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Training physicians and health care providers to accurately read coronary arteriograms. A training program
R M Fleming1, D M Fleming, R Gaede
1Center for Clinical Cardiology & Research, Cedar Falls, Iowa, USA.
Insights
A standardized training program significantly improved the accuracy of interpreting coronary arteriograms (CAs) for assessing coronary artery disease (CAD). This training reduced errors in measuring percent diameter stenosis (%DS), enhancing diagnostic reliability.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Visual interpretation of coronary arteriograms (CAs) often leads to inaccurate assessment of percent diameter stenosis (%DS).
- Such errors can result in overestimation of angioplasty outcomes and the extent of coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the effectiveness of a standardized training program in improving the accuracy of %DS interpretation from CAs.
- To reduce variability and errors in assessing the severity of CAD.
Main Methods:
- Forty-one participants (physicians, nurses, students) standardized 45 Kodachromes and 5 photographic reproductions.
- Eleven participants completed a three-part training program focused on accurate %DS interpretation from CAs.
Main Results:
- Sixty-nine percent of CAs showed improved %DS readings, with statistical significance in one-third of cases (4%-84%DS).
- Reporting variability decreased by 26%, and bias in estimating disease severity was reduced.
- Improvement was observed with phantoms but not photographic images with outlined edges.
Conclusions:
- Accurate %DS assessment from CAs is crucial for clinical management, interventional procedures, and research.
- Previous studies often relied on unreliable %DS estimates, leading to data interpretation issues.
- The standardized training program demonstrated significant improvement in accurately assessing CAD, enhancing diagnostic reliability.
Unlabelled:
Patterns in visual interpretation of coronary arteriograms (CAs) frequently cause incorrect assessment of percent diameter stenosis (%DS). These errors result in overestimating the results of angioplasty as well as of the number of arteries significantly affected by coronary artery (CAD) disease.
Methods:
Forty-one physicians, nurses, and students participated in the standardization of 45 Kodachromes (39 arteries, 6 phantoms) and 5 photographic reproductions. Eleven of the 41 participated in a three-part training program designed to eliminate errors and improve accuracy of interpreting %DS from CAs.
Results:
Improvement in reading %DS was seen in 69% of CAs with statistical (P < or = 0.05) improvement in one third of these cases, whose narrowings ranged from 4% to 84%DS. Variability of reporting was reduced in 26% of the cases. Skewing, representing an overestimation of "severe" disease and underestimation of "less severe" disease, was reduced with statistical improvement (P < or = 0.05) in reported %DS noted after training. Similar improvement was seen with phantoms but not in photographic images where the arterial edges were outlined.
Conclusion:
The outcomes of clinical management, invasive and interventional (mechanical, thrombolytic) procedures, as well as research studies depend in part upon the accuracy of reading %DS from CAs. Most studies to date have completed using extremely unreliable estimates of %DS with resultant problems in data interpretation. The use of this standardized training program has led to significant improvement in accurately assessing CAD.
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