Radiology Residents’ On-Call Interpretation of Chest Radiographs for Congestive Heart Failure 1 Eric J. Feldmann, MD, Vineet R. Jain, MD, Saul Rakoff, MD, Linda B. Haramati, MD Rationale and Objectives. This study was designed to evaluate the performance of radiology residents in interpreting emergency department (ED) chest radiographs for congestive heart failure and to characterize the factors associated with a subsequent amended interpretation by an attending radiologist. Materials and Methods. We retrospectively reviewed all amended reports for ED chest radiographs between January 2004 and July 2005 and identified those with discrepant interpretations regarding the diagnosis of congestive heart failure. A total of 1.9% (476 of 24,600) of chest radiographs were amended over the study period. Forty-eight patients (75% female, mean age 66 years) whose chest radiograph was amended for the diagnosis of congestive heart failure and were available for review formed the study population. A control group of 35 patients (69% female, mean age 67 years) were individually matched to a convenience subset of patients by age, gender, clinical indication, and radiographic projection. Chest radiographs were in the anteroposterior projection in 62% (30 of 48) of study patients and 60% (21 of 35) of con- trols. A blinded expert panel of three board-certified cardiothoracic radiologists jointly reviewed each chest radiograph for the presence or absence of congestive heart failure and its specific radiographic findings. Results. The expert panel diagnosed congestive heart failure in 19% (9 of 48) of study patients and in 23% (8 of 35) of controls (P = .65). When present, congestive heart failure was mild to moderate in severity in both the study and control groups (P = 1.00). There was a significant difference in the expert panel agreement between the attending versus the resi- dent interpretation (65% versus 35%, P = .008), for the study group. This resulted in fair agreement ( = 0.29) between the expert panel and the attending interpretation and no agreement ( =-0.29) between the expert panel and the resident interpretation. In contrast, the expert panel agreed with the joint resident/attending interpretation in 83% (29 of 35) of controls, yielding substantial agreement ( = 0.72). Conclusion. Interpretation of chest radiographs for congestive heart failure by radiology residents has a low error rate. The majority of chest radiographs with discrepant resident and attending interpretations were portable films of female pa- tients with subtle radiographic findings of congestive heart failure, and were inherently difficult to interpret. Key Words. Chest radiography; congestive heart failure; emergency department. © AUR, 2007 With a prevalence of 1% to 2% and an incidence of 400,000 persons per year, the ubiquity of congestive heart failure in the United States is alarming. Despite advances in diagnosis and treatment, the median survival of slightly greater than 3 years for men and 5 years for women is unchanged from that of the early 1970s. One third of patients with conges- tive heart failure are hospitalized every year, making it the leading diagnosis-related group in patients over 65 years of age and the single greatest cost to the Centers for Medicare and Medicaid Services (CMS) (1–3). This high hospitalization rate may be partially explained by the recidivist nature of congestive heart failure, which prompts a high frequency of emergency department (ED) visits (4). The presenting signs and symptoms of congestive heart failure are well characterized. Unfortunately, each sign or Acad Radiol 2007; 14:1264 –1270 1 From the Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467. Received April 19, 2007; accepted June 5, 2007. Address correspon- dence to: L.B.H. e-mail: lharamati@aecom.yu.edu © AUR, 2007 doi:10.1016/j.acra.2007.06.007 1264 Radiology Resident Education