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MRI Interpretation Proficiency of Musculoskeletal Fellows in Training

Posted Feb 28, 2009 Updated Apr 7, 2023
By Subramanyeswara R. Arekapudi MB BS , David A. Jamadar MB BS , Elaine M. Caoili MD , Jon A. Jacobson MD , Gikota Girish MB BS , Catherine J. Bron MD , Qian Dong MD , Yoav Morag MD , David Fessell MD , Sung-Moon Kim MD
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Rationale and Objectives

The aim of this study was to evaluate the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training.

Materials and Methods

Between July 2003 and June 2007, 14 musculoskeletal fellows were independently tested with 20 MRI studies of the knee and shoulder at four separate time points during their fellowship years. Trends in true-positive and false-positive interpretation results were evaluated. Fellows who completed their residencies at the fellowship institution (internal fellows) were compared with those from other residencies (external fellows).

Results

There was a significant improvement in proficiency between the initial and final (9-month) evaluations ( P < .0001). At the initial evaluation, there was a mean of 52.8% (41.7 of 79) true-positive results (range, 32–51); at 9 months, there was a mean of 71.0% (56.1 of 79; range, 40–72). The number of false-positive results also declined during this time period from a mean of 8.1 (range, 2–13) at initial evaluation to 4.7 (range, 2–8) at 9 months ( P < .001). External fellows had more incorrect diagnoses initially but showed greater improvement than internal fellows at 9 months.

Conclusion

Fellows continued to improve their MRI interpretation skills throughout the first 9 months of their fellowships. External fellows were slightly less proficient at the start of their fellowships but slightly more proficient at 9 months compared to internal fellows.

Although the aims of fellowship training are primarily to provide experience and to increase knowledge in a specialized area beyond that achieved during residency , the structure of fellowship training can vary widely. There is a variety of opinions and practices regarding the length of such training, the degree of supervision, the continuity of training, and the choice of staying at the residency institute or going to an outside institution for a fellowship. Although there are many ways to assess the effectiveness of fellowship training and fellows’ competence, image interpretation accuracy is one important method.

In this study, we evaluated the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training. We sought to determine how fellows’ MRI interpretation skills changed throughout the course of their fellowships. We also wanted to compare the progress of internal fellows (those remaining at the same institution after residency) working in a familiar environment to that of external fellows (those who completed their residency training at different institutions from their fellowships).

Materials and methods

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Figure 1, A 58-year-old woman with a tear of the posterior horn of the left medial meniscus. Coronal T 2 -weighted fat-saturated magnetic resonance image (repetition time, 3000 ms; echo time, 19 ms) shows a meniscal tear (straight arrow) . The curved arrow indicates the meniscofemoral ligament. Four of 14 fellows correctly identified this finding at initial evaluation, and 11 of 14 fellows made the correct interpretation at 9 months. F, medial femoral condyle, Fib, fibula.

Figure 2, A 57-year-old woman with a ruptured Baker's cyst. Axial T 2 -weighted fat-saturated magnetic resonance image (repetition time, 3700 ms; echo time, 14 ms) distal to the right knee joint shows the distal portion of a Baker's cyst (curved arrow) separate from fluid in the adjacent tissues (straight arrow) . Five of 14 fellows correctly identified this finding at initial evaluation, and 13 of 14 fellows made the correct interpretation at 9 months.

Figure 3, A 44-year-old woman with mucoid degeneration of the right anterior cruciate ligament. Sagittal T 2 -weighted fat-saturated magnetic resonance image (repetition time, 3000 ms; echo time, 20 ms) shows high signal with linear low-signal fibers of an intact anterior cruciate ligament (curved arrow) . Two of 14 fellows correctly identified this finding at initial evaluation, and 11 of 14 fellows made the correct interpretation at 9 months.

Figure 4, A 55-year-old man with fatty infiltration and atrophy of the right infraspinatus muscle. Coronal oblique T 1 -weighted magnetic resonance image (repetition time, 650 ms; echo time, 15 ms) shows a feathery appearance of fatty infiltration and atrophy of the infraspinatus muscle (IST). Two of 14 fellows correctly identified this finding at initial evaluation, and four of 14 fellows made the correct interpretation at 9 months. H, humerus; S, spine of scapula.

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Results

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Figure 5, Graph of percentage improvement in true-positive results at 3, 6, and 9 months compared to the previous time point. There was a 22% improvement between the start of fellowship (initial evaluation) and 3 months but only a 1.1% improvement between 6 and 9 months.

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Figure 6, Graph of average percentage true-positive results of findings by fellows over the four time periods tested. External fellows on average scored lower initially but performed better at 9 months than internal fellows, although there were no significant differences between the two groups. All fellows improved during the 9 months of fellowship training.

Figure 7, Graph of average number of false-positive results by fellows over the four time periods tested. External fellows on average scored a higher number of false-positive results initially but performed better at 9 months than internal fellows. All fellows improved (fewer false-positive results) by 9 months.

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Discussion

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Acknowledgments

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Academic Radiology, Volume 16, Issue 3
Journals General Radiology
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