TRAINING PHYSICIANS AND HEALTH-CARE PROVIDERS TO ACCURATELY READ CORONARY ARTERIOGRAMS - A TRAINING-PROGRAM

Patterns in visual interpretation of coronary arteriograms (CAs) frequ ently cause incorrect assessment of percent diameter stenosis (%DS). T hese errors result in overestimating the results of angioplasty as wel l as of the number of arteries significantly affected by coronary arte ry (CAD) disease. Methods. Forty-one physicians, nurses, and students participated in the standardization of 45 Kodachromes (39 arteries, 6 phantoms) and 5 photographic reproductions. Eleven of the 41 participa ted in a three-part training program designed to eliminate errors and improve accuracy of interpreting %DS from CAs. Results. Improvement in reading %DS was seen in 69% of CAs with statistical (P less than or e qual to 0.05) improvement in one third of these cases, whose narrowing s ranged from 4% to 84%DS. Variability of reporting was reduced in 26% of the cases. Skewing, representing an overestimation of ''severe'' d isease and underestimation of ''less severe'' disease, was reduced wit h statistical improvement (P less than or equal to 0.05) in reported % DS noted after training. Similar improvement was seen with phantoms bu t not in photographic images where the arterial edges were outlined. C onclusion. The outcomes of clinical management, invasive and intervent ional (mechanical, thrombolytic) procedures, as well as research studi es depend in part upon the accuracy of reading %DS from CAs. Most stud ies to date have been completed using extremely unreliable estimates o f %DS with resultant problems in data interpretation. The use of this standardized training program has led to significant improvement in ac curately assessing CAD.