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Physician competency is a critical
factor in the overall quality of medical diagnostics and accuracy of
interpretation is the key determinant of their competency.1 The
process of quality assurance in the practice of radiology is important to
ensure high-level patient care and is rapidly recognized at the institutional
levels. From a quality assurance point of view, the report should be the true
right one and discrepancies and errors must be minimized.2   Understanding the baseline discrepancy rate
for interpretation of an imaging examination is necessary for monitoring of
radiologist skills.3 Discrepant reports between initial and
subsequent radiologist interpretations can be due to a variety of factors
including inadequate clinical information, poor imaging technique, perceptual
errors and communication errors.4 
There is no consensus on a standard method or protocol for evaluating
errors and discrepancies in imaging reports.5  Multiple variations in study parameters
including sampling sources, methods, imaging modalities, specialties,
categories, interpreter training levels and degrees of blinding may have contributed
to this wide spectrum.2

            Computerized
(or computed) tomography, and often formerly referred to as computerized axial
tomography (CAT) scan, is an X-ray procedure that combines many X-ray images
with the aid of a computer to generate cross-sectional views and, if needed,
three-dimensional images of the internal organs and structures of the body.
Computerized tomography is more commonly known by its abbreviated names, CT
scan or CAT scan. A CT scan is used to define normal and abnormal structures in
the body and/or assist in procedures by helping to accurately guide the
placement of instruments or treatments. A large donut-shaped X-ray machine or
scanner takes X-ray images at many different angles around the body. These
images are processed by a computer to produce cross-sectional pictures of the
body. In each of these pictures the body is seen as an X-ray “slice”
of the body, which is recorded on a film. This recorded image is called a
tomogram. “Computerized axial tomography” refers to the recorded
tomogram “sections” at different levels of the body.3

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            In recent years, the CT scan has
become the diagnostic modality of choice for many clinical situations and is
readily available even in smaller centers with no on-site radiologists. Head CT
scan study is one of the common investigations which usually need to be
interpreted by emergency doctors and management plans are initiated before the
formal radiologist’s interpretation becomes available.6  While accuracy of interpretation of brain CT
scan by emergency physicians is of crucial importance, many EM residency
programs do not allocate enough time to brain CT scan interpretation training.7
Zan et al sampled 4534 neuroradiology cases with an outside report for
comparison and found that 347 (7.7%) had clinically significant discrepancies
between the outside study and the interpretation of subspecialty-trained
neuroradiologists.8  Babiarz
and Yousem performed a study in which 1000 studies were internally reviewed and
they found a significant discrepancy rate of 2.0% among subspecialty-trained neuroradiologists
at a major university hospital.2 Viertel VG et al concluded that
there was a 1.8% rate of clinically significant detection or interpretation
discrepancy among academic neuroradiologists.9  In a recently published work done by Guérin G
et al found that the inter-observer agreement regarding head CT studies with
positive and negative results for clinically pertinent findings was 0.86
(0.77–0.95) but concordance was only 75.6% (67.2%–82.5%).10  

            The rationale of our study was to
determine the discrepancy rate and inter-observer agreement in reporting the CT
Scan of Head in our setting. This will help us in identifying the areas which
needs to be improved in the training of radiologists to minimize the errors in
reporting. This would eventually be helpful for the better management of these
patients.

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