Understanding interpretive errors in radiologists learning computed tomography colonography

Jeff L. Fidler, Joel Garland Fletcher, C. Daniel Johnson, James E. Huprich, John M. Barlow, Franklin Earnest IV, Brian Jack Bartholmai

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Rationale and objectives To determine if interpretive errors in the course of learning CT colonography are secondary to failures in detection or in characterization and determine the types of lesions frequently missed. Materials and methods Fifteen radiologists completed an electronic CTC training module consisting of two parts: 1) a teaching file demonstrating the varied appearances of polyps, cancers, and pitfalls in interpreting exams; and 2) a test of 50 complete CTC datasets. Following review of each test case, radiologists were asked to indicate if and where a polyp was visualized. The module then showed each neoplasm (if any) located within the dataset. For false negative examinations, radiologists indicated if the lesion was not seen, was seen but interpreted as colonic wall or fold, or was seen but interpreted as stool or fluid. Results The average sensitivity for sessile, pedunculated, and flat polyps for these novice readers was 76%, 63%, and 32%, respectively. Average sensitivity for all morphologies of cancers (annular, polypoid, flat) was high (93%, 85%, 95%), with 8/11 missed cancers being secondary to failure in detection. The most frequently missed cancer was an annular constricting tumor (5/11). Overall, 55% (73/132) of errors were failures of detection and 45% (59/132) were errors in characterization. Conclusion Radiologists learning CT colonography had slightly more errors of detection than characterization, but this difference was not statistically significant. Flat and pedunculated polyps and annular constricting cancers were the most frequently missed morphologies. Examples of these abnormalities should be emphasized in CTC training programs.

Original languageEnglish (US)
Pages (from-to)750-756
Number of pages7
JournalAcademic Radiology
Volume11
Issue number7
DOIs
StatePublished - Jul 2004

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Tomography
Learning
Polyps
Neoplasms
Computed Tomographic Colonography
Radiologists
Teaching
Education
Datasets

Keywords

  • colon
  • colon neoplasms
  • Colonoscopy
  • computed tomography (CT)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Understanding interpretive errors in radiologists learning computed tomography colonography. / Fidler, Jeff L.; Fletcher, Joel Garland; Johnson, C. Daniel; Huprich, James E.; Barlow, John M.; Earnest IV, Franklin; Bartholmai, Brian Jack.

In: Academic Radiology, Vol. 11, No. 7, 07.2004, p. 750-756.

Research output: Contribution to journalArticle

Fidler, Jeff L. ; Fletcher, Joel Garland ; Johnson, C. Daniel ; Huprich, James E. ; Barlow, John M. ; Earnest IV, Franklin ; Bartholmai, Brian Jack. / Understanding interpretive errors in radiologists learning computed tomography colonography. In: Academic Radiology. 2004 ; Vol. 11, No. 7. pp. 750-756.
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abstract = "Rationale and objectives To determine if interpretive errors in the course of learning CT colonography are secondary to failures in detection or in characterization and determine the types of lesions frequently missed. Materials and methods Fifteen radiologists completed an electronic CTC training module consisting of two parts: 1) a teaching file demonstrating the varied appearances of polyps, cancers, and pitfalls in interpreting exams; and 2) a test of 50 complete CTC datasets. Following review of each test case, radiologists were asked to indicate if and where a polyp was visualized. The module then showed each neoplasm (if any) located within the dataset. For false negative examinations, radiologists indicated if the lesion was not seen, was seen but interpreted as colonic wall or fold, or was seen but interpreted as stool or fluid. Results The average sensitivity for sessile, pedunculated, and flat polyps for these novice readers was 76{\%}, 63{\%}, and 32{\%}, respectively. Average sensitivity for all morphologies of cancers (annular, polypoid, flat) was high (93{\%}, 85{\%}, 95{\%}), with 8/11 missed cancers being secondary to failure in detection. The most frequently missed cancer was an annular constricting tumor (5/11). Overall, 55{\%} (73/132) of errors were failures of detection and 45{\%} (59/132) were errors in characterization. Conclusion Radiologists learning CT colonography had slightly more errors of detection than characterization, but this difference was not statistically significant. Flat and pedunculated polyps and annular constricting cancers were the most frequently missed morphologies. Examples of these abnormalities should be emphasized in CTC training programs.",
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