Around-the-Clock Attendings and Radiologist Residents’ Interpretations

On-call radiology resident performance in image interpretations improves when there is 24/7 in-house radiology attending coverage, according to a study presented at RSNA 2016.

Researchers from New York performed a retrospective review to assess the impact of 24/7 in-house radiology attending coverage on radiology resident performance. The researchers reviewed radiology resident reports on emergent diagnostic radiology procedures, including plain radiographs, ultrasounds, CTs, and MRIs, over an 11-month period. All reports were assessed for accuracy in terms of missed findings as compared to the final attending reading. Missed findings, which were categorized as minor or major depending on whether or not the finding impacted subsequent patient management, were identified using emergency room call back forms. A radiology attending and resident reviewed each missed finding in order to determine, by consensus, the significance of the missed finding. Resident performance was also stratified by year of training.

The results showed that 29,636 studies were preliminarily interpreted by 17 on-call radiology residents who were under 24/7 supervision by an in-house radiology attending. Based on literature, the resident-faculty discrepancy rate for radiographs is 0.8% versus 1.4%. For cross-sectional studies the rates respectively were, based on literature:

• CT 0.5% versus 2.4%

• US 0.1% versus 0.6%

• MR 1.1% versus 3.7%

When evaluating plain radiographs, chest radiography was the most common area for discrepant findings. The rate of minor and major discrepancies substantially decreased by increasing resident year of training.

The researchers concluded that when radiologist residents worked with 24/7 in-house radiology attendings, there was improvement in patient care, emergency room management/discharge time, and appropriateness of management.