Fellows learning coronary CTA come up to speed slowly

Physicians who are experienced in performing multislice coronary CT angiography can diagnose better, but acquiring the expertise is a time-consuming effort.

Researchers from the Netherlands conducted a study to evaluate the effect of experience with coronary CTA, which is becoming a practical alternative to conventional angiography, on the ability to detect more than 50% of coronary stenoses.

The study involved three radiologists and one cardiologist who were inexperienced with the technique. They attended an MSCT unit for a one-year fellowship and interpreted 12 to 15 coronary CTA scans weekly.

The same cases were also interpreted by two experts.

To assess their progress in diagnostic performance, the fellows interpreted 50 coronary CTA test cases as beginners, after two months and six months of study, and at the end of the yearlong fellowship.

After six months, the fellows' sensitivity ranged from 59% to 79%, specificity ranged from 73% to 83%, and the diagnostic odds ratio ranged from six to 12. After one year, their sensitivity ranged from 66% to 75%, specificity from 87% to 92%, and diagnostic odds ratio from 15 to 26. The sensitivity of the expert physicians was 95%, specificity was 93%, and the diagnostic odds ratio was 256.

The researchers concluded that training and acquisition of clinical competence may take more than a year.

Another study from Israel revealed, not surprisingly, that residents who are on call feel less stressed when an experienced radiologist is available to help with difficult cases. The study, done to determine the effects of international teleradiology attending radiologist coverage on residency training, included 61 residents at six institutions.

Such coverage, whether provided by staff radiologists or outsourced to teleradiology groups, improves the educational experience of residency training.

Residents said that talking immediately by telephone to an experienced radiologist allows critical discussions that are better than simply reviewing the case the next day. Others commented that it's always helpful to discuss equivocal findings on a case.