AB1411 CLINICIANS’ INTERPRETATION OF UNREPORTED CHEST RADIOGRAPHS IN BIOLOGIC PRESCRIPTION WORKUP SERVICE: A COMPREHENSIVE ANALYSIS
Authors: F. Farman, A. Mohammed Murad, K. Sunmboye
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Chest X-rays (CXR) are crucial for diagnosing pulmonary and cardiovascular conditions, constituting 25% of diagnostic radiographic scans <sup>[1]</sup>. However, postgraduate doctors often lack adequate CXR interpretational skills, which is essential for screening before starting biological treatments [2,3]<sup></sup>. <h3>Objectives:</h3> This 2023 cross-sectional study investigated the confidence in CXR interpretation among clinicians in rheumatology, dermatology, and gastroenterology departments at an NHS hospital to identify areas of improvement in radiology teaching. The existing knowledge is there are no prior studies exploring this issue. <h3>Methods:</h3> Using Kruskall-Wallis test, more than two groups of responses were assessed. <sup>[4]</sup> The importance of this study lies in the use of descriptive ordinal values on the original questionnaire used (very confident, confident, neither confident nor not confident, not confident, not very confident) rather than numerical values taking into consideration "confident" and "certainty" are subjective and vary based on individual self-assessment. This provided more reliable results that reflect the actual level of confidence among clinicians. Main limitation of the study was poor response rate where majority of data was obtained via online questionnaires. Although most online participants were aware of the purpose of this study, reluctance to reply remained an issue. Hence, the total online responses received comprised 26.7% of the total participants. Selection bias was another limitation of this study, attributed to the possibility of mainly contributors with more experience and confidence completed the questionnaire. <h3>Results:</h3> Data analysis revealed 78% of participants exhibited familiarity with necessary pre-biologic workup, and 62.5% demonstrated confidence in recognising contraindications to biologic treatment through medical history, whereas 37.5% did not. In interpretational skills, 57.7% of participants displayed confidence while 48.2% did not. 57.1% of participants were confident in identifying a CXR as 'normal' without a formal report, while 42.8% were not. When asked about the need for CXR interpretation training courses, 78.6% expressed a clear desire for it. Although majority displayed familiarity with pre-biologic testing, clinicians, including higher speciality registrars had suboptimal confidence in interpreting CXR, attributed to shortage of adequate training programs. This can be reflect in longer waiting hours and delayed starting biological therapies, and in turn the quality of delivered healthcare, outcome, and response to treatment. Furthermore, this study highlighted an important issue that the Tust has not previously assessed. <h3>Conclusion:</h3> This study identified a gap in competency and in interpreting CXR among clinicians responsible for pre-biologic screening which requires addressing via structured training programs and maintenance courses. Potential solutions include providing clinicians with sufficient training to robust confidence in interpreting CXR [5]<sup></sup>. In one study, the importance of utilizing picture archiving and communication system (PACS) rather than plain films was highlighted, yielding better resolution. The ability to modify images by altering grey scale to reduce the effect of technical factors such as incorrect exposure [6]<sup></sup>. <h3>REFERENCES:</h3> [1] (Speets et al. 2006) Chest radiography in general practice: indications, diagnostic yield and consequences for patient management. [2] (Miranda et al. 2019) Radiological Imaging Interpretation Skills of Medical Interns [3] (Smith et al. 2018) Preparing patients for biologic medications for dermatologic and rheumatic diseases [4] (Peng et al. 2017) Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study [5] (Dawes et al. 2004) Training improves medical student performance in image interpretation [6] (R. G. Dreyer et al. 2023) Assessing and comparing chest radiograph interpretation in the Department of Internal Medicine at the University of the Witwatersrand medical school, according to seniority <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>