Internet-based measurement of visual assessment skill of trainee radiologists: developing a sensitive tool

Objective: Expert radiologists exhibit high levels of visual diagnostic accuracy from review of radiological images, doing so after accumulating years of training and experience. To train new radiologists, learning interventions must focus on the development of these skills. By developing a web-based measure of image assessment, a key part of visual diagnosis, we aimed to capture differences in the performance of expert, trainee and non-radiologists. Methods: Twelve consultant paediatric radiologists, twelve radiology registrars, and thirty-nine medical students were recruited to the study. All participants completed a two-part, online task requiring them to visually assess 30 images (25 containing an abnormality) drawn from a library of 150 paediatric skeletal radiographs assessed prior to the study. Participants first identified whether an image contained an abnormality, and then clicked within the image to mark its location. Performance measures of identification accuracy, localisation precision, and task time were collected. Results: Despite the difficulties of web-based testing, large differences in performance, both in terms of the accuracy of abnormality identification and in the precision of abnormality localisation were found between groups, with consultant radiologists the most accurate both at identifying images containing abnormalities (p < 0.001) and at localising abnormalities on the images (p < 0.001). Conclusions: Our data demonstrate that an online measurement of radiological skill is sufficiently sensitive to detect group level changes in performance consistent with the development of expertise. Advances in knowledge: The developed tool will allow future studies assessing the impact of different training strategies on cognitive performance and diagnostic accuracy

The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review

Results: 221 infants with NEC were referred for surgical evaluation; 182 (82%) underwent surgery; 15 (8%) required a laparotomy on NICU. Five had NEC totalis, 4 multifocal disease and 6 focal disease. Five had an open and close laparotomy, 8 stoma with/without bowel resection and 2 bowel resection and primary anastomosis. Ten (67%) died at a median of 6.5-hours (2-72) postoperatively; 2 died at 72 and 264-days. The 30-day mortality rate was higher (p = 0.01) among infants undergoing a laparotomy on NICU (10/15; 67%) than in theatre (54/167; 32%). There was no significant difference in mean Paediatric Index of Mortality 2 Scores between survivors and nonsurvivors (p = 0.55). Three (20%) infants remain alive with no or minimal disability at 1.4 (0.5-7.5) years. Conclusion: Laparotomy for NEC on NICU is a treatment option for neonates who are too unstable to transfer to theatre. However, with 67% dying within 6.5-hours and a further 13% after months in hospital, we must consider whether surgery is always in their best interests. Development of a prediction model to help distinguish those at highest risk of long-term morbidity and mortality could help with decision making in this difficult situation

Introduction of a novel magnetic resonance imaging-based scoring system for assessing disease activity in children with juvenile dermatomyositis

Objectives: We aimed to develop and assess the reliability of a novel MRI-based scoring system for reporting the severity of MRI findings in children with suspected JDM. Methods: Nine consultant paediatric radiologists independently assessed and scored 40 axial and 30 coronal thigh MR images of children with suspected JDM on two occasions using the juvenile dermatomyositis magnetic resonance Imaging Score (JIS). JIS was calculated for both reads for each plane and each limb, with possible scores ranging from 0 (normal) to 100 (severe). Inter- and intraobserver agreement was calculated using the intraclass correlation coefficient (ICC) and two- and one-way random effects models, respectively. Bland-Altman plots of the difference in JIS against the average JIS were also produced for each rater. Results: Overall, the interobserver reliability and agreement was good-for axial images, JIS ranged from 46.8 to 61.0 [ICC = 0.88 (95% CI: 0.82, 0.92)] for the left limb and 47.9-61.4 [ICC = 0.87 (95% CI: 0.81, 0.92)] for the right limb. For coronal images, JIS ranged from 56.7 to 65.1 [ICC = 0.90 (95% CI: 0.85, 0.95)] for the left limb and 55.7 to 66.8 [ICC = 0.90 (95% CI: 0.84, 0.94)] for the right limb. The intraobserver reliability and agreement was good, with ICC ranging from 0.90 to 0.94. Conclusion: JIS is a semi-objective scoring system with potential to serve as a reliable biomarker of disease severity and response to therapeutic interventions in children with JDM