ARRS 2022 Abstracts


E1582. Accuracy in Diagnosis of Pneumonia on Pediatric Chest Radiographs: A Comparison Among Radiologists With Varying Levels of Experience
  1. Peter Hoeksema; Henry Ford Health System
  2. Lisa Betz; Cincinnati Children’s Hospital Medical Center
  3. Alanna Van Hooser; Henry Ford Health System
  4. Gauravi Sabharwal; Henry Ford Health System
  5. Denise Collins; Henry Ford Health System
  6. Karyn Ledbetter; Henry Ford Health System
Small airways disease (SAD) is a common pathology seen in pediatric patients. In suspected cases of SAD/RSV/bronchiolitis, chest radiographs may be ordered to diagnose disease but are more commonly performed to rule out other conditions, such as bacterial pneumonia. SAD and pneumonia have unique radiographic features, so the threshold to diagnose such findings may depend on radiologist experience and training background. The purpose of this study is to investigate differences in accuracy when diagnosing bacterial pneumonia on pediatric chest radiography between radiologists with varying levels of experience.

Materials and Methods:
An IRB-approved retrospective review was performed of all stat pediatric chest radiographs performed in patients aged 6 months to 6 years over a 1-year period. Three pediatric radiologists at different stages of their careers (early, mid, and late career), and two resident radiologists at different stages (junior and senior) assigned a diagnosis of normal, SAD, or pneumonia to each of 100 randomly selected qualifying cases, 24 of which were pneumonia cases. Accuracy was then assessed.

The junior resident radiologist and senior resident radiologist correctly identified pneumonia in 13% and 42% of cases, respectively. The early, mid, and late-career pediatric radiologists correctly identified pneumonia in 75%, 67%, and 58%, respectively. The junior resident diagnosed “SAD” in 76% and “normal” in 24% of their missed pneumonia cases, the senior resident diagnosed SAD in 79% and normal in 21% of their missed cases, and the early-career pediatric radiologist diagnosed SAD in 67% and normal in 33% of their missed cases. Both the mid-career and late-career pediatric radiologists diagnosed SAD in 100% of their missed cases and never incorrectly labeled a pneumonia case as normal.

Our findings demonstrate that accuracy in diagnosing pneumonia in pediatric chest radiographs trends upward as the radiologist continued further in training up until early-career. However, there was no significant difference in accurately diagnosing pneumonia between pediatric radiologists of different experience levels. Furthermore, cases that were not correctly labeled as pneumonia were often called “SAD,” and radiologists in their mid-to-late career were less likely to incorrectly call pneumonia “normal.”