[Diffusion-weighted MR imaging of liver pathology: principles and clinical applications].

International audienceDue to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols

Measuring performance in the interpretation of chest radiographs: a pilot study

This paper was published in the journal Clinical Radiology and the definitive published version is available at http://dx.doi.org/10.1016/j.crad.2016.11.004.AIM: To develop a system to assess the image interpretation performance of radiologists in identifying signs of malignancy on chest radiographs. MATERIALS AND METHODS: A test set of 30 chest radiographs was chosen by an experienced radiologist consisting of 11 normal and 19 abnormal cases. The malignant cases all had biopsyproven pathology; the normal and benign cases all had at least 2 years of imaging follow-up. Fourteen radiologists with a range of experiences were recruited. Participants individually read the test set displayed on a standard reporting workstation, with their findings entered directly into a laptop running specially designed reporting software. For each case, relevant clinical information was given and the reader was asked to mark any perceived abnormality and rate their level of suspicion on a five-point scale (normal, benign, indeterminate, suspicious, or malignant). On completion, participants were given instant feedback with performance parameters including sensitivity and specificity automatically calculated. An opportunity was then given to review the cases together with an expert opinion and pathology. The time each participant took to complete the test was recorded. RESULTS: Six consultant radiologists who took part showed significantly better performance as determined by receiver operating characteristic (ROC) analysis compared to eight specialist registrars (area under the ROC curve [AUC]¼0.9297 and 0.7648 respectively, p¼0.003). There was a significant correlation with years of experience in the interpretation of chest radiographs and performance on the test set (r¼0.573, p¼0.032). Consultant radiologists completed the test significantly more quickly that the specialist registrars: mean time 19.65 minutes compared to 26.51 minutes (p¼0.033). CONCLUSION: It is possible to use a test set to measure individual differences in the interpretation of chest radiographs. This has the potential to be a useful tool in performance testing

Competency in Chest Radiography: A Comparison of Medical Students, Residents, and Fellows

BACKGROUND: Accurate interpretation of chest radiographs (CXR) is essential as clinical decisions depend on readings. OBJECTIVE: We sought to evaluate CXR interpretation ability at different levels of training and to determine factors associated with successful interpretation. DESIGN: Ten CXR were selected from the teaching file of the internal medicine (IM) department. Participants were asked to record the most important diagnosis, their certainty in that diagnosis, interest in a pulmonary career and adequacy of CXR training. Two investigators independently scored each CXR on a scale of 0 to 2. PARTICIPANTS: Participants (n = 145) from a single teaching hospital were third year medical students (MS) (n = 25), IM interns (n = 44), IM residents (n = 45), fellows from the divisions of cardiology and pulmonary/critical care (n = 16), and radiology residents (n = 15). RESULTS: The median overall score was 11 of 20. An increased level of training was associated with overall score (MS 8, intern 10, IM resident 13, fellow 15, radiology resident 18, P<.001). Overall certainty was significantly correlated with overall score (r = .613, P<.001). Internal medicine interns and residents interested in a pulmonary career scored 14 of 20 while those not interested scored 11 (P = .027). Pneumothorax, misplaced central line, and pneumoperitoneum were diagnosed correctly 9%, 26%, and 46% of the time, respectively. Only 20 of 131 (15%) participants felt their CXR training sufficient. CONCLUSION: We identified factors associated with successful CXR interpretation, including level of training, field of training, interest in a pulmonary career and overall certainty. Although interpretation improved with training, important diagnoses were missed