Are radiology trainees adequately educated on imaging appropriateness, safety?

In order to provide high-quality care to patients, physician trainees should possess a working knowledge of appropriate imaging use, radiation dose and safety. 

However, research published in the January 2019 issue of Current Problems in Diagnostic Radiology demonstrated half of trainees lack basic information in order to provide quality diagnostic imaging and patient care.  

“In our series of surveys of post-graduate physician trainees across a variety of specialties in a large academic health system, we found that most trainees report regularly requesting diagnostic imaging examinations for their patients,” wrote lead author Thaddeus D. Hollingsworth, MD, a radiologist at Emory University School of Medicine in Atlanta, and colleagues. “However, considerable knowledge gaps among trainees exist in several important areas that should be considered when selecting and requesting these examinations.” 

The researchers sent three online surveys about contrast material safety, imaging appropriateness and radiation dose to all trainees enrolled in Accreditation Council for Graduate Medical Education-accredited internships, residencies and fellowships at Emory University School of Medicine from January 2016 through January 2017. 

Overall, 72 percent (509 of 706) of survey respondents reported regularly ordering diagnostic imaging exams. However, roughly half reported they had not heard of American College of Radiology Appropriateness Criteria and only nine percent reported regular use of it, according to the researchers.  

Two-thirds of trainees (325 of 488) incorrectly chose imaging exams in scenarios involving pregnant patients. Additionally, nearly one-third of trainees did not understand that an MRI magnetic field remains on even when a scanner is not in use, according to the researchers.  

Overall, roughly 75 percent of trainees agreed that more training about appropriate imaging, radiation safety and MRI and contrast material safety is needed for better patient care and to narrow knowledge gaps.

“Selection of appropriate diagnostic imaging examinations is a critical step in the diagnostic pathway, however, trainees demonstrate widely variable knowledge of appropriate imaging, particularly pertaining to imaging pregnant patients,” Hollingsworth et al. wrote. “Given that less than 10 percent of trainees currently report regular use of ACR Appropriateness Criteria, embedded clinical decision support in the ordering process may be a useful way to improve patient care.”