E4515. Radiology Resident Competency in Detecting Pancreatic Lacerations: A Simulation-Based Assessment
  1. Anjali Patel; University of Florida College of Medicine
  2. Abheek Raviprasad; University of Florida College of Medicine
  3. Kevin Pierre; University of Florida College of Medicine
  4. Priya Sharma; University of Florida College of Medicine
  5. Roberta Slater; University of Florida College of Medicine
  6. Christopher Sistrom; University of Florida College of Medicine
  7. Anthony Mancuso; University of Florida College of Medicine
Pancreatic lacerations are traumatic injuries that can be challenging to diagnose, especially in the context of multiorgan trauma from blunt abdominal injuries. The subtle changes associated with these injuries can easily be overlooked or misinterpreted. Correctly identifying pancreatic lacerations is important. Although many can be managed conservatively, significant lacerations, especially those involving the main pancreatic duct or major blood vessels, might require surgical intervention. Conversely, an improperly characterized diagnosis can lead to unnecessary surgery and increase risk of long-term pancreatic insufficiency. A delayed or missed diagnosis can lead to severe complications, including peritonitis and abscess formation. Our study aims to evaluate the competency of radiology residents in recognizing pancreatic lacerations on imaging within a simulated call-shift scenario.

Materials and Methods:
Competency was tested via simulated on-call scenarios using the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM). This reliable, tested computer-aided emergency imaging simulation was designed to gauge the readiness of radiology residents to cover independent on-call duties. The simulation comprised 65 cases of varying complexity, including normal studies, with one case specifically targeting pancreatic lacerations. Faculty members manually scored the residents' free-text responses using a grading rubric, and classified errors by type.

A total of 197 radiology residents who encountered contrasted abdominal CT images of pediatric pancreatic lacerations were included. Irrespective of years in training, pancreatic lacerations were consistently underdiagnosed, with a median score of 0/10 and an average score of 1.57/10. The average number of points lost due to observational errors (unrecognized imaging findings) was 7.82 out of 10, whereas interpretive errors (misdiagnosis) accounted for an average loss of 0.45 points. An effective report (scores between 7 and 10) was produced by 17% of residents. Conversely, 83% of residents produced reports with critical errors (scores between 0 and 2). A subsequent simulation, featuring a similar case and 321 radiology residents, revealed similar challenges, with only 21% of residents producing effective quality reports and 79% producing reports with critical errors. The average score was 2.69. The third simulation involved 316 residents. The average score only slightly improved to 3.15/10. The number of effective reports was 10%, and the number of reports that produced critical errors was 43%.

These findings identify a potential deficiency in radiology residency programs' training in accurately identifying pancreatic lacerations, suggesting a need for additional targeted instruction in this area.