Influence of observer experience and training on proficiency in coronary CT angiography interpretation.

Purpose: To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience.
Methods and Materials: Nine radiologist and cardiologist observers with varying prior CCTA experience ranging from novice to expert independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50-74%, 75-99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series. Diagnostic accuracy on a per-segment basis was compared for all readers and both case series, respectively.
Results: Correlation coefficients between CCTA and catheter angiography initially ranged between good (r=0.87) and poor (r=0.26), depending on reader experience, and significantly (p<0.05) improved in the second case series (range: r=0.42 to r=0.91). Diagnostic accuracy was significantly (p<0.05) higher for more experienced readers (range: 96.5-97.8%) as compared to less experienced observers (range: 90.7-93.6%). After completion of the second case series for less experienced readers sensitivity and PPV significantly (p<0.05) improved (range: 62.7-67.8%/51.4-84.1%), but still remained significantly (p<0.05) lower as compared to more experienced observers (range: 89.8-93.3%/80.6-93.3%).
Conclusion: The level of experience appears to be a strong determinant of proficiency in CCTA interpretation. Limited one-time training improves proficiency in novice readers, but not to clinically satisfactory levels.
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