The feasibility of carotid evaluation by resident radiologists to expand access to ultrasound services.

Aims: The purpose of our study was to determine resident radiologists' accuracy in diagnosing carotid atherosclerotic plaque and to assess any factors leading to incorrect findings.

Materials and methods: The results of preliminary carotid scanning performed by radiology residents from December 1, 2021, to August 1, 2022, were retrospectively reviewed. These scans received an instant review by experts. The discrepancy rates of the resident radiologists were evaluated using expert diagnoses. Then, the plaque detection rate of the resident radiologists was investigated for different plaque characteristics. The causes of incorrect stenosis diagnoses were analyzed.

Results: In the investigation of carotid plaque detection, a total of 274 carotid scans from 137 patients were evaluated in our hospital. The overall agreement rate of plaque detection was 90.9%. Echolucent plaques, plaques in the lateral or near wall, and plaques in the carotid bulbs were more likely to be misdiagnosed by resident radiologists. A total of 325 plaques were included in the investigation of carotid artery stenosis classification. The overall agreement rate of stenosis evaluation was 67.7%. The misclassification of moderate stenosis was greater than that of mild and severe stenosis (p=0.0003). The sensitivity was as low as 55.56%. Nonstandard sonographic techniques and incorrect application of interpretive criteria were two main causes.

Conclusions: Resident radiologists could accurately and efficiently detect carotid plaques. Scanning by resident radiologists can expand access to ultrasound services. Only the diagnosis of moderate stenosis by resident radiologists was not satisfactory and may require a specialized review from experienced radiologists.