Interpretation Of Radiographs Research Articles

Effectiveness of an e-Learning Platform for Image Interpretation Education of Medical Staff and Students.

Medical staff must be able to perform accurate initial interpretations of radiography to prevent diagnostic errors. Education in medical image interpretation is an ongoing need that is addressed by text-based and e-learning platforms. The effectiveness of these methods has been previously reported. Here, we describe the effectiveness of an e-learning platform used for medical image interpretation education. Ten third-year medical students without previous experience in chest radiography interpretation were provided with e-learning instructions. Accuracy of diagnosis using chest radiography was provided before and after e-learning education. We measured detection accuracy for two image groups: nodular shadow and ground-glass shadow. We also distributed the e-learning system to the two groups and analyzed the effectiveness of education for both types of image shadow. The mean correct answer rate after the 2-week e-learning period increased from 34.5 to 72.7%. Diagnosis of the ground glass shadow improved significantly more than that of the mass shadow. Education using the e-leaning platform is effective for interpretation of chest radiography results. E-learning is particularly effective for the interpretation of chest radiography images containing ground glass shadow.

The equine cheek teeth

Marianna Biggi, equine diagnostic imaging specialist, from Vet-CT teleradiology services, advises on the acquisition and interpretation of head radiographs

LO44: Optimizing skill retention in radiograph interpretation: a multicentre randomized control trial

Introduction: Simulation-based education systems have increased physician skill in radiograph interpretation. However, the degree of skill retention and the factors that influence it are relatively unknown. The main objective of this research was to determine the rate and quantity of skill decay in post-graduate trainee physicians who completed a simulation-based learning intervention of radiograph interpretation. The impact of testing and refresher education on skill decay was also examined. Methods: This was a prospective, multicenter, analysis-blinded, four arm randomized control trial conducted from November 2014 to June 2016. Study interventions were administered using an on-line learning and measurement platform. Pediatric and emergency medicine residents in the United States and Canada were eligible for study participation. Participants were randomized to one of four groups. All participants completed an 80-case deliberately practiced learning set of pediatric elbow radiographs followed by an immediate 20-case post-test. Following this, Group 1 had no testing until 12 months; Groups 2, 3, and 4 had testing (20 cases without feedback) every 2 months until 12 months, but Group 3 also had refresher education (20 cases with feedback) at six months while Group 4 had refresher education at two, six, and ten months. The main outcome measure was accuracy at 12 months, adjusted for immediate post-test score, days to completion of 12 month test, and time on case. Based on prior data, we assumed the smallest important difference between groups in learning decay is 10%, a between-participant/within-group standard deviation of 17%, a type I error probability of 5%, a power of 80% and adjusted for three tests with a Bonferroni correction. For the primary analysis of Group 1 versus 2, 3, 4, this resulted in a minimal total sample size of 56, with 14 participants per group. Results: We enrolled 106 participants that completed all study interventions. The sample sizes in Groups 1, 2, 3, and 4 were 42, 22, 22, and 20 respectively. Overall, accuracy increased by 11.8% (95% CI 9.8, 13.8) with the 80-case learning set and then decreased by 5.5% (95% CI 2.5, 8.5) at 12 months. The difference in learning decay in Group 1 vs. Groups 2, 3, 4 was -8.1% (95% CI 2.5, 13.5), p=0.005. For Group 2 vs. Group 3 and 4, it was +0.8% (95% CI -7.2, 7.3), p=0.8, and between Group 3 vs. Group 4 it was +0.8% (95% CI -7.3, 10.1), p=0.8. Conclusion: Skill decay was significantly reduced by testing with 20 cases every two months. Refresher education had no additional effect to testing on reducing learning decay.

LO41: Competency-based learning of pediatric musculoskeletal radiographs

Introduction: Pediatric musculoskeletal (MSK) image interpretation has been identified as a knowledge gap among emergency medicine trainees. The main objective of this study was to implement a validated on-line pediatric MSK radiograph interpretation system with a performance-based competency endpoint into pediatric emergency fellowship programs and examine the number of cases needed to achieve a competency threshold of 80% accuracy, sensitivity and specificity. We further determined proportion who successfully achieved competency in a given module and the change in accuracy from baseline to competency. Methods: This was a prospective cohort multi-centre study. There were seven MSK radiograph modules, each containing 200-400 cases (demo-https://imagesim.com/course-information/demo/). Thirty-seven pediatric emergency medicine fellows participated for 12 months. Participants did cases until they reached competency, defined as at least 80% accuracy, sensitivity and specificity. We calculated the overall and per module median number of cases required to achieve competency, proportion of participants who achieved competency, median time on case, and the mean change in accuracy from baseline to competency. Results: Overall, the median number of cases required to achieve competency was 76 (min 54, max 756). Between different body parts, there was a significant difference in the median number of cases needed to achieve competency, p <0.0001, with ankle and knee being among the most challenging modules. Proportions of those who started a module and completed it to competency varied significantly, and ranged from 32.4% in the ankle module to 97.1% in the forearm/hand, p<0.0001. The overall median time on each case was 34.1 (min 7.6, max 89.5) seconds. The overall change in accuracy from baseline to 80% competency was 13.5% (95% CI 12.1, 14.8), with the respective Cohens effect size of 1.98. The change in accuracy was different between modules, p=0.001, with post-hoc analyses demonstrating that the ankle/foot radiograph module had a greater increase in accuracy relative to elbow (p=0.009) and pelvis/femur (p=0.006). Conclusion: It was feasible for pediatric emergency medicine fellows to complete each learning pediatric MSK learning module to competency within approximately one hour, with the exception of the ankle module. Learners who completed the modules to competency demonstrated very significant increases in interpretation skill.

Reduction of Radiography with Point-of-Care Elbow Ultrasonography for Elbow Trauma in Children

To determine whether point-of-care elbow ultrasound (US), with history and physical examination, can decrease radiography for patients with elbow trauma. Secondary outcomes included evaluation of pediatric emergency department (PED) length of stay (LOS) and test performance characteristics. This was a prospective study of patients up to age 21 years with elbow trauma necessitating radiography. After clinical examination and before radiography, pediatric emergency physicians performed elbow ultrasonography of the posterior fat pad and determined whether radiography was required. All patients underwent elbow radiography and received clinical follow-up. Times for US and radiography were recorded. A total of 100 patients with a mean age of 7.9 years were enrolled, 42 of whom had a fracture. In 23 patients, the physician determined that radiography could be eliminated. Elbow US combined with clinical suspicion for fracture had a sensitivity of 100% (95% CI, 92%-100%). Elbow US took a median of 3 minutes (IQR, 2-5 minutes), and completion and interpretation of elbow radiography took a median of 60 minutes (IQR, 43-84 minutes). The overall sensitivity of elbow US was 88% (95% CI, 75%-96%). Elbow US has a high sensitivity to rule out fracture and is best used in patients with a low clinical suspicion of fracture. The use of conventional radiography and PED LOS may be reduced in patients with a low clinical concern for fracture and normal elbow US.

Intra- and Interobserver Reliability of Three Classification Systems for Hallux Rigidus.

There are over ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. The purpose of this study was to evaluate intra- and interobserver reliability using three commonly used classifications for hallux rigidus. Twenty-one plain radiograph sets were presented to ten ACFAS board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation was used to calculate intra- and interrater reliability. The intrarater reliability of individual sets for the Roukis and Hattrup and Johnson classification systems was "fair to good" (Roukis, 0.62±0.19; Hattrup and Johnson, 0.62±0.28), whereas the intrarater reliability of individual sets for the Regnauld system bordered between "fair to good" and "poor" (0.43±0.24). The interrater reliability of the mean classification was "excellent" for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. In our study, Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, our results indicate that all three of these classification systems show reliability and reproducibility.

Tip of the Iceberg Findings: Subtle Radiographic Abnormalities Indicating Significant Pathology in the Knee

Knee injuries are common and radiographs remain the first line of study in the majority of cases. In many instances, subtle or small radiographic findings actually represent significant underlying pathology that requires expeditious diagnosis and treatment. By using a mechanistic search strategy, one that applies a comprehensive search for avulsions at ligamentous/tendinous/connective tissue attachments and potential sites of impaction, one may maximize the diagnostic accuracy of radiographic interpretation. This article will provide a review of important indicators of ligament, tendon, and osseous injuries with an emphasis on their mechanism of injury.

Morphology of the anterior clinoid process in a select Kenyan population

Knowledge of the morphological variations of the anterior clinoid process is pertinent during anterior clinoidectomy to prevent injury to the adjacent neurovascular structures as well as in the interpretation of skull base radiographs. Fifty-one open crania (102 anterior clinoid processes) were obtained from the Departments of Human Anatomy in three Kenyan Universities. Caroticoclinoid foramen was present in nine (17.6%) out of the 51 skulls studied. Of the 9 skulls, 2 had bilateral complete foramina while the remaining 7 had unilateral foramina, all on the left side. The mean length of the anterior clinoid process ranged between 5.0 and 18.8mm with a mean of 10.92±2.79 mm. The mean width was found to be 10.43±2.67 mm (range: 5.3-18.0mm) while the average thickness was 5.43±2.02mm (range: 1.3-11.9mm). There were no statistically significant side differences in the dimensions of the anterior clinoid process. Type IIIb anterior clinoid process was the commonest (47.1%) while type IIIa was the least common (7.8%). Compared to other populations, the anterior clinoid process in our setting shows some differences involving its type and the caroticoclinoid foramen. These features should be taken into account when interpreting skull base radiographs and planning for anterior clinoidectomies.Keywords: Clinoid Process, Kenya, Morphology

A survey of cariology teaching in Australia and New Zealand

BackgroundThe Australian and New Zealand chapter of the Alliance for a Cavity Free Future was launched in 2013 and one of its primary aims was to conduct a survey of the local learning and teaching of cariology in dentistry and oral health therapy programs.MethodsA questionnaire was developed using the framework of the European Organisation for Caries Research (ORCA)/Association of Dental Education in Europe (ADEE) cariology survey conducted in Europe in 2009. The questionnaire was comprised of multiple choice and open-ended questions exploring many aspects of the cariology teaching. The survey was distributed to the cariology curriculum coordinator of each of the 21 programs across Australia and New Zealand via Survey Monkey in January 2015. Simple analysis of results was carried out with frequencies and average numbers of hours collated and open-ended responses collected and compiled into tables.ResultsSeventeen responses from a total of 21 programs had been received including 7 Dentistry and 10 Oral Health programs. Key findings from the survey were – one quarter of respondents indicated that cariology was identified as a specific discipline with their course and 41% had a cariology curriculum in written format. With regard to lesion detection and caries diagnosis, all of the program coordinators who responded indicated that visual/tactile methods and radiographic interpretation were recommended with ICDAS also being used by over half them. Despite all respondents teaching early caries lesion management centred on prevention and remineralisation, many taught operative intervention at an earlier stage of lesion depth than current evidence supports. Findings showed over 40% of respondents still teach operative intervention for lesions confined to enamel.ConclusionDespite modern theoretical concepts of cariology being taught in Australia and New Zealand, they do not appear to be fully translated into clinical teaching at the present time.

The Impact of Interruptions on Chest Radiograph Interpretation: Effects on Reading Time and Accuracy

The objective of this study was to experimentally test the effect of interruptions on image interpretation by comparing reading time and response accuracy of interrupted case reads to uninterrupted case reads in resident and attending radiologists. Institutional review board approval was obtained before participant recruitment from an urban academic health-care system during January 2016-March 2016. Eleven resident and 12 attending radiologists examined 30 chest radiographs, rating their confidence regarding the presence or the absence of a pneumothorax. Ten cases were normal (ie, no pneumothorax present), 10 cases had an unsubtle pneumothorax (ie, readily perceivable by a nonexpert), and 10 cases had a subtle pneumothorax. During three reads of each case type, the participants were interrupted with 30 seconds of a secondary task. The total reading time and the accuracy of interrupted and uninterrupted cases were compared. A mixed-factors analysis of variance was run on reading time and accuracy with experience (resident vs attending) as a between-subjects factor and case type (normal, unsubtle, or subtle) and interruption (interruption vs no interruption) as within-subjects factors. Interrupted tasks had significantly longer reading times than uninterrupted cases (P = .032). During subtle cases, interruptions reduced accuracy (P = .034), but during normal cases, interruptions increased accuracy (P = .038). Interruptions increased reading times and increased the tendency for a radiologist to conclude that a case is normal for both resident and attending radiologists, demonstrating that interruptions reduce efficiency and introduce patient safety concerns during reads of abnormal cases.

National Trends in the Utilization of Skeletal Radiography From 2003 to 2015

PurposeExamine recent trends in the use of skeletal radiography and assess the roles of various nonradiologic specialties in the interpretations. MethodsMedicare Part B fee-for-service claims data files from 2003 to 2015 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) procedure codes related to skeletal radiography. The files provide examination volume, and we calculated utilization rates per 1,000 Medicare beneficiaries. Medicare’s physician specialty codes were used to determine the specialties of the providers. Total utilization rate trends were analyzed, as well as those for radiologists and nonradiologists. We determined which nonradiologist specialties were the highest users of skeletal radiography. Medicare place-of-service codes were used to identify the locations where the services were provided. ResultsThe total utilization rate per 1,000 of skeletal radiography within the Medicare population increased 9.5% from 2003 to 2015. The utilization rate for radiologists increased 5.5% from 2003 to 2015 versus 11.1% for nonradiologists as a group. Among nonradiologist specialties in all health care settings over the study period, orthopedic surgeons increased 10.6%, chiropractors and podiatrists together increased 14.4%, nonphysician providers (primarily nurse practitioners and physician assistants) increased 441%, and primary care physicians’ rate decreased 33.5%. Although radiologists do almost all skeletal radiography interpretation in hospital settings, nonradiologists do the majority in private offices. There has been strong growth in skeletal radiography in emergency departments, but a substantial drop in inpatient settings. ConclusionsThe utilization of skeletal radiography has increased more rapidly among nonradiologists than among radiologists. This raises concerns about self-referral and quality.

Interobserver and Intraobserver Reliability of Cone-beam Computed Tomography in Identification of Apical Periodontitis

IntroductionAccurate radiographic interpretation is of the utmost importance in the diagnosis and treatment of patients. Previous studies have indicated subjectivity in the radiographic interpretation of periapical tissues irrespective of using conventional radiography, digital radiography, or cone-beam computed tomographic (CBCT) imaging. No studies to date have evaluated the reliability of the interpretation of periapical tissues based on the size of periapical radiolucency (PAR). The purpose of this study was to assess the interobserver and intraobserver reliability of CBCT interpretation by observers from different specialties and different levels of experience when identifying PARs of various sizes. MethodsLimited field of view CBCT scans were selected such that a variety of PARs with various sizes were included. Six observers with different levels of experience and fields of specialty evaluated periradicular tissues of 28 roots on the CBCT scans at 3 separate sittings each a month apart. ResultsThe overall Fleiss kappa coefficient for interobserver reliability and intraobserver reliability was 0.88 and 0.85; the larger the PAR, the more reliable the radiographic interpretation. Increased experience level improved the intraobserver reliability. ConclusionsCBCT imaging appears to be a reliable method for the interpretation of PAR. The larger the PAR is the more reliable the radiographic interpretation.

MANIFESTACIONES ORALES EN PACIENTES CON ARTRITIS REUMATOIDEA QUE ASISTEN AL INSTITUTO DE REHABILITACIÓN Y REUMATOLOGIA DE BUCARAMANGA

Purpose: To determine the orofacial and bucodental profile of patients with Rheumatoid Arthritis according to the development of the disease.Material and methods: Forty eight individuals with Rheumatoid Arthritis were analyzed. The prevalence of alterations in the facial exam, temporomandibular joint (TMJ) intraoral exam, COP index, periodontal condition (CPITN), and radiographic interpretation were determined.Results: In the group studied, 77.08% were female and their average mean age was 48.7% years old. The scalp showed the highest frequency of abnormality, 22.9%; the most frequent TMJ alteration was pain, 60.42% which was 41.67% bilateral; oral mucosa showed the greatest number of lesions (37.5%); the periodontal condition was 50% of the population had periodontal pockets of 4 to 5 mm in the presence of subgingival calculus. Radiographically, 19.05% had thin roots; 42.86% had posterior hypercementosis; 11.9% reduced TM joint space.Conclusions: The alterations of the oral mucosa reflect an elevated prevalence of red lesions. Furthermore, these patients have a greater risk of developing periodontal disease.

Discrepancies in Radiograph Interpretation Between Pediatric Radiologists and Pediatric Intensivists in the Pediatric or Neonatal Intensive Care Unit

BackgroundIn pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PR). ObjectiveTo quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU. Materials and MethodsThis institutional review board–approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs. Interpretations of chest and abdominal radiographs by PIs and PRs were recorded on online forms and compared. Discrepancies in interpretations were classified as “miss,” “misinterpretation,” or “overcall.” The discrepancies were also categorized as “actionable” or “nonactionable” based on extrapolation of the ACR actionable reporting work group’s list of actionable findings. ResultsIn 960 radiographic interpretations, the total, nonactionable, and actionable discrepancy rates between PRs and PIs were 34.7%, 26.8%, and 7.9%, respectively. The most common actionable discrepancies were line or tube positions and identification and interpretation of parenchymal opacities in the lungs. Identification of air leaks in the PICU and differentiation of normal from abnormal bowel gas patterns in the NICU followed in frequency. Air leaks accounted for 1% of total discrepancies and 11% of actionable discrepancies. Most discrepancies were nonactionable and included retrocardiac atelectasis and mischaracterization of neonatal lung disease in the PICU and NICU, respectively. ConclusionAlthough the total discrepancy rate was high, most discrepancies were nonactionable. Actionable discrepancies were predominantly due to line and tube position, which should be an area of focused education.

Dental Students' Interpretations of Digital Panoramic Radiographs on Completely Edentate Patients.

The ability of dental students to interpret digital panoramic radiographs (PANs) of edentulous patients has not been documented. The aim of this retrospective study was to compare the ability of second-year (D2) dental students with that of third- and fourth-year (D3-D4) dental students to interpret and identify positional errors in digital PANs obtained from patients with complete edentulism. A total of 169 digital PANs from edentulous patients were assessed by D2 (n=84) and D3-D4 (n=85) dental students at one Canadian dental school. The correctness of the students' interpretations was determined by comparison to a gold standard established by assessments of the same PANs by two experts (a graduate student in prosthodontics and an oral and maxillofacial radiologist). Data collected were from September 1, 2006, when digital radiography was implemented at the university, to December 31, 2012. Nearly all (95%) of the PANs were acceptable diagnostically despite a high proportion (92%) of positional errors detected. A total of 301 positional errors were identified in the sample. The D2 students identified significantly more (p=0.002) positional errors than the D3-D4 students. There was no significant difference (p=0.059) in the distribution of radiographic interpretation errors between the two student groups when compared to the gold standard. Overall, the category of extragnathic findings had the highest number of false negatives (43) reported. In this study, dental students interpreted digital PANs of edentulous patients satisfactorily, but they were more adept at identifying radiographic findings compared to positional errors. Students should be reminded to examine the entire radiograph thoroughly to ensure extragnathic findings are not missed and to recognize and report patient positional errors.

Radiological diagnosis of pneumoperitoneum in children with typhoid intestinal perforation

Background: Typhoid fever is a severe systemic illness caused by the gram-negative bacillus Salmonella typhi and transmitted by the faecal-oral route. This study sought to determine the value of plain abdominal and chest radiographs in detecting pneumoperitoneum in children with typhoid intestinal perforation (TIP). Methods: A retrospective review of plain abdominal and chest radiographs of children who had surgery for TIP between June 2009 and December 2011 in our unit. All the films were reviewed by the same radiologist who was blinded to the intraoperative findings, for the presence or absence of various signs of pneumoperitoneum. Data were collected on a structured questionnaire and analysed using SPSS version 15.0. Results: Radiographs of 54 children were reviewed. Their ages ranged from 3 years to 13 years (median 7 years). Thirty-three of them were boys and 21 were girls (male-to-female ratio 1.57:1). Pneumoperitoneum was detected in 47 patients (87%). In the erect abdominothoracic films, air under the right hemidiaphragm was detected in 16 of 41 cases (39%), and extraluminal or intraperitoneal air-fluid levels in 31 of 41 cases (75.6%). In the supine abdominal films, the commonest sign of pneumoperitoneum was the right upper quadrant gas sign (23 of 50 cases; 46%). Conclusions: A careful interpretation of plain abdominal and chest radiographs in the child suspected to have TIP, would lead to more accurate diagnosis of pneumoperitoneum. Keywords: pneumoperitoneum; typhoid intestinal perforation; radiographs; children; air–fluid levels

Intraobserver and interobserver agreement on the radiographical diagnosis of canine cranial cruciate ligament rupture

Even though radiography is one of the most frequently used imaging techniques for orthopaedic disorders, it has been demonstrated that the interpretation can vary between assessors. As such, the purpose...

Relationship Between Sever Disease and Skeletal Maturity.

Sever disease is a common condition in active, growing children. This condition presents as pain in the heel and is thought to be an overuse condition of the calcaneal apophysis. There are currently no defined radiographic diagnostic criteria for evaluation of Sever disease, with radiographs generally showing normal appearance of the calcaneal apophysis. A better understanding of the relationship of Sever disease and skeletal maturity may allow for improved interpretation of radiographs when trying to diagnose this condition. ICD-9 code 732.5 was used to search for patients diagnosed with Sever disease from 2007 to 2015 at a single hospital. For every patient with Sever disease with available calcaneal imaging within 40 days of diagnosis, heel x-rays were staged for calcaneal maturity score using a previously described calcaneal skeletal maturity assessment system. Controls matched by age, race, and sex were evaluated for calcaneal stage to compare with the Sever patients. The chart review yielded 78 patients diagnosed with Sever disease by the orthopaedic attending, 39 of which have x-rays around the time of diagnosis. Calcaneal scores averaged 2.2±0.8 for all patients, 2.1±0.9 for male individuals, and 2.3±0.8 for female individuals. The average age for male individuals was 10.4±1.9 years and for female individuals, 9.2±2.2 years. The ages of diagnosis were similar for patients with and without x-rays. Twenty-two of 39 patients with Sever disease were calcaneal stage 2, and 37 of 39 were stages 1, 2, or 3. We calculated the absolute difference from stage 2 for the Sever and control groups. Mean difference from stage 2 was 0.51±0.68 for the Sever patients and 0.95±0.79 for control patients (P=0.01). Sever disease occurs in a very narrow range of skeletal maturity, as measured by the calcaneal skeletal maturity assessment system and our observations with chronological age. When compared with age-matched and race-matched controls, stage 2 was seen more frequently in the Sever patients. If a child is not within calcaneal stages 1, 2, or 3, then a different diagnosis should be considered. Level III-retrospective case-control study.

Interpretation of chest radiographs

It is vital that every junior doctor has a thorough knowledge of the fundamentals of interpreting chest radiographs. Frequently, hospital-based trainees in general practice need to make a decision regarding patient treatment on an unreported chest X-ray. This article covers the basic interpretation of chest radiographs and the most common pathologies encountered.

The impact of Video Assisted learning (VAL) on slow learners

Background: Every medical graduate after completion of his course is posted in the emergency room where he/she faces many chest emergencies. In some chest emergencies a small intervention can be life-saving. In view of evidence based clinical practice every medical graduate should be confident to diagnose chest emergencies (e.g. Tension pneumothorax, massive pleural effusion, periodical effusion etc.) on radiographs, where an immediate intervention is necessary. Video Assisted learning (VAL) improves the performance of learners as it addresses a variety of learning styles. Video can be as good as an instructor in communicating facts or demonstrating procedures to assist in mastery learning where a student can view complex clinical or mechanical procedures as many times as they need to. In this study the advantages of video assisted learning would be used to enhance the academic output of learners. Method : 60 medical students of 6th semester were exposed to video assisted learning after traditional didactic lecture teaching on chest emergencies in the discipline of Radiology. Pretest OSCE was conducted in the form of interpretation of chest radiographs and post test OSCE was conducted after the intervention (VAL) Results: The average pretest score was 25.2 (31.5%) and average post test score was 48.15(60.18%). Based on the pretest scores, students were divided into three groups, i.e. Top one-third students, Middle one-third students and Bottom one-third students (i.e. slow learners). The pretest and post test results were compared as mean scores of the groups, with Paired t test. The difference in the scores was found to be statistically significant in all the groups (p value less than 0.001). The students perceived VAL as a good instructor which improves the understanding of complex case scenarios. Conclusion: Video assisted learning is an effective medium for teaching learning in graduate medical education.