INTERPRETATION OF EMERGENCY COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAM

Zamara Sohail, Muhammad Abdullah, Ali Asghar, Saira Yasmin, Raheel Ahmad

Abstract


Background: Computer tomography pulmonary angiogram (CTPA) is the recommended diagnostic method for individuals suspected of having pulmonary embolism (PE). The objective of this study was to determine the degree of concordance and discordance of CTPA interpretations for diagnosis of PE between the resident and consultant radiologist at Rehman Medical Institute, Peshawar.

Materials & Methods: This was a cross sectional study conducted between 1st January 2022 and 30th June 2022 at radiology department of the Rehman Medical Institute in Peshawar. A consultant radiologist’s report was contrasted to the first interpretation of the on-call radiology resident. For pulmonary embolism, studies were categorized as positive, negative, or equivocal. Inter-rater agreement was examined using an unweighted Kappa coefficient with a 95% confidence range. SPSS version 26 was used for data analysis.

Results: Fifty successive CTPA tests were examined. The results showed that consultant interprets 43 (86%) of the studies as negative for PE. Residents, on the other hand, interpret 40 (80%) of them negatives. The concordance rate was 88%, with moderate statistical agreement, kappa = 0.597: 95% CI, 0.187- 0.765. The discordance rate was 12%. Regarding cardiac chambers, the consultant reported 10 (20%) with cardiomegaly. However, residents interpreted only 2 (4%) of them cardiomegaly. Overall concordance rate was 82%, with weak kappa = 0.350: 95% CI, 0.00- 0.688. In 18% of the cases, there was discordance.

Conclusion: Resident radiologist can provide high level of interpretation of CTPA for PE, achieving moderate concordance with consultant radiologist.


Keywords


Pulmonary embolism; CTPA; Contrast; Radiologist; Residents.

Full Text:

PDF

References


Torres-Macho J, Mancebo-Plaza AB, Crespo-Giménez A, Sanz de Barros MR, Bibiano-Guillén C, Fallos-Martí R, et al. Clinical features of patients inappropriately undiagnosed of pulmonary embolism. Am J Emerg Med. 2013;31(12):1646-1650. https://doi.org/10.1016/j.ajem.2013.08.037

Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-71. https://doi.org/10.1161/ATVBAHA.114.304488

Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016;118(9):1340-47.https://doi.org/10.1161/CIRCRESAHA.115.306841

Ghaye B, Szapiro D, Mastora I, Delannoy V, Duhamel A, Remy J, et al. Peripheral pulmonary arteries: how far in the lung does multi-detector row spiral CT allow analysis? Radiology. 2001;219(3):629-636. https://doi.org/10.1148/radiology.219.3.r01jn32629

Lee YJ, Choi SY, Kim KS, Yang PS. Variability in Observer Performance Between Faculty Members and Residents Using Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, Fifth Edition (2013). Iran J Radiol. 2016;13(3):e28281. https://doi.org/10.5812/iranjradiol.28281

Son AY, Hong GS, Lee CW, Lee JH, Chung WJ, Lee JB. Patient recalls associated with resident-to-attending radiology report discrepancies: predictive factors for risky discrepancies. Insights Imaging. 2022;13(1):97. https://doi.org/10.1186/s13244-022-01233-4

Tamjeedi B, Correa J, Semionov A, Mesurolle B. Interobserver Agreement between On-Call Radiology Resident and General Radiologist Interpretations of CT Pulmonary Angiograms and CT Venograms. PLoS One. 2015;10(5):e0126116. https://doi.org/10.1371/journal.pone.0126116

Safriel Y, Sclafani S, Gale B, Patel D, Gordon D. Comparing the interpretations of CT pulmonary angiograms by attending and resident radiologists: can residents identify life-threatening pulmonary emboli in hospitalized patients? Emerg Radiol. 2002;9(1):55-9. https://doi.org/10.1007/s10140-001-0192-5

Cervini P, Bell CM, Roberts HC, Provost YL, Chung T-B, Paul NS. Radiology Resident Interpretation of On-call CT Pulmonary Angiograms. Academic Radiology. 2008;15(5):556-62. https://doi.org/10.1016/j.acra.2007.12.007

Albano MC, Ross GW, Ditchek JJ, Duke GL, Teeger S, Sostman HD, et al. Resident interpretation of emergency CT scans in the evaluation of acute appendicitis. Acad Radiol. 2001;8(9):915-8. https://doi.org/10.1016/S1076-6332(03)80772-9

Wysoki MG, Nassar CJ, Koenigsberg RA, Novelline RA, Faro SH, Faerber EN. Head trauma: CT scan interpretation by radiology residents versus staff radiologists. Radiology. 1998;208(1):125-8. https://doi.org/10.1148/radiology.208.1.9646802

Ginsberg MS, King V, Panicek DM. Comparison of interpretations of CT angiograms in the evaluation of suspected pulmonary embolism by on-call radiology fellows and subsequently by radiology faculty. AJR Am J Roentgenol. 2004;182(1):61-6. https://doi.org/10.2214/ajr.182.1.1820061

Shaham D, Heffez R, Bogot NR, Libson E, Brezis M. CT pulmonary angiography for the detection of pulmonary embolism: interobserver agreement between on-call radiology residents and specialists (CTPA interobserver agreement). Clin Imaging. 2006;30(4):266-70. https://doi.org/10.1016/j.clinimag.2006.01.001

Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities. Clin Imaging. 2002;26(2):101-5. https://doi.org/10.1016/S0899-7071(01)00366-7

Jones SE, Wittram C. The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome. Radiology. 2005;237(1):329-37. https://doi.org/10.1148/radiol.2371041520




DOI: https://doi.org/10.46903/gjms/21.01.1234

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023. Zamara Sohail, Muhammad Abdullah, Ummara Siddique Umer, Ali Asghar, Abdullah Safi, Saira Yasmin

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

JOURNAL INDEXING