完成第二组病例后，敏感性和阳性预测值（PPV）显著（p<0.05）提高（范围：62.7-67.8%/51.4-84.1%），但仍明显（p<0.05）低于经验更丰富的观察者（范围：89.8-93.3%/80.6-93.3%）。
经验水平似乎是 CCTA 解读能力的一个重要决定因素。有限的一次性培训可以提高新手读者的水平，但仍不能达到临床满意的水平。
