JACR: Pediatric imaging ordering by rad residents shows need for education
To improve pediatric residents' ability to make decisions regarding imaging exams, radiologists must educate the residents with uniform case-based and didactic sessions, as each decision made by a resident reflects individual training, said an article published in the May edition of the Journal of the American College of Radiology.

David A. Hirschl, MD, from the department of radiology at Albert Einstein College of Medicine at Montefiore Medical Center in the Bronx, N.Y., and colleagues created a study to compare the imaging ordering practices of pediatric residents in specific clinical scenarios with the ACR Appropriateness Criteria-developed to ensure that patients are receiving appropriate imaging studies.

Utilizing a multiple-choice questionnaire consisting of 10 clinical scenarios excerpted from the ACR Appropriateness Criteria, the questionnaires were administered to 69 pediatric residents (ranging postgraduate years from one to three years) at Children's Hospital of New York at Columbia University Medical Center (CHONY) and to 75 pediatric residents at the Children's Hospital at Montefiore Medical Center (CHAM). According to the researchers, for each of the 10 scenarios, five possible answer choices were listed, including four possible diagnostic imaging examinations and a choice of no imaging at all.

After receiving feedback from 39 individuals from CHAM and 41 responses from CHONY, Hirschl and colleagues compared the answers from the 27 first-year residents, 28 second-year residents and 25 third-year residents with the ACR Appropriateness Criteria.

The researchers found that the average number of questions answered incorrectly by first-year residents was 4.1, by second-year residents, 4.4 and by third-year residents, 4.5. Noting the importance of this finding, the authors wrote, “We found that pediatric residents' ability to choose the first appropriate diagnostic imaging test did not improve as the level of training increased. A similar study performed with medical house staff showed the opposite trend.” 

Hirschl and colleagues attributed this finding to pediatric residents not referring to the ACR Appropriateness Criteria when making clinical decisions, due to a possible “lack of knowledge of their existence, difficulty with the user interface or the use of alternative diagnostic algorithms available online."

“There are several possible reasons that may explain the lack of improvement with increased training,” the authors wrote. “It is likely that as radiologists, it is incumbent on us to continue to foster an environment of continued education and collaborative thinking. We must provide clinical residents with uniform didactic and case-based instruction that illustrates the benefits and limitations of diagnostic imaging.”

The article concluded that although important to emphasize the risk of radiation for modalities such as CT, the benefits must not be overlooked.