INTERPRETATION OF ABNORMAL LUMBOSACRAL SPINE RADIOGRAPHS - A TEST COMPARING STUDENTS, CLINICIAN, RADIOLOGY RESIDENTS, AND RADIOLOGISTS IN MEDICINE AND CHIROPRACTIC

Study Design. Controlled comparison of radiographic interpretive perfo rmance based on training and experience. Objectives, This study compar ed each of these groups in medicine and chiropractic by testing abilit ies to interpret abnormal plain film radiographs of the lumbosacral sp ine and pelvis, Summary of Background Data, Low back pain is a common and costly problem that is evaluated and treated primarily by medical physicians, orthopedists, and chiropractors. Although radiology is use d extensively in patients with low back pain, the radiographic interpr etations of students, clinicians, radiology residents, and radiologist s have never been compared. Methods. Pour hundred ninety-six eligible volunteers from nine target groups completed a test of radiographic in terpretation consisting of nineteen cases with oo. clinically importan t radiographic findings. The nine groups included 22 medical students, 183 chiropractic students, 27 medical radiology residents, 13 chiropr actic radiology residents, 66 medical clinicians (including 12 general practice physicians, 25 orthopedic surgeons, 21 orthopedic residents, and 8 rheumatologists), 46 chiropractic clinicians, 48 general medica l radiologists, 55 chiropractic radiologists, and 36 skeletal radiolog ists and fellows. Results, The test established a high level of intern al consistency reliability (0.880) and revealed that, in the interpret ation of abnormal plain film radiographs of the lumbosacral spine and pelvis, significant differences were found among professional groups ( P < 0.0001). Post hoc tests (P < 0.05) revealed that skeletal radiolog ists achieved significantly higher test results than did all other med ical groups; that the test results of general medical radiologists and medical radiology residents was significantly higher than those of me dical clinicians; that test results of medical students was significan tly poorer than that of all other medical groups; that the performance of chiropractic radiologists and chiropractic radiology residents was significantly higher than that of chiropractic clinicians and chiropr actic students; that no significant difference was revealed in the mea n values of performance of chiropractic clinicians and chiropractic st udents; that the test results of chiropractic radiologists, chiropract ic radiology residents, and chiropractic students was significantly hi gher than that of the corresponding medical categories (general medica l radiologists, medical radiology residents, and medical students, res pectively); that no significant difference in test results was identif ied between chiropractic radiologists and skeletal radiologists or bet ween chiropractic and medical clinicians; and that th length of time i n practice for clinicians; and that the length of time in practice for clinicians and radiologists was not a significant factor in the test results. Conclusions. These data demonstrate a substantial increase in the test results of all radiologists and radiology residents when com pared to students and clinicians in both medicine and chiropractic rel ated to the interpretation of abnormal radiographs of the lumbosacral spine pelvis. Furthermore, the study reinforces the need for radiologi c specialists to reduce missed diagnoses, misdiagnoses, and medicolega l complications.