Discrepancy in reporting among specialist registrars and the role of a paediatric neuroradiologist in reporting paediatric CT head examinations.

AIM: To evaluate the discrepancy rate among specialist registrars (SPR) to assess whether seniority had a bearing on the discrepancy rate. To investigate which were the commonly missed abnormalities and the consequences for teaching purposes. To investigate the role of a specialist consultant neuroradiologist in reporting paediatric head computed tomography examinations. MATERIALS AND METHODS: The study was carried out over a 9-month period at the regional paediatric hospital during which time 270 CT head examinations were reported. Reporting in the department is carried out by one of the five general paediatric radiologists (GR) and also a specialist paediatric neuroradiologist (NR). The NR was considered the reference standard, who corroborated in areas of discrepancy with a second senior NR for this study. Of the 270 examinations, 260 were reported by the paediatric NR, 160 were reported by the SPR, GR, and NR, and 51 were reported by an SPR and the NR. In addition, four were reported by the GR and the NR, 45 by the NR only, seven by the GR only, and three cases were reported by the GR and an SPR. The discrepancy rates were calculated for GR versus NR, and SPR versus NR. All the discrepancies were re-evaluated by a second senior NR and confirmed in all cases. The reports of the SPR were further scrutinized. The trainees of training years 1-3 were considered junior and 4-5 were considered senior. RESULTS: There was a discrepancy in 26/164 cases (15.9%) reported by the GR and NR. There was a discrepancy in 59/211 cases (28%) reported by an SPR and NR. The chi-squared test (two-sided) showed a significant difference (p=0.005) between the two groups. There was a discrepancy in 36/118 cases (30.5%) reported by the junior SPR and NR. There was a discrepancy in 23/93 cases (24.7%) reported by a senior SPR and NR. The chi-squared test (two-sided) showed a non-significant difference (p=0.353) between the two groups. CONCLUSION: The performance of the SPR was considered to be significantly different than the GR in this study. The year of training did not have a statistically significant bearing on the discrepancy rates. This study has been useful in guiding SPR with regards to paediatric CT head examination reporting. The NR played an important role, particularly in picking up subtle fractures and congenital abnormalities, which were missed by both the SPR and GR.

Plexiform neurofibroma of the oesophagus: a mimicker of malignancy.

We report the first case of a plexiform neurofibroma of the oesophagus, presenting with dysphagia in a 67-year-old man known to suffer from von Recklinghausen's neurofibromatosis. The clinical symptoms and radiological findings mimicked malignancy, and raised considerable concern. Numerous investigations failed to elucidate the benign nature of the condition. The diagnosis was finally achieved at surgery and the patient was successfully treated by oesophageal resection. Plexiform neurofibromas, though only found in 20-30% of affected individuals are pathognomonic of von Recklinghausen's neurofibromatosis. This report highlights the tendency of plexiform neurofibromas to grow extensively and encase surrounding structures, thereby mimicking a neoplastic process.

An overview of vascular closure devices: what every radiologist should know.

Haemostatic devices can be categorised according to their mechanism of action into three main types; namely pressure devices, topical haemostatic pads and vascular closure devices (VCD). Of these three categories, it is the development of VCDs that revolutionised management of endovascular procedures. Currently available VCDs fall into three major classes, those that use a collagen plug, those that use clips and those that perform suture closure at the arteriotomy site. This article provides a comprehensive review of the all three classes with examples of commercially available devices.