ArticleEmergency radiology2025
Diagnostic performance of radiology residents versus attending radiologists in detecting retained surgical items: a pilot study.
Article in Emergency radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo compare the diagnostic performance of radiology residents and attending radiologists in detecting retained surgical items (RSIs) on intraoperative radiographs.
methodsIn this pilot study, 100 de-identified intraoperative radiographic cases (18 positive for RSIs, 82 negative) were reviewed. For each case, upper-level radiology resident (PGY-3 to PGY-5) and attending radiologist participants recorded the presence or absence of an RSI, their confidence on a three-point scale, and their decision time. We compared accuracy, sensitivity, specificity, confidence, and interpretation time between the two groups. We fit a multivariable logistic regression (fixed-effects GLM) to identify predictors of a correct interpretation, followed by a mixed-effects logistic regression (GLMM) with random intercepts for reader and case to account for clustering.
resultsA total of 1,178 interpretations were analyzed (619 from residents, 559 from attendings). There was no significant difference in diagnostic accuracy between residents (94.2%) and attendings (94.3%) (Fisher's exact p = 0.84 for accuracy, 0.82 for sensitivity, and 0.74 for specificity). Attendings were slightly faster (median time 16.4s vs. 18.8s; p = 0.0038) and reported higher confidence (mean 2.65 vs. 2.52; p < 0.001). In the fixed-effects GLM, participant type was not associated with accuracy (resident vs. attending AOR 0.92, 95% CI 0.52-1.59, p = 0.76). Compared with 'unsure,' being 'somewhat confident' (AOR 9.75, 95% CI 4.72-20.4) and 'very confident' (AOR 20.9, 95% CI 9.71-46.4) markedly increased the odds of a correct interpretation (both p < 0.001). Longer response times were associated with lower odds of correctness (AOR 0.66, 95% CI 0.46-0.94, p = 0.020). Aside from non-significant associations with response time and foreign-body type, findings were otherwise consistent in the mixed-effects model.
conclusionUpper-level radiology residents demonstrate diagnostic accuracy for detecting retained surgical items that is statistically indistinguishable from that of attending radiologists. These preliminary findings suggest that a resident-led preliminary interpretation model for RSI studies at the point of service is a feasible and potentially efficient approach that would not compromise patient safety.
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