Emergency residents' skill level in chest X-ray interpretation

Background: Emergency residents frequently perform chest X-rays (CXRs) in emergency departments (ED), yet their competency in interpreting these images is often questioned. This study evaluates the competency of ED residents in interpreting and diagnosing CXRs, and primarily determines their confidence and accuracy in CXR reading. Additionally, the current study assesses the factors influencing residents’ skills and the possibility of making medical decisions based on CXR images. Methods: An electronic survey was distributed to all Saudi emergency medicine residents (612 at the time of the study), collecting demographic data and participant characteristics, including sex, years of practice, elective rotation, interest in diagnostic radiology, and frequency of CXR readings per week. The survey had a response rate of 69.6% (426/612) and included the most commonly encountered CXR cases, each accompanied by a brief clinical description. Respondents selected the correct answers from multiple choices and rated their diagnostic confidence on a Likert scale from 1 to 5. Results: The accuracy of interpreting the ten CXR images was 70.6%, while the overall diagnostic confidence was notably low at 29.0%. Normal chest radiographs exhibited the highest interpretation accuracy (99.7%) but with only 23.8% confidence. The highest confidence was reported for diagnosing Pneumoperitoneum at 64.6%. The residents who completed an elective in diagnostic radiology had a higher diagnostic accuracy than those who did not receive adequate training (p = 0.0088). Despite their training, all ED residents indicated a significant lack of adequate training (p < 0.0001). Conclusions: Emergency residents displayed moderate accuracy in interpreting CXRs; however, they could not make medical decisions based solely on their interpretations. Further research is needed to determine the most cost-effective technique for reducing misinterpretations, and introducing artificial intelligence may be a future solution to increase CXR interpretation accuracy.

Residency program; Chest X-ray; Emergency medicine; Radiographs; Diagnostic error; Radiology education; Pneumothorax

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