E2164. Resident Interpretation of Thoracic Emergencies Using Computed Tomography (CT): A Simulation Study
  1. Andrew Blum; University of Florida College of Medicine
  2. Priya Sharma; University of Florida College of Medicine
  3. Dhanashree Rajderkar; University of Florida College of Medicine
  4. Roberta Slater; University of Florida College of Medicine
  5. Christopher Sistrom; University of Florida College of Medicine
  6. Anthony Mancuso; University of Florida College of Medicine
Patients with life threatening thoracic emergencies frequently undergo CT. The on-call resident needs to be able to correctly interpret imaging findings as a crucial piece of the care team. The purpose of this study is to identify how well residents diagnose thoracic emergencies using a simulated emergency radiology call shift.

Materials and Methods:
The Wisdom in Diagnostic Imaging SIMulation is a strategically designed computer aided simulation of an emergency imaging shift that has been rigorously tested and proven to be a reliable means for assessing resident preparedness to competently and independently cover radiology call. Residents are shown 65 cases over 8 hours across modalities and subspecialties. Cases vary in difficulty, and include normal exams. Free text interpretations are scored by faculty using a 10-point scale. Scores below 3 are unacceptable. CTs were presented to test four emergent diagnoses: bronchial transection, pulmonary emboli, septic emboli, and ventricular perforation by pacemaker lead. Also included was a normal CT, and the residents’ ability to call a true negative study was assessed.

From 2012-20, 1019 residents in all levels of training, from 46 programs, were evaluated. Across all modalities and subspecialties, mean score was 6.02, with 26% of all responses given an unsatisfactory score. Mean score increased, as residents progressed through training. 320 residents given bronchial disruption had a mean score of 6.57. Only 4% were unsatisfactory. There were no significant differences in scores at any level. 195 residents interpreted a case of pulmonary embolism. Mean score was 7.06. 4% were unsatisfactory, all at the R1 level. As a group, there was no significant variation in mean score. 194 residents saw the case of septic emboli. Mean score was 7.39. No interpretations were unsatisfactory. Mean increased each from year to year, from R1 mean of 7.09 to R4 mean of 8.70. 242 residents interpreted a case of ventricular perforation. Mean score was 7.42. 27% were unsatisfactory, the majority of which were in R1. 241 residents interpreted a normal exam. The average score was 9.59 with only 4% unsatisfactory, all within R1 and R2. All R3 and R4 responses received a perfect score.

CT is the preferred modality for the evaluation of acute thoracic emergencies. The on-call resident encounters a wide variety of pathology that could be life threatening. Proper diagnosis of thoracic emergencies is of critical importance for the on-call resident. Residents perform well in the diagnosis of thoracic emergencies, as shown by the four abnormal and one normal case given. There was a high accuracy in correctly calling a normal CT. As the duration in the residency training increases, fewer misinterpretations are made on relatively common thoracic emergencies encountered on both the adult and pediatric patients.