P240 Assessing the Accuracy and Confidence of Chest X-Ray Reporting by Medical Doctors

The reporting of CXRs for medical patients admitted to hospital vary across Europe. Our local policy is that all admission x-rays are reported but this may not be available at the time of senior medical review on the assessment unit. Comparison between physicians and radiology reporting has suggested radiologists provide improved quality (1) and accuracy (2) of reporting. There are no current curriculum competencies for trainees nor is CXR reporting formally assessed in undergraduate or post-graduate examinations. To assess the accuracy and confidence of CXR reporting by all grades within the medical division for common chest diagnoses presenting to the medical assessment unit. 10 CXRs were presented to all grades within the medical division with a short clinical history and one digital CXR. Doctors were asked to give a pre-test confidence (out of 5) in reporting CXRs and then also give individual confidence levels for each of their CXR diagnoses. A total of 138 doctors completed the CXR quiz with average results and 95% confidence intervals shown in figure 1. The least well answered CXR diagnoses were left lower lobe collapse (38%), emphysema (45%), and mediastinal widening (57%). When correlated with average % confidence for each diagnosis, doctors were on average over-confident in the incorrect CXRs they answered; left lower lobe collapse (64%), emphysema (62%), bilateral pneumothoraces (74%). Interestingly, for the correct diagnosis, the average confidence for diagnosing effusions, TB and pneumonia were much less. SPRs and Consultants scored the highest marks with the highest average confidence levels. Junior trainees felt least confident about making their diagnosis and were less likely to be correct. We recommend that SPRs and consultants must review all the CXRs requested to ensure accuracy of diagnosis. There also needs to be discussion with the JRCPTB and educationalist about including CXR competency as part of a trainee’s generic curriculum on the e-portfolio, something which is currently lacking. Weiner SN. Radiology by non-radiologists: is report documentation adequate? Am J Manag Care. 2005 Dec; 11(12). Zohair Al Aseri. Accuracy of chest radiograph interpretation by emergency physicians. Emergency Radiology, 2009; 16(2).