Appropriately trained radiology residents on-call can accurately read emergency head CT studies and determine if a patient has had a stroke and is a potential candidate for thrombolytic therapy, a new study shows. There is a short window of time that thrombolytic therapy can be administered, so accurate and timely reading of the CT scans is critical.
Radiology residents taking in-house call are often the logical choice for providing the best on-site expertise in reading time-sensitive head CT scans in many teaching hospitals, whose initial interpretation is later confirmed by an attending radiologist, said Linda Tang, MD, a resident at Santa Clara Valley Medical Center in San Jose, CA, and the lead author of the study. The study compared the residents' interpretation of 1,113 urgent head scans to attending physicians' diagnoses for the same scans, said Dr. Tang. In 97% of the cases, the attending physicians and the residents were in complete agreement, she said. There were 33 discrepant cases, only two of which had the potential for an immediate change in the patient's treatment. Neither of the two patients would have been candidates for thrombolytic therapy, said Dr. Tang. The junior residents had a 3.43% discrepancy rate compared to the senior residents' 2.17% discrepancy rate. The study shows that "appropriately trained radiology residents can reliably provide timely interpretation of head CT scans for initial triaging of acute stroke patients for potential thrombolytic therapy," Dr. Tang said.
"The result of this study corroborated the idea that wet readings by residents is an efficient method for triaging potential tPA candidates after hours and it has affected the protocol and practice at our hospital," she said. She added that the radiology residents at her facility must undergo certification prior to taking call. This includes one month of neuroradiology training, one month emergency room rotation, two weeks of MR training and one hour neuroradiology conferences every week, as well as focused and individualized training.
Dr. Tang will present the study on May 19 at the American Roentgen Ray Society Annual Meeting in New Orleans. She was mentored by Mahesh Patel, MD, for the study.
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