Assessing the accuracy and certainty in interpreting chest X-rays in the medical division

Abstract

The chest X-ray (CXR) is an important diagnostic tool in diagnosing and monitoring a spectrum of diseases. Despite our universal reliance on the CXR, our ability to confidently diagnose and accurately document our findings can be unreliable. We sought to assess the diagnostic accuracy and certainty of making a diagnosis based on 10 short clinical histories with one CXR each. We conclude from our study that specialist registrars (StRs) and consultants scored the highest marks with the highest average certainty levels. Junior trainees felt least certain about making their diagnosis and were less likely to be correct. We recommend that StRs and consultants review all the CXRs requested to ensure accuracy of diagnosis. There also needs to be discussion with the Joint Royal Colleges of Physicians Training Board (JRCPTB) about the need of including a separate CXR competency as part of a trainee's generic curriculum on the e-portfolio, something which is currently lacking.

Keywords: Chest X-ray; education; radiology; reporting; training.

Fig 1.

Comparison of average scores from CXR quiz across grades with 95% confidence intervals. CMT = core medical trainee; CXR = chest X-ray; FY = foundation year; GPST = general practitioner trainee; StR = specialist registrar.

Fig 2.

Left lower lobe collapse.

Fig 3.

Comparison of diagnostic accuracy with certainty for each CXR diagnosis averaged across all grades. B/L = bilateral; CCF = congestive heart failure; CMT = core medical trainee; CXR = chest X-ray; FY = foundation year; GPST = general practitioner trainee; LLL = lower left lobe; RLL = right lower lobe; StR = specialist registrar; TB = tuberculosis.