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E2220. ER Call Primer for Residents: Review of Abdominal and Pelvic Discrepancies
Authors
  1. Mark Rupasinghe; University of California Irvine Department of Radiological Sciences
  2. Thanh-Lan Bui; University of California Irvine Department of Radiological Sciences
  3. William Grant; University of California Irvine Department of Radiological Sciences
  4. Hanna Liu; University of California Irvine Department of Radiological Sciences
  5. Justin Glavis-Bloom; University of California Irvine Department of Radiological Sciences
  6. Roozbeh Houshyar; University of California Irvine Department of Radiological Sciences
  7. Maryam Golshan-Momeni; University of California Irvine Department of Radiological Sciences
Background
Imaging of the abdomen and pelvis is extremely common in the emergency setting. Generally, diagnostic error rates range from 3-5%, and this can be elevated in emergent settings or with a resident on call. Most errors on the reading side are due to under-reading, where a finding is present on the image but is missed by the reader. Errors in interpretation of diagnostic radiology cases can be classified by the location of the finding (e.g. solid organ, hollow viscus, vascular, etc.), or by etiology of the mistake (e.g. failure of search pattern, satisfaction of search, mimickers, etc.). Errors in interpretation of emergency department (ED) cases may lead to delays in care, patient morbidity and mortality, and increased cost of medical care. We provide a case-based primer highlighting often missed ED radiology pathology in the abdomen and pelvis from a level 1 trauma center. We aim to prepare residents for their on-call experiences by reviewing ED cases with discrepancies and discussing the key findings, techniques, and error types for each.

Educational Goals / Teaching Points
We provide a review of frequently missed radiology findings of ED pathology in the abdomen and pelvis including common and uncommon cases. We present the patient history, review key imaging findings and location of the miss, and classify the error type to provide a primer for residents to avoid common mistakes during call.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Prior studies have found that resident discrepancy rates are highest in magnetic resonance imaging (MRI) and computed tomography (CT) and lowest in ultrasound. We accordingly focus on MRI and CT discrepancies.

Conclusion
Interpretation of emergent diagnostic radiology exams is a challenging experience for residents. However, residents can be better prepared by reviewing often missed pathology in the abdomen and pelvis, knowing key imaging hallmarks, localizing findings, and understanding error types.