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A structured training program significantly improved the reliability of Radiographic Assessment of Lung Edema (RALE) scoring for pulmonary edema on chest radiographs. Expert feedback further enhanced consistency among clinicians of all experience levels.

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Area of Science:

  • Medical Imaging
  • Pulmonary Medicine
  • Clinical Education

Background:

  • Quantifying pulmonary edema on chest radiographs is difficult for clinicians.
  • The Radiographic Assessment of Lung Edema (RALE) score offers a structured approach but lacks standardized training.
  • This limits its clinical application and prognostic use in acute respiratory failure (ARF).

Purpose of the Study:

  • To evaluate if a standardized RALE training program with expert feedback improves inter-rater reliability.
  • To assess the impact of training across different levels of clinician experience.

Main Methods:

  • 16 physicians (interns to attendings) underwent a 3-phase RALE training program.
  • Training included self-study, a virtual session, and iterative expert feedback via the Pulmo-Annotator platform.
  • Inter-rater reliability was measured using ICC, Bland-Altman, and Deming regression.

Main Results:

  • Inter-rater reliability (ICC) improved from 0.89 to 0.93 post-training, further increasing to 0.93 after expert feedback.
  • Fellows showed the greatest ICC improvement (0.89 to 0.97).
  • Training reduced systematic bias, though residents showed more variability.

Conclusions:

  • Structured RALE training with expert feedback significantly enhances inter-rater reliability for pulmonary edema assessment.
  • RALE scoring is teachable across experience levels and can be integrated into curricula.
  • This training improves consistency in chest radiograph interpretation for ARF.