Concordance and discordance between radiology residents and consultant radiologists in interpretation of hysterosalpingography for tubal patency in infertile women

Abstract

Introduction: The quality of a training program for Radiology residents can be assessed by comparing their ability to accurately read standard images to that of their senior counterparts or consultants.

Objective: To evaluate the concordance and discordance rate between residents and consultant radiologists for reporting tubal patency on hysterosalpingography images in infertile women.

Materials & Methods: A comparative study was conducted at the Radiology Department of Rehman Medical Institute Peshawar, Pakistan from June 2021 to December 2022 on 200 infertile women of ages 18-50 years who underwent fluoroscopic hysterosalpingography (HSG) for tubal patency status. Images were reviewed and interpreted initially by radiology residents (1st year and 2nd year) on their respective workstations, which were then compared to the final reports of radiology consultants. The data were analyzed using IBM SPSS version 26 for descriptive and comparative statistics.

Results: The results showed that out of 200 cases of infertility, 83(41.5%) cases were of primary infertility and 117(58.5%) of secondary infertility. The mean age was 35 ± 9.5 years. Normal uterine cavity with normal peritoneal spill was found in 157(78.50%) cases while 43(21.5%) cases had abnormalities. Out of 43 abnormal HSGs, 37 (86.05%) cases were of fallopian tube blockage while 6 (13.95%) cases had other abnormalities like uterine abnormality (n=3), hydrosalpinx (n=2), cervical stenosis and salpingitis isthmica nodosa (n=1). The total concordance with 1st year residents was 95.5%, and 98% with 2nd year residents. Total discordance was 6.5%, in which 4.5% was with 1st year resident and 2% was with 2nd year resident. Overall inter-observer variability showed moderate agreement, (kappa, k=0.7, 95%CI  ±0.51), fair agreement  with first year residents (k=0.4, 95%CI 0.3-0.5), and moderate agreement with 2^nd year residents (k=0.5, 95%CI 0.39-0.5).

Conclusion:  The level of radiology residency training affects discordance rates significantly with the junior resident having higher rates of discordance than the senior residents.