Trainee reporting of computed tomography examinations: do they make mistakes and does it matter?

Abstract

AIM: To determine the accuracy of trainees reporting computed tomography (CT) examinations.

MATERIAL AND METHODS: Over a 6-month period a single consultant reviewed all the CT examinations reported by registrars in one radiology department. After recording a provisional registrar report each examination was jointly reviewed by the consultant and registrar. The consultant's opinion was regarded as the gold standard. Data collected included: the error rate, whether an error was significant, leading to a change in patient management, and whether the mistake was a false-negative or positive.

RESULTS: Three hundred and thirty-one patients were included in the study. There was an overall error rate of 21.5%. A significant error leading to a change in management was made in 10% of reports, and a significant error that did not lead to a change in management was made in 9.3%; 2.1% of reports had insignificant errors; and 69% of errors were false-negatives.

CONCLUSION: Registrars make a significant number of errors affecting patient management when reporting CT and ideally all examinations should be reviewed by a consultant.

Introduction

Errors in radiology are well recognized. Since 1959 when Garland published his work on the accuracy of diagnostic procedures¹ there has been much debate about the actual level of error in radiology. Many studies have simply tried to quantify the error levels and their clinical significance. More recent interest has focused on strategies to reduce these error rates. These strategies include second reporting2., 3. and educational input.⁴ Second reporting of barium enemas and mammograms has consistently been shown to reduce error rates.2., 3.

An area that has been studied less closely is the accuracy of reporting by registrars during their training. What little data are available generally relate to error rates in plain film reporting. Consultant second reporting of CT images is commonplace in teaching hospitals, and is assumed to be both of educational benefit for the trainee, and also to contribute to patient care.

This study was designed to determine how accurate registrars were in their reporting of CT examinations, and to assess the type of errors that were made, i.e. whether these were false-negative or false-positives, and whether the mistakes were clinically important.