Research reveals ‘remarkable gap’ in x-ray interpretation skills between primary care physicians, radiologists

Family medicine residents have trouble accurately diagnosing common emergency conditions on chest x-rays compared to radiologists-in-training, according to survey results shared recently.

In fact, responses from more than 200 physicians revealed family medicine practitioners were more than 30 percentage points less accurate than radiologists. Researchers from the Eastern Province of Saudi Arabia believe these front-line doctors need assistance, during both medical school and clinical practice, they explained in a BMC Family Practice study shared with Health Imaging.

“The findings were rather striking,” Ali Hassan, MD, with the Department of Radiology in Salmaniya Medical Complex in Manama, Bahrain, told Health Imaging over email. “The study should ring a bell on the importance of incorporating radiology courses for all residency trainees, regardless of their specialties, to ensure they become competent in diagnosing radiographs of emergency conditions,” he explained, adding that practices should also provide constant access to radiologists.

Chest x-ray is a critical diagnostic tool and a typical first-line imaging choice for urgent cases. But many primary healthcare organizations don’t have immediate access to imaging professionals, forcing family physicians to rely on their own skill set.

To investigate this problem further, the researchers sent electronic surveys to 600 physicians, receiving 205 responses over a two-week period. Most were medical interns, while 36.1% and 10.2% were family medicine and diagnostic radiology residents, respectively.

Respondents were presented with a series of 10 cases, including a short clinical vignette and corresponding chest x-ray. They were then asked to diagnose the condition via multiple-choice options and rate their diagnostic confidence on a 5-point scale.

The entire group achieved a diagnostic accuracy of 63.1%, with a “remarkable gap” between family medicine residents’ 58% mark and radiology residents’ 90.5% accuracy, the authors found. Multivariable regression showed that being a radiology resident and having higher diagnostic confidence were both independent predictors of accuracy.

The researchers pointed out that family med providers were least accurate at interpreting left lower-lob pneumonia cases, the most frequent indication for ordering chest x-rays in general practice. Hassan et al. went on to explain, however, that every case was something “all physicians should be able to recognize.”

A majority of participants completed the survey tasks on their cellphones, which may have limited the results.

Overall, the team underscored that every specialty should be proficient in reading chest x-rays, particularly given the COVID-19 pandemic, which has shown medical staff may be needed in the emergency department on short notice.