Josef Matthias Kerl MD, Presenter: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

U. Joseph Schoepf MD, Abstract Co-Author: Research Consultant, Bayer AG Research Grant, Bayer AG Research Consultant, Bracco Group Research Grant, Bracco Group Research Consultant, General Electric Company Research Grant, General Electric Company Research Consultant, Siemens AG Research Grant, Siemens AG

Ralf W. Bauer MD, Abstract Co-Author: Research Consultant, Siemens AG Speakers Bureau, Siemens AG

Philip Costello MD, Abstract Co-Author: Nothing to Disclose

Peter Zwerner MD, Abstract Co-Author: Nothing to Disclose

Christopher Herzog MD, Abstract Co-Author: Speakers Bureau Siemen AG

Thomas Josef Vogl MD, PhD, Abstract Co-Author: Nothing to Disclose

To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience.

This study was IRB approved and HIPAA compliant. Three radiologists with 8 years, 5 years, and 12 months of experience in reading CCTA, a first year radiology resident, and an interventional cardiologist without previous experience independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50%-74%, 75%-99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series. Diagnostic accuracy on a per-segment basis was compared for all readers and both case series, respectively.

Correlation coefficients between CCTA and catheter angiography initially ranged between good (r=0.87) and poor (r=0.26), depending on reader experience, and significantly (p<0.05) improved in the second case series (range: r=0.91 to r=0.51). Diagnostic accuracy was significantly (p<0.05) higher for readers with >12 months of experience (range: 97.8-96.5%) as compared to the inexperienced readers (range: 90.7-93.1%) and only slightly (p=0.26) increased in the second case series. However, PPV significantly (p<0.05) increased. For both inexperienced readers diagnostic accuracy (range: 95.6-95.9%) significantly (p<0.05) increased and equalized (p=0.04) in the second case series, but sensitivity and PPV still remained rather low (range: 62.7-66.1% / 78.0-84.1%).

The level of experience is the strongest determinant of proficiency in CCTA interpretation. Limited one-time training improves proficiency, but not to clinically satisfactory levels.

This study highlights the need for dedicated training in cardiac CT interpretation of a level and duration which exceeds currently proposed minimum requirements.

Kerl, J, Schoepf, U, Bauer, R, Costello, P, Zwerner, P, Herzog, C, Vogl, T, Influence of Observer Experience and Training on Proficiency in Cardiac CT Interpretation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026526.html