Interobserver Agreement between On-Call Radiology Resident and General Radiologist Interpretations of CT Pulmonary Angiograms and CT Venograms.

Bahar Tamjeedi,José Correa,Benoît Mesurolle,Alexandre Semionov,Elena Cavarretta

doi:10.1371/journal.pone.0126116

Bahar Tamjeedi, José Correa + Show 3 more

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https://doi.org/10.1371/journal.pone.0126116

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Journal: PloS one	Publication Date: May 4, 2015
Citations: 37	License type: CC BY 4.0

Affiliation: McGill University Health Centre, Statistics Canada

Abstract

ObjectivesTo evaluate the interobserver agreement (IOA) between the initial radiology resident and the final staff radiologist reports of combined computed tomographic pulmonary angiograms (CTPA) and computed tomographic venograms (CTV) performed during on-call hours.Materials and MethodsApproval by the institutional review board was obtained. Six-hundred and ninety-six consecutive studies (CTPA or CTPA with CTV) performed during on-call hours and interpreted by 30 residents were identified. Radiology residents’ reports were compared to the final staff reports. Three tests outcomes were considered (positive, P; negative, N; indeterminate, I). Discordant cases were reviews by a chest radiologist.ResultsCTPAs were reported by staff radiologists as positive for pulmonary embolism (PE) in 18% (126/694), with a kappa of 0.81 (95% CI 0.77-0.86) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.85-0.94) with 2 outcomes (P, N). Regarding PE location, good concordance was observed for positive studies, with a kappa of 0.86 (95% CI 0.78 – 0.95). CTVs were reported as positive by staff radiologists in 8.5% (33/388), with a kappa of 0.66 (95% CI 0.55-0.77) with 3 outcomes (P, N, I), and a kappa of 0.89 (95% CI 0.8-1.0) with 2 outcomes (P, N). The IOA between residents and staff radiologists increased with increasing residency year level for CTPAs, but did not for CTVs.ConclusionsVery good and good IOA were observed between resident and staff radiologist interpretations for CTPA and CTV, respectively, with tendency towards improved IOA as residency level of training increased for CTPA, but not for CTV.

Highlights

Acute pulmonary embolism (PE) has long been recognized as a life-threatening emergency, and the statistics vary widely depending on the clinical setting [1], associated mortality rates have been estimated at 100 000 deaths per year in the United States, including 15% of in-hospital deaths [2]
computed tomographic pulmonary angiogram (CTPA) were reported by staff radiologists as positive for pulmonary embolism (PE) in 18% (126/694), with a kappa of 0.81 with 3 outcomes (P, N, I), and a kappa of 0.89 with 2 outcomes (P, N)
The interobserver agreement (IOA) between residents and staff radiologists increased with increasing residency year level for CTPAs, but did not for computed tomographic venogram (CTV)

Summary

Introduction

Acute pulmonary embolism (PE) has long been recognized as a life-threatening emergency, and the statistics vary widely depending on the clinical setting [1], associated mortality rates have been estimated at 100 000 deaths per year in the United States, including 15% of in-hospital deaths [2]. The ability to obtain rapid and accurate diagnosis of PE becomes critical for clinical management, namely, early initiation of anticoagulant therapy. Current clinical practice algorithms advocate use of computed tomographic pulmonary angiogram (CTPA) to reliably diagnose or exclude PE [1]. In addition to the diagnosis of PE, the evaluation of the lower limbs in order to detect the presence of DVT is important for appropriate patient management. DVT can be diagnosed or excluded via sonographic evaluation of the lower limbs with Doppler technique, the use of combined CTPA and computed tomographic venogram (CTV) for one-time imaging allows diagnosing both PE and DVT [3]. PIOPED II study, combining CTPA and CTV showed increased sensitivity for PE from 83 to 90% and similar specificity (95%) [4, 5]

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