Discrepancy rates of radiology resident interpretations of on-call neuroradiology MR imaging studies

Radiology. 2008 Dec;249(3):972-9. doi: 10.1148/radiol.2493071543.


Purpose: To determine the discrepancy rates of radiology residents interpreting emergent neuroradiology magnetic resonance (MR) imaging studies and to assess any adverse clinical outcomes.

Materials and methods: Three hundred sixty-one brain and spine MR imaging and MR angiographic examinations that were ordered emergently after hours and given preliminary interpretations by radiology residents were retrospectively reviewed from December 1, 2006 to May 31, 2007 with institutional review board approval. Discrepancies between the interpretations of radiology residents and the final reports of attending neuroradiologists were classified as either false-negative (FN, failure to recognize abnormalities) or false-positive (FP, misinterpreting normal images as abnormal). Discrepancies that could affect patient care or clinical outcome were considered major.

Results: Overall, the agreement rate was 92.8%, the overall discrepancy rate was 7.2%, the major disagreement rate was 4.2%, and the minor disagreement rate was 2.2%. Misinterpretations among 1st-year residents on call were significant (P < .04) when compared with more senior-level residents. There were 23 FN interpretations. The most common misses were acute stroke (n = 3), aneurysm (n = 3), vascular occlusion (n = 3), and disk herniation (n = 2). There were only three FP interpretations (misdiagnoses of syrinx, arachnoiditis, and acute infarct).

Conclusion: There was no adverse clinical outcome as a result of misinterpretations, owing in part to rapid turnaround time for final reporting. Level of residency training has a significant effect on the rate of discrepancy, which may be mitigated by recent changes regarding 1st-year radiology residents' overnight call.

MeSH terms

  • Brain / pathology*
  • Diagnostic Errors
  • Emergencies*
  • Humans
  • Internship and Residency / standards*
  • Intervertebral Disc Displacement / diagnosis
  • Intracranial Aneurysm / diagnosis
  • Magnetic Resonance Imaging / standards*
  • Observer Variation
  • Patient Care / standards*
  • Radiology / education*
  • Retrospective Studies
  • Spine / pathology*
  • Stroke / diagnosis
  • Treatment Outcome
  • Vascular Diseases / diagnosis