Discrepancy Rates in Chest X-Ray Interpretation by Radiology Residents: A Retrospective Performance Audit
DOI:
https://doi.org/10.52206/jsmc.2026.16.1.1291Abstract
Background: Chest radiography is a cornerstone of diagnostic imaging and plays a critical role in the evaluation of respiratory, cardiac, and traumatic conditions. Accurate and timely interpretation of chest X-rays is essential, as reporting errors can directly influence clinical decision-making, treatment initiation, and patient outcomes. Interpretation variability is well recognized in radiology practice and may arise from perceptual errors, misinterpretation, or limited clinical experience. In many academic institutions, preliminary interpretations during on-call hours are provided by radiology residents, making assessment of their diagnostic performance an important component of quality assurance.
Objective: To evaluate the discrepancy rate between preliminary chest radiograph interpretations by radiology residents and final reports issued by attending radiologists, with particular focus on key thoracic and pediatric findings.
Methodology: This retrospective study reviewed chest radiographs (anteroposterior and posteroanterior views) interpreted by radiology residents during on-call hours at Rehman Medical Institute, Peshawar, from June 1, 2022, to June 30, 2024. Resident preliminary reports were compared with attending radiologist final reports. Discrepancies were categorized as major, minor, or none based on clinical significance. Interobserver agreement was assessed using Cohen’s kappa (κ) statistics.
Results: A total of 552 chest radiographs were analyzed, including 285 studies reported by junior residents (1st–2nd year) and 267 by senior residents (3rd–4th year). Discrepancy rates varied across diagnostic categories, ranging from 5% to 32%, with higher discrepancy rates observed among junior residents. Cohen’s kappa values ranged from 0.22 (fair agreement) to 0.58 (moderate agreement), with consistently better agreement demonstrated by senior residents.
Conclusion: Radiology residents showed high concordance with attending radiologists for major findings such as pneumothorax, consolidation, and cardiomegaly. However, discrepancies were more frequent for subtle findings and pediatric conditions, including transient tachypnea of the newborn, meconium aspiration, and cardiac anomalies. These findings highlight the need for targeted educational interventions and continuous performance monitoring to enhance diagnostic accuracy and patient safety.
Keywords: Chest Radiography, Diagnostic Discrepancy, Interobserver Agreement, Quality Assurance, Radiology Residency Training.
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