Madness and method in stress echo reading

Aim To assess whether 'eye education' through short-term, high-intensity jo int reading sessions may improve diagnostic accuracy and inter-observer agr eement among beginners. Methods and Results Seventeen cardiologists with absent to minimal (<100 st udies performed) previous stress echo experience independently and blindly read 18 stress echo studies, nine at the beginning ('pre-training' set) and nine at the end ('post-training' set) of a 2 day stress echo school which included a joint reading session of 50 tapes. The two sets were balanced as far as type of stress and image quality. The 17 observers had an average a ccuracy score of 51+/-16.4 before and 64.3+/-8.7% after the training (P<0.0 05). Concordant (i.e. >14 readers giving the same response) interpretation occurred in three out of nine studies before and in eight out of nine studi es after the training (33% vs 88%, P<0.01). Kappa Values went from 0.14 (po or) before to 0.39 (fair, close to moderate) after the training. Conclusion Short-term, high-intensity dedicated training in stress echo, wi th joint reading sessions and consensus development of reading criteria sig nificantly increased accuracy and markedly reduced the inter-observer varia bility in the reading of stress echos by beginners. If there is a Shakespea rean madness in stress echo reading,'yet there is a method in't' (Hamlet, I I, II, 205-206).