Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy: training readers to improve diagnostic accuracy

Marjolein M N Leeuwenburgh; Bart M Wiarda; Shandra Bipat; C Yung Nio; Thomas L Bollen; J Joost Kardux; Sebastiaan Jensch; Patrick M M Bossuyt; Marja A Boermeester; Jaap Stoker

doi:10.1148/radiol.120111896

Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy: training readers to improve diagnostic accuracy

Marjolein M N Leeuwenburgh, Bart M Wiarda, Shandra Bipat, C Yung Nio, Thomas L Bollen, J Joost Kardux, Sebastiaan Jensch, Patrick M M Bossuyt, Marja A Boermeester, Jaap Stoker

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: To determine if training with direct feedback helps to improve the diagnostic performance of inexperienced readers in the detection of appendicitis on magnetic resonance (MR) images.

MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. Nine radiologists and eight residents without experience in evaluating MR images for acute abdominal conditions evaluated a training set of images from 100 MR imaging examinations of patients suspected of having appendicitis and received direct feedback after each evaluation. An expert panel made a diagnosis of appendicitis in 45 patients and an alternative diagnosis in 55 patients on the basis of histopathologic examination and follow-up. Readers recorded two diagnoses: the first after viewing images from conventional MR sequences (half-Fourier rapid acquisition with relaxation enhancement and true fast imaging with steady-state precession) and the second after viewing diffusion-weighted (DW) MR images. Reader sensitivity and specificity were calculated per set of 25 cases.

RESULTS: The average reader sensitivity for detecting appendicitis improved significantly after training (0.82 vs 0.92, P = .003); the average specificity improved nonsignificantly (0.82 vs 0.88, P = .10). Sensitivity for radiologists increased from 0.81 in the first set of 25 cases to 0.91 in the last set, and specificity improved from 0.82 to 0.85. For residents, sensitivity increased from 0.82 to 0.94, and specificity increased from 0.82 to 0.91. Sensitivity improved from 0.80 to 0.87 (P < .001) in all readings combined when DW images were read in addition to conventional MR images.

CONCLUSION: Diagnostic accuracy of inexperienced readers in the evaluation of abdominal MR images for acute appendicitis improved after training with direct feedback, and the addition of DW images improved reader sensitivity.

Original language	English
Pages (from-to)	455-463
Number of pages	9
Journal	Radiology
Volume	264
Issue number	2
DOIs	https://doi.org/10.1148/radiol.120111896 https://doi.org/10.1148/radiol.12111896
Publication status	Published - Aug 2012

Keywords

Adolescent
Adult
Aged
Appendicitis/diagnosis
Child
Clinical Competence
Contrast Media
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging/methods
Male
Middle Aged
Pregnancy
Retrospective Studies
Sensitivity and Specificity

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Leeuwenburgh, M. M. N., Wiarda, B. M., Bipat, S., Nio, C. Y., Bollen, T. L., Kardux, J. J., Jensch, S., Bossuyt, P. M. M., Boermeester, M. A., & Stoker, J. (2012). Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy: training readers to improve diagnostic accuracy. Radiology, 264(2), 455-463. https://doi.org/10.1148/radiol.120111896, https://doi.org/10.1148/radiol.12111896

@article{fdb47be49241486c85a78f8ecd5ce4e6,

title = "Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy: training readers to improve diagnostic accuracy",

abstract = "PURPOSE: To determine if training with direct feedback helps to improve the diagnostic performance of inexperienced readers in the detection of appendicitis on magnetic resonance (MR) images.MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. Nine radiologists and eight residents without experience in evaluating MR images for acute abdominal conditions evaluated a training set of images from 100 MR imaging examinations of patients suspected of having appendicitis and received direct feedback after each evaluation. An expert panel made a diagnosis of appendicitis in 45 patients and an alternative diagnosis in 55 patients on the basis of histopathologic examination and follow-up. Readers recorded two diagnoses: the first after viewing images from conventional MR sequences (half-Fourier rapid acquisition with relaxation enhancement and true fast imaging with steady-state precession) and the second after viewing diffusion-weighted (DW) MR images. Reader sensitivity and specificity were calculated per set of 25 cases.RESULTS: The average reader sensitivity for detecting appendicitis improved significantly after training (0.82 vs 0.92, P = .003); the average specificity improved nonsignificantly (0.82 vs 0.88, P = .10). Sensitivity for radiologists increased from 0.81 in the first set of 25 cases to 0.91 in the last set, and specificity improved from 0.82 to 0.85. For residents, sensitivity increased from 0.82 to 0.94, and specificity increased from 0.82 to 0.91. Sensitivity improved from 0.80 to 0.87 (P < .001) in all readings combined when DW images were read in addition to conventional MR images.CONCLUSION: Diagnostic accuracy of inexperienced readers in the evaluation of abdominal MR images for acute appendicitis improved after training with direct feedback, and the addition of DW images improved reader sensitivity.",

keywords = "Adolescent, Adult, Aged, Appendicitis/diagnosis, Child, Clinical Competence, Contrast Media, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging/methods, Male, Middle Aged, Pregnancy, Retrospective Studies, Sensitivity and Specificity",

author = "Leeuwenburgh, {Marjolein M N} and Wiarda, {Bart M} and Shandra Bipat and Nio, {C Yung} and Bollen, {Thomas L} and Kardux, {J Joost} and Sebastiaan Jensch and Bossuyt, {Patrick M M} and Boermeester, {Marja A} and Jaap Stoker",

year = "2012",

month = aug,

doi = "10.1148/radiol.120111896",

language = "English",

volume = "264",

pages = "455--463",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "2",

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Leeuwenburgh, MMN, Wiarda, BM, Bipat, S , Nio, CY, Bollen, TL, Kardux, JJ, Jensch, S, Bossuyt, PMM, Boermeester, MA & Stoker, J 2012, 'Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy: training readers to improve diagnostic accuracy', Radiology, vol. 264, no. 2, pp. 455-463. https://doi.org/10.1148/radiol.120111896, https://doi.org/10.1148/radiol.12111896

TY - JOUR

T1 - Acute Appendicitis on Abdominal MR Images: Training Readers to Improve Diagnostic Accuracy

T2 - training readers to improve diagnostic accuracy

AU - Leeuwenburgh, Marjolein M N

AU - Wiarda, Bart M

AU - Bipat, Shandra

AU - Nio, C Yung

AU - Bollen, Thomas L

AU - Kardux, J Joost

AU - Jensch, Sebastiaan

AU - Bossuyt, Patrick M M

AU - Boermeester, Marja A

AU - Stoker, Jaap

PY - 2012/8

Y1 - 2012/8

N2 - PURPOSE: To determine if training with direct feedback helps to improve the diagnostic performance of inexperienced readers in the detection of appendicitis on magnetic resonance (MR) images.MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. Nine radiologists and eight residents without experience in evaluating MR images for acute abdominal conditions evaluated a training set of images from 100 MR imaging examinations of patients suspected of having appendicitis and received direct feedback after each evaluation. An expert panel made a diagnosis of appendicitis in 45 patients and an alternative diagnosis in 55 patients on the basis of histopathologic examination and follow-up. Readers recorded two diagnoses: the first after viewing images from conventional MR sequences (half-Fourier rapid acquisition with relaxation enhancement and true fast imaging with steady-state precession) and the second after viewing diffusion-weighted (DW) MR images. Reader sensitivity and specificity were calculated per set of 25 cases.RESULTS: The average reader sensitivity for detecting appendicitis improved significantly after training (0.82 vs 0.92, P = .003); the average specificity improved nonsignificantly (0.82 vs 0.88, P = .10). Sensitivity for radiologists increased from 0.81 in the first set of 25 cases to 0.91 in the last set, and specificity improved from 0.82 to 0.85. For residents, sensitivity increased from 0.82 to 0.94, and specificity increased from 0.82 to 0.91. Sensitivity improved from 0.80 to 0.87 (P < .001) in all readings combined when DW images were read in addition to conventional MR images.CONCLUSION: Diagnostic accuracy of inexperienced readers in the evaluation of abdominal MR images for acute appendicitis improved after training with direct feedback, and the addition of DW images improved reader sensitivity.

AB - PURPOSE: To determine if training with direct feedback helps to improve the diagnostic performance of inexperienced readers in the detection of appendicitis on magnetic resonance (MR) images.MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. Nine radiologists and eight residents without experience in evaluating MR images for acute abdominal conditions evaluated a training set of images from 100 MR imaging examinations of patients suspected of having appendicitis and received direct feedback after each evaluation. An expert panel made a diagnosis of appendicitis in 45 patients and an alternative diagnosis in 55 patients on the basis of histopathologic examination and follow-up. Readers recorded two diagnoses: the first after viewing images from conventional MR sequences (half-Fourier rapid acquisition with relaxation enhancement and true fast imaging with steady-state precession) and the second after viewing diffusion-weighted (DW) MR images. Reader sensitivity and specificity were calculated per set of 25 cases.RESULTS: The average reader sensitivity for detecting appendicitis improved significantly after training (0.82 vs 0.92, P = .003); the average specificity improved nonsignificantly (0.82 vs 0.88, P = .10). Sensitivity for radiologists increased from 0.81 in the first set of 25 cases to 0.91 in the last set, and specificity improved from 0.82 to 0.85. For residents, sensitivity increased from 0.82 to 0.94, and specificity increased from 0.82 to 0.91. Sensitivity improved from 0.80 to 0.87 (P < .001) in all readings combined when DW images were read in addition to conventional MR images.CONCLUSION: Diagnostic accuracy of inexperienced readers in the evaluation of abdominal MR images for acute appendicitis improved after training with direct feedback, and the addition of DW images improved reader sensitivity.

KW - Adolescent

KW - Adult

KW - Aged

KW - Appendicitis/diagnosis

KW - Child

KW - Clinical Competence

KW - Contrast Media

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Middle Aged

KW - Pregnancy

KW - Retrospective Studies

KW - Sensitivity and Specificity

U2 - 10.1148/radiol.120111896

DO - 10.1148/radiol.120111896

M3 - Article

C2 - 22700556

SN - 0033-8419

VL - 264

SP - 455

EP - 463

JO - Radiology

JF - Radiology

IS - 2

ER -