Interpretation Of Chest Radiographs Research Articles

Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children

Although chest radiography is commonly used to establish the diagnosis of pneumonia in children, the reliability of radiographic findings among radiologists is not well described. We sought to evaluate the inter-rater and intra-rater reliability of radiographic features commonly described by radiologists in childhood pneumonia. Prospective case-based study. One hundred and ten radiographs of children evaluated in a pediatric emergency department for suspicion of pneumonia were interpreted by six radiologists at two academic children's hospitals. Radiologists were blinded to the clinical history. Reliability of standardized radiographic features was evaluated using the kappa statistic. The radiographic finding of an alveolar infiltrate demonstrated substantial reliability among radiologists (κ = 0.69). The presence of 'any infiltrate' and pleural effusion demonstrated moderate reliability (κ = 0.47 and k=0.45, respectively). Other radiographic features were less reliable: air bronchograms (κ = 0.32), hilar adenopathy (κ = 0.21), and interstitial infiltrate (κ = 0.14). Similarly, the finding of alveolar infiltrate demonstrated substantial intra-rater reliability upon review of ten duplicate radiographs, whereas interstitial infiltrate was less reliable. The radiographic finding of an alveolar infiltrate is very reliable among pediatric radiologists, whereas the finding of an interstitial infiltrate is less reliable.

Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children

Our objective was to compare the inter-observer level of agreement in diagnosing pneumonia using the World Health Organization (WHO) guidelines for the interpretation of radiographs. We conducted a prospective study in a pediatric emergency room. Fifteen observers (13 pediatricians, 2 radiologists) interpreted 200 pediatric (<5 years old) chest radiographs using the WHO guidelines. Observers were blinded to the clinical presentation. RESULTS were analyzed for kappa values. Individual readings were compared to two "gold standard" teams: (1) radiologist and pediatrician and (2) two radiologists. Alveolar pneumonia, non-alveolar pneumonia, and no pneumonia were found (by radiologists) in 12.8%, 2.7%, and 78.6% of readings, respectively. The mean kappa values for alveolar pneumonia, non-alveolar pneumonia, and no pneumonia of observers versus the team consisting of a radiologist and a pediatrician were 0.73, 0.23, and 0.61, respectively. For non-alveolar pneumonia, the mean kappa value was higher for the gold standard consisting of a radiologist and a pediatrician when compared to the two-radiologist team. Pediatricians overdiagnosed "non-alveolar pneumonia" compared with radiologists. In contrast, for the alveolar pneumonia and no-pneumonia diagnoses, no significant differences were found. The WHO guidelines for interpretation of chest radiographs result in high level of agreement between readers for the definition of "alveolar pneumonia" and "no pneumonia" but poor agreement for non-alveolar pneumonia. The disagreement with regard to the latter was associated with overdiagnosis by pediatricians, which may lead to overtreatment. We believe that radiographic non-alveolar pneumonia should not be an endpoint for clinical trials and research, nor should it be implemented in clinical setting.

Evaluation of the Effectiveness of Systematized Training of Advanced Trauma Life Support Protocol in the Interpretation of Cervical Spine and Chest Radiographs in Three Different Emergency Services

Most Brazilian hospitals have no medical radiologists for emergencies. The radiologic evaluation is provided by doctors with heterogeneous generalist training. The objective is to demonstrate the need for systematization in the care of trauma in the interpretation of cervical spine and chest radiographs. Is it possible that, through a continuing education program, generalist doctors could be trained in the evaluation of these radiographs? Twenty-five doctors of various specialties were evaluated in the mid region of Santa Catarina Stage, in three stages. Initially, the doctors evaluated seven cervical spine radiographs and seven chest radiographs (stage I). After this evaluation (without knowing the results of the examinations), the doctors received advanced trauma life support protocol training for the interpretation of cervical spine and chest radiographs, through an exhibition class (stage II). Three weeks later, the same doctors were evaluated again, interpreting the same radiographs. The mean percentage of correct answers was 60.73% in the first interpretation of cervical radiographs and 65.25% for the chest radiographs. None of the participant had reached 100%. In stage III, the average success rates in cervical spine and chest radiographs were 86.95% and 87.53%, respectively, an improvement of 21.72% and 26.18% (p < 0.001). During evaluation in the stage III, seven doctors obtained 100% success in the evaluation of cervical spine radiographs and two doctors achieved 100% success in the evaluation of chest radiographs. The systematized training, through the advanced trauma life support protocol, significantly increased the success rate of the evaluation of cervical spine and chest radiographs.

Viral and bacterial etiologies of community-acquired acute lower respiratory infections among hospitalized Cambodian patients

Community-acquired acute lower respiratory infections (ALRI) remain a major public health problem, particularly in tropical and low/middle-income countries. There is still a paucity of data regarding viral and bacterial etiologies. Beginning in April 2007, we enrolled all-aged patients hospitalized with acute respiratory symptoms excluding known tuberculosis and positive HIV serology in Cambodia. Etiology was assigned based on laboratory data from direct sputum examination, blood and sputum cultures and nasopharyngeal swabs. Diagnosis of ALRI was determined from medical charts’ reviews and interpreting chest radiographs by expert pulmonologists. Severe ALRI case (SARI) was defined on the basis of oxygen saturation, respiratory rates according to age and severe clinical symptoms. During April 2007 - December 2009, 2,824 patients presented with ALRI on admission including 948 (34%) in the 5 year-olds, the proportions were different: 56.4% PI, 38.1% BI and 12.9% pleurisy. A total of 821 (28.9%) SARI were identified of which 639 (77.8%) aged 5 year-olds. SARI was also frequently found in BI (71%) among <5 year-old children and significantly less frequent in older children and adults (8%). Specimens for bacteriology testing was only available in 1,004 patients including 14 who aged <5 years, 30 in the 5 – 17 year age group and 960 (95.6%) among adults. In the 14 <5 year-old children, 12 bacteria were identified including Burkholderia pseudomallei, 2 Streptococcus pneumoniae, 2 Haemophilus influenzae, 2 Klebsiella pneumoniae and 4 acid fast-bacilli (AFB); in the 5-17 year age group, there were 4 AFB, 4 H. influenzae and 4 S. pneumoniae. Of the 960 adults, etiology was found in 525 (64.7%) ones of which the most commonly identified bacteria were AFB (48.8%), H. influenzae (21.1%) and S. pneumoniae (9.1%) followed by K. pneumoniae (7.8%) and B. pseudomallei (5.6%). Of the 70 SARI cases for which specimens were available, the most frequently found bacteria were AFB (18.6%), B. pseudomallei (10.0%), H. influenzae (8.6%), and K. pneumoniae (7.1%). Viral identification was possible in 927 (30.1%) of the 3,083 patients’ nasopharyngeal swabs (57.7% in <5 year-olds, 15.5% in adults). The three most frequently identified viruses were rhinoviruses (42.3%), RSV (29.1%), and seasonal Influenza A & B (7%). This is the first report of the etiology of community-acquired ALRI in Cambodia – a tropical/low-income country. Our results indicated that the etiology profile in Cambodia was similar to that of other Southeast Asian countries. Supported by the French Development Agency through the Surveillance and Investigation of Epidemic Situations in Southeast Asia (SISEA) project.

62 Does GP clinical history influence radiologists' interpretation of chest radiographs or reliably predict eventual diagnosis of lung malignancy?

62 Does GP clinical history influence radiologists' interpretation of chest radiographs or reliably predict eventual diagnosis of lung malignancy?

Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice?

To assess the impact of a Picture Archiving and Communication System (PACS) on the diagnostic accuracy of the interpretation of chest radiology examinations in a "real life" radiology setting. During a period before PACS was introduced to radiologists, when images were still interpreted on film and reported on paper, images and reports were also digitally stored in an image database. The same database was used after the PACS introduction. This provided a unique opportunity to conduct a blinded retrospective study, comparing sensitivity (the main outcome parameter) in the pre and post-PACS periods. We selected 56 digitally stored chest radiograph examinations that were originally read and reported on film, and 66 examinations that were read and reported on screen 2 years after the PACS introduction. Each examination was assigned a random number, and both reports and images were scored independently for pathological findings. The blinded retrospective score for the original reports were then compared with the score for the images (the gold standard). Sensitivity was improved after the PACS introduction. When both certain and uncertain findings were included, this improvement was statistically significant. There were no other statistically significant changes. The result is consistent with prospective studies concluding that diagnostic accuracy is at least not reduced after PACS introduction. The sensitivity may even be improved.

Agreement on Radiological Diagnosis of Acute Lower Respiratory Tract Infection in Children

Chest radiographs are often used to support the decision to use antibiotics in children aged <5 years with moderate to severe lower acute respiratory infection (ARI). This study aimed to evaluate inter-observer agreement in the interpretation of chest radiographs of children with suspected lower ARI. Three experienced paediatric sub-specialists: a radiologist, an intensivist and a pulmonologist were provided with basic clinical information on each of 48 cases, but the individual standardized evaluations were blinded for clinical diagnoses and for the assessment by the other two specialists. While for specific radiographic findings Kappa agreement values revealed considerable variation, agreement was higher (fair to substantial) on overall diagnostic impression. These findings reiterate that radiographs of children with a clinical suspicion of lower ARI are a limited but potentially useful resource for case management.

Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study

BackgroundAlthough World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with a high incidence of tuberculosis.MethodologyWe performed a cross-sectional study enrolling consecutive HIV-infected inpatients with unexplained cough and negative sputum smears for acid-fast bacilli at Mulago Hospital in Kampala, Uganda. Trained medical officers prospectively collected data on standard symptoms and signs of systemic respiratory illness, and two radiologists interpreted chest radiographs in a standardized fashion. We calculated positive- and negative-likelihood ratios of these factors for diagnosing pulmonary tuberculosis (defined when mycobacterial cultures of sputum or bronchoalveolar lavage fluid were positive). We used both conventional and novel regression techniques to develop multivariable prediction models for pulmonary tuberculosis.Principal FindingsAmong 202 enrolled HIV-infected adults with negative sputum smears for acid-fast bacilli, 72 (36%) had culture-positive pulmonary tuberculosis. No single factor, including respiratory symptoms, physical findings, CD4+ T-cell count, or chest radiographic abnormalities, substantially increased or decreased the likelihood of pulmonary tuberculosis. After exhaustive testing, we were also unable to identify any combination of factors which reliably predicted bacteriologically confirmed tuberculosis.Conclusions and SignificanceClinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting. Enhanced diagnostic methods for smear-negative tuberculosis are urgently needed.

Intraobserver and interobserver agreement of the interpretation of pediatric chest radiographs

The objective of this study is to quantify the magnitude of intraobserver and interobserver agreement among physicians for the interpretation of pneumonia on pediatric chest radiographs. Chest radiographs that produced discordant interpretations between the emergency physician and the radiologist's final interpretation were identified for patients aged 1-4 years. From 24 radiographs, eight were randomly selected as study radiographs, and 16 were diversion films. Study participants included two pediatric radiologists, two senior emergency medicine physicians, and two junior fellowship-trained pediatric emergency medicine physicians. Each test included 12 radiographs: the eight study radiographs and four randomly interspersed diversion radiographs, and each radiograph was paired with a written clinical vignette. Testing was repeated on four occasions, separated by > or =2 weeks. The dependent variable was the interpretation of presence or absence of pneumonia; primary analysis done with Cohen's kappa (95% confidence intervals). Intraobserver agreement was good for pediatric radiologists (kappa = 0.87; 95% CI 0.60-0.99) for both but was lower for senior emergency physicians (mean kappa = 0.68; 95% CI 0.40-0.95) and junior pediatric emergency physicians (mean kappa = 0.62; 95% CI 0.35-0.98). Interobserver agreement was fair to moderate overall; between pediatric radiologists, kappa = 0.51 (0.39-0.64); between senior emergency physicians, kappa = 0.55 (0.41-69), and between junior pediatric emergency medicine physicians, kappa = 0.37 (0.25-0.51). Practicing emergency clinicians demonstrate considerable intraobserver and interobserver variability in the interpretation of pneumonia on pediatric chest radiographs.

Measuring the incidence of adult community-acquired pneumonia in a Native American community

Few population-based studies have investigated the epidemiology of adult community-acquired pneumonia (CAP). We aimed to determine the incidence of CAP in a population at high-risk for pneumococcal disease and to evaluate a standardized method for interpreting chest radiographs adapted from the World Health Organization paediatric chest radiograph interpretation guidelines. We reviewed radiology records at the two healthcare facilities serving the White Mountain Apache tribe to identify possible pneumonia cases > or =40 years of age. We categorized patients with clinical criteria and a physician diagnosis of pneumonia as clinical CAP and those with clinical criteria and an acute infiltrate as radiographic CAP. We identified 100 (27/1000 person-years) and 60 (16/1000 person-years) episodes of clinical and radiographic CAP, respectively. The incidence of CAP increased with age. Both radiographic and clinical CAP were serious illnesses with more than half of patients hospitalized. Our case definitions and methods may be useful for comparing data across studies and conducting vaccine trials.

Editorial: Breathing New Life Into Pneumonia Epidemiology

Pneumonia kills more children than any other illness, according to the World Health Organization (1). In spite of its disease burden and the fact that there are effective health interventions, pneumonia is a disease that has received neither the public attention nor the funding that it deserves (2). In a recent review sponsored by The George Institute for International Health, pneumonia research was the most glaringly underfunded of all the major “neglected” diseases (3). The gap in research is perhaps most evident in the field of pneumonia epidemiology. A recent systematic review of childhood pneumonia by the World Health Organization found that of 2,200 published manuscripts, only 28 were deemed of adequate quality for inclusion in a review and modeling exercise (4). The first-ever World Pneumonia Day—November 2, 2009—provides a useful opportunity to consider the challenges and opportunities for epidemiologic research in pneumonia. The epidemiologic study of pneumonia is hampered by many methodological challenges. Case definitions for the clinical syndrome of pneumonia have traditionally been inconsistent. Interobserver variations in the interpretation of chest radiographs and chest auscultation, for example, have limited the utility of these relatively specific diagnostic techniques (5). Other techniques, such as counting respiratory rate or observing signs of difficult breathing such as chest in-drawing, are more readily standardized but have lower specificity, particularly in areas with a high rate of malaria (6). Etiology-specific diagnoses are similarly hampered by traditional methods. The use of blood cultures, for example, is highly specific but insensitive, in that it detects only a fraction of the bacterial causes of pneumonia and becomes even less sensitive if the patient has received antibiotics before specimen collection. Sampling the upper respiratory tract, on the other hand, may yield agents that are being carried (i.e., colonizing organisms) and not the cause of the acute episode. Lastly, the study of very severe and fatal childhood pneumonia is complicated by the fact that most episodes occur in the very populations not served by adequate health systems (i.e., children in developing countries); as a result, these populations are often left out of epidemiologic research. With advances in diagnostic technology and collaborative interactions, the challenges of the past are increasingly solvable. Digital radiographs, for example, can help minimize interobserver variation by transmitting all images to a single reviewer. Using new techniques to detect nucleic acids rather than relying on isolation of viable pathogens should also help with etiologic-specific diagnoses. Finally, the use of geographic information systems and community-based researchers can help assure that all populations are studied and, where they are missed, that bias and underreporting are quantified. With approximately 2 million child deaths every year due to pneumonia, and hundreds of millions of cases each year in both children and adults, new efforts to study the epidemiology of pneumonia worldwide—using the latest techniques and methods—are urgently needed (1). The effort to generate a new evidence base of pneumonia epidemiology will require concerted action by investigators, sponsors, and journals. Investigators must work to develop standardized methods and case definitions while pursuing creative approaches to overcoming historical obstacles. Sponsors need to realign their funding investments to levels commensurate with the burden of pneumonia worldwide. Journals, such as this one, can also play a part by encouraging the reporting of pneumonia epidemiology studies in ways that allow the quality of the research to be carefully assessed and any biases determined and quantified. Together, these actions could provide a much-needed increase in the quality and representativeness of epidemiologic data on pneumonia that in turn breathe new life into the fight against this important killer.

Assessing Processes of Care to Promote Timely Initiation of Antibiotic Therapy for Emergency Department Patients Hospitalized for Pneumonia

A mixed-methods quality improvement (QI) project for patients with pneumonia hospitalized from the emergency department (ED) was undertaken to (1) delineate the basic steps in the flow of patient care from presentation in the ED to time to first antibiotic dose (TFAD), (2) identify perceived barriers to and facilitators of reduced TFAD within these steps, (3) describe QI strategies to improve TFAD rates, and (4) identify perceived strategies for facilities to enhance performance. The QI project was conducted at 10 lower- and 10 higher-performing Veterans Affairs hospitals on the basis of the proportion of patients whose TFAD was within four hours of presentation. An ED physician, an ED nurse, a radiologist, a pharmacist, and a quality manager from each site were invited to participate in a survey and focus group. Of the 82 survey participants, 59 (72%) perceived that ordering and performing the chest radiograph was the step most frequently resulting in TFAD delays. Medical provider assessment, chest radiograph interpretation, ordering/obtaining blood cultures, and ordering/administering initial antibiotic therapy also caused TFAD delays. The most commonly perceived barriers were patient and x-ray equipment transportation delays and communication delays between providers. The most frequently used strategies to reduce TFAD were stocking antibiotics in the ED and physician education. Focus groups emphasized the importance of multifaceted QI approaches and a top-down hospital leadership style to improve TFAD performance. TFAD relies on a series of complex, stepwise processes of care that involve numerous hospital departments and is often delayed by well-described barriers. Addressing these barriers, as well as involving facility leadership in setting institutional QI goals, could possibly improve performance on this pneumonia quality measure.

Discordance in interpretation of chest radiographs between pediatric intensivists and a radiologist: Impact on patient management

Purpose When radiologists are not available, chest radiographs (CXRs) of pediatric intensive care unit (PICU) patients are commonly interpreted by pediatric intensivists. We prospectively investigated the frequency of errors in CXR interpretation by pediatric intensivists and their impact on patient management. Materials and Methods Chest radiographs of PICU patients were evaluated by 5 pediatric intensivists then by a pediatric radiologist (the “gold standard”). If the interpretation of the radiologist and intensivist differed, an independent intensivist determined whether a management change took place. A pediatric pulmonologist determined how many intensivist interpretations were different from the radiologist's interpretations. Results Seven hundred twenty-eight radiographic findings were identified by the radiologist in 460 CXRs. There were 33 interpretation errors by the intensivists (4.5% of the findings in 7.1% of the CXRs). Only 3/33 error corrections (0.45% of the findings in 0.7% of the CXRs) resulted in change in patient management. Conclusions Errors in interpretation of CXRs by pediatric intensivists were common but less than that in other series, probably because of education of the pediatric intensivists through daily rounds with the radiologist. Although interpretation errors that affected patient management were rare, their clinical importance supports the growing practice of 24/7 remote radiograph reading by radiologists.

Interobserver Variations in Diagnosing Asbestosis According to the ILO Classification

Inhalation of asbestos fibres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains difficult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Office (ILO) classification system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fibrosis was 26.66% for the diameter of changes and 42.2% for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93%. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classification system. This study has revealed a significant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe high-resolution computed tomography (HRCT) should also be used as a part of international classification.

Chest Radiography in Thoracic Polytrauma

Chest radiography is the first-line imaging examination for assessment of thoracic polytrauma, serving to evaluate the extent of injury and facilitate early triage to observation, further imaging, or immediate surgical intervention. The objective of this article is to review the spectrum of injuries that occur in the chest and upper abdomen after blunt and penetrating trauma. Pathophysiology, imaging findings, and management recommendations will be discussed for injuries to the chest wall, diaphragm, pleura, lungs, mediastinum, heart, aorta, and great vessels. Chest radiography plays an important role in the initial evaluation of blunt and penetrating chest trauma, providing rapid imaging information to supplement the history and physical examination. In the emergency department, familiarity with the spectrum of injuries that can occur in the chest and upper abdomen is important for accurate interpretation of chest radiographs as well as establishment of appropriate recommendations for management and follow-up.

Dissimilarity-based classification in the absence of local ground truth: Application to the diagnostic interpretation of chest radiographs

In this paper classification on dissimilarity representations is applied to medical imaging data with the task of discrimination between normal images and images with signs of disease. We show that dissimilarity-based classification is a beneficial approach in dealing with weakly labeled data, i.e. when the location of disease in an image is unknown and therefore local feature-based classifiers cannot be trained. A modification to the standard dissimilarity-based approach is proposed that makes a dissimilarity measure multi-valued, hence, able to retain more information. A multi-valued dissimilarity between an image and a prototype becomes an image representation vector in classification. Several classification outputs with respect to different prototypes are further integrated into a final image decision. Both standard and proposed methods are evaluated on data sets of chest radiographs with textural abnormalities and compared to several feature-based region classification approaches applied to the same data. On a tuberculosis data set the multi-valued dissimilarity-based classification performs as well as the best region classification method applied to the fully labeled data, with an area under the receiver operating characteristic (ROC) curve ( A z ) of 0.82. The standard dissimilarity-based classification yields A z = 0.80 . On a data set with interstitial abnormalities both dissimilarity-based approaches achieve A z = 0.98 which is closely behind the best region classification method.

Chest Radiograph Evaluation and Interpretation

Chest imaging is an important tool in managing critically ill patients. Basic chest radiology is still used to quickly detect abnormalities in the chest. Critical care nurses are often the ones who first read the radiologist’s report of chest radiograph results and provide their interpretation to a physician. Oftentimes, chest radiographs are obtained routinely on a daily basis for every critical care patient, with the goal of effective clinical management. Critical care nurses can confirm cardiopulmonary assessment findings by also evaluating their patient’s chest radiographs and reviewing the radiologist’s report. By learning some basic skills in interpreting and evaluating chest radiographs, nurses can recognize and localize gross pathologic changes visible on a chest radiograph. This article provides basic chest radiograph interpretation information that allows readers to review relevant anatomy and physiology, summarize normal and abnormal findings on chest radiographs, and describe radiographic findings in common pulmonary and cardiac disorders.

Chest Radiograph Evaluation and Interpretation

Chest imaging is an important tool in managing critically ill patients. Basic chest radiology is still used to quickly detect abnormalities in the chest. Critical care nurses are often the ones who first read the radiologist's report of chest radiograph results and provide their interpretation to a physician. Oftentimes, chest radiographs are obtained routinely on a daily basis for every critical care patient, with the goal of effective clinical management. Critical care nurses can confirm cardiopulmonary assessment findings by also evaluating their patient's chest radiographs and reviewing the radiologist's report. By learning some basic skills in interpreting and evaluating chest radiographs, nurses can recognize and localize gross pathologic changes visible on a chest radiograph. This article provides basic chest radiograph interpretation information that allows readers to review relevant anatomy and physiology, summarize normal and abnormal findings on chest radiographs, and describe radiographic findings in common pulmonary and cardiac disorders.

Chest Radiograph Evaluation and Interpretation

Chest Radiograph Evaluation and Interpretation

Accuracy of chest radiograph interpretation by emergency physicians

Chest radiographs are one of the most complex imaging modalities to interpret. The objective of this study was to assess how accurately emergency physicians interpreted chest radiographs in relation to radiologist reports. Radiological descriptions of chest radiographs from 667 emergency department (ED) patients, aged 14 to 84 years, were retrospectively reviewed. The overall level of agreement and agreement for different categories (congestive heart failure, pneumonia, and other) were assessed in 312 cases for which reports were available. Statistical analysis was done using the chi-square test, and interobserver agreement was calculated. The proportion of agreement between emergency physician and radiologist reports for normal, congestive heart failure, and pneumonia cases was 84.3%, 41.4%, and 41.4%, respectively. Emergency department physicians frequently missed specific radiographic abnormalities, and there was considerable discrepancy between their interpretations and those of trained radiologists. The agreement for some diagnostic categories such as pneumonia and congestive heart failure was low. This study's findings emphasize the need for improving interpretive skills among ED physicians.