Discrepancy rate and clinical impact of preliminary reports from radiology residents.

Background: Residents usually cover night and weekend shifts issuing the preliminary reading of radiological studies in university hospitals. This is essential to strengthening decision-making skills when facing complex cases independently. However, there should be a balance between patient safety and academic experience since some concern has been expressed about the accuracy of the interpretations generated by trainees. This work aims to evaluate and characterize the discrepancies in preliminary reports issued by radiology residents. Material and methods: Radiologists filled out a questionnaire to evaluate preliminary reports of trainees considering diagnosis, findings description, clinical approach changes, and critical findings. Analysis was performed considering modality, imaging type, body part, and resident academic year. A Chi-square test with a significance level α of 0.05 was used to make group comparisons. Results: A total of 9072 studies were reviewed. Major and minor overall discrepancy rates were 1.7% and 8.3%, respectively. Minor discrepancy rate, findings description, and critical findings identification improved with increasing academic year, both overall and by modality. Discrepancy rates were lower for CT than MR and neuroimaging than for body-imaging studies. The highest major and minor discrepancy rates as abdomen/pelvis CT and lumbar-spine MR, respectively. Two percent of reports presented discrepancies that could generate a medical approach change. Conclusion: Discrepancy rates are low and comparable with those reported in the literature. These rates tend to improve as the resident's academic year increases. Our results suggest that radiology residents' coverage of night shifts and weekends is a practice that benefits the educational process without negatively impacting patient safety.

Impact of an educational initiative targeting non-radiologist staff on overall notification times of critical findings in radiology.

INTRODUCTION: The timely reporting of critical findings is considered by the Joint Commission as one of the main patient safety goals. Delays in critical radiological findings communication are directly related to delayed treatment initiation and death, constituting a major cause of medical malpractice suits. The aim of this study was to evaluate the impact of an educational initiative performed to reduce the notification times of critical radiological findings. MATERIALS AND METHODS: All records of critical findings reported in the Radiology Department were evaluated. The notification times before and after performing the educational intervention taking into account the patient type, study, and critical diagnosis were calculated, evaluated, and compared. T test and chi-square test were used for statistical analysis, considering a p value less than 0.05 to indicate statistically significant differences. RESULTS: We included 1949 reports, 805 before (41.3%) and 1144 (58.7%) after the intervention. Before the intervention, the mean time of critical finding report was 2.85 h for emergency patients and 3.07 h for hospitalized patients. After the intervention, a statistically significant decrease in the notification time was observed with a mean of 1.37 h for emergency patients and 2.43 h in the hospitalization patients. A statistically significant increase was observed in the proportion of reported findings in less than 15 min (7.08%, p < 0.01), 45 min (45.55%, p < 0.01), 60 min (55.86%, p < 0.01), and 120 min (80.68%, p < 0.01). CONCLUSION: The healthcare process in the Department of Radiology involves multiple actors who must be sensitized in the identification and reporting of critical radiological findings in order to reduce the notification times. Ensuring effective communication of critical findings is indispensable to ensure timely medical treatment.

Diagnosis of mesial temporal sclerosis: sensitivity, specificity and predictive values of the quantitative analysis of magnetic resonance imaging.

In the diagnosis of mesial temporal sclerosis (MTS), sensitivity, specificity and predictive values of qualitative assessment using conventional magnetic resonance imaging are low, mainly in mild or bilateral atrophy. Quantitative analysis may improve this performance. We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of quantitative analysis using the hippocampal volumetric index (HVI) and hippocampal asymmetry index (HAI) compared with qualitative assessment in the MTS diagnosis. Twenty-five patients diagnosed with MTS, and 25 healthy subjects underwent conventional magnetic resonance imaging. Hippocampal volumes were obtained using an automated software (FreeSurfer); HVI and HAI were calculated. Receiver operating characteristic curve analysis was performed to obtain the optimal threshold values. Sensitivity, specificity and predictive values were calculated. Sensitivity, specificity, PPV and NPV for qualitative analysis were 44.00%, 96.00%, 91.67% and 63.16%, respectively. In the quantitative analysis, a threshold value of K = 0.22 for HVI provided a sensitivity value of 76.00%, specificity value of 96.00%, PPV of 95.00% and NPV of 80.00%. A threshold value of K = 0.06 for HAI provided the minimum C1 and C2 errors, with a sensitivity value of 88.00%, specificity value of 100%, PPV of 100% and NPV of 89.30%. A statistically significant difference was observed for HAI ( P < 0.0001), and ipsilateral HVI (left MTS, P = 0.0152; right MTS, P < 0.0001), between MTS and healthy groups. The HVI and HAI, both individually and in conjunction, improved the sensitivity, specificity and predictive values of magnetic resonance imaging in the diagnosis of MTS compared to the qualitative analysis and other quantitative techniques. The HAI is highly accurate in the diagnosis of unilateral MTS, whereas the HVI may be better for bilateral MTS cases.