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. 2025 Jul 1;25(1):246.
doi: 10.1186/s12880-025-01781-3.

Incidence and predictors of discrepancies in radiology resident interpretations of coronary CT in the emergency department

Na Young Kim  1 , Ji Hoon Kim  2   3 , Young Joo Suh  4
Affiliations

Incidence and predictors of discrepancies in radiology resident interpretations of coronary CT in the emergency department

Na Young Kim et al. BMC Med Imaging. .

Abstract

Background: Discrepancies between preliminary reports by on-call radiology residents and final reports of coronary computed tomography angiography (CCTA) in the emergency department (ED) have not been thoroughly investigated.

Methods: We conducted a retrospective quality assurance analysis of CCTA examinations performed during off-hours in a level-1 ED at a tertiary teaching hospital between March 2020 and April 2022. Discrepancies in identifying significant coronary artery disease (≥ 50% stenosis) between preliminary reports by on-call residents and final reports by board-certified cardiac radiologists were evaluated.

Results: Among the 766 patient visits (median age, 59 years [interquartile range, 47-70]; 415 men), 82 cases (10.7%) showed discrepancies. Univariable logistic regression analyses identified HEART score, day of ED visit, ED crowding index, and coronary artery calcium (CAC) score as significant factors associated with discrepancies. Multivariable analysis revealed that an ED crowding index < 40 (adjusted odds ratio = 2.06; P = 0.005), and positive CAC scores were independently associated with increased discrepancies (adjusted odds ratio = 4.56 for scores > 0 and ≤ 100, P < 0.001; 4.79 for scores > 100 and ≤ 400, P < 0.001; 3.69 for scores > 400, P = 0.002). The rate of unnecessary invasive coronary angiography was significantly higher in the discrepancy group (80.0%, 12 of 15) compared to the agreement group (14.4%, 16 of 111) (P < 0.05).

Conclusions: A substantial discrepancy rate was observed between preliminary and final CCTA interpretations in the ED. A lower ED crowding index and positive CAC scores were independently associated with an increased risk of discrepancies.

Keywords: Acute chest pain; Coronary computed tomography angiography; Discrepancy; Emergency department; Radiology resident.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. The institutional review board of Severance Hospital approved this study and waived the requirement for informed consent (IRB 4-2023-0702). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cases of discrepancy
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of the multivariable logistic regression model for predicting discrepancies between preliminary and final coronary CT angiography interpretations
Fig. 3
Fig. 3
Patient flowchart of ICA procedures and outcomes
See this image and copyright information in PMC

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