Diagnostic accuracy of computed tomography for acute appendicitis: Comparison among in-training, junior, and senior radiologists

Puwitch Charoenchue; Nartanong Jaijina; Suwalee Pojchamarnwiputh; Natipat Jitmahawong; Amonlaya Amantakul

doi:10.46475/asean-jr.v27i3.1026

Authors

Puwitch Charoenchue, M.D., Ph.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
Nartanong Jaijina, M.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Department of Radiology, Srisangwan Hospital, Mae Hong Son, Thailand.
Suwalee Pojchamarnwiputh, M.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
Natipat Jitmahawong, M.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
Amonlaya Amantakul, M.D., Ph.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200

DOI:

https://doi.org/10.46475/asean-jr.v27i3.1026

Keywords:

Acute appendicitis, Computed tomography, Diagnostic accuracy, Experience, Radiology training

Abstract

Background: Computed tomography (CT) is widely used for diagnosing acute appendicitis, but the impact of radiologist experience on diagnostic accuracy remains unclear. This study compares the diagnostic performance of in-training, junior, and senior radiologists to assess whether experience influences accuracy and interobserver agreement.

Materials and Methods: A retrospective study analyzed CT scans of 196 patients suspected of having acute appendicitis from January to December 2020. Three radiologists—in training, junior, and senior—interpreted the scans independently. The diagnostic performance of each reader was compared based on pathological or clinical follow-up. Diagnostic accuracy indices were calculated for each reader, and interobserver agreement was assessed.

Results: CT demonstrated high diagnostic accuracy across all reader groups. The senior radiologist achieved the highest accuracy (94.4%; 95% CI, 90.2-97.2), followed by the junior radiologist (93.9%; 95% CI, 89.5-96.8) and the in-training radiologist (91.3%; 95% CI, 86.5-94.9), with no statistically significant differences. The AUROC values were 0.944 for the senior radiologist, 0.938 for the junior radiologist, and 0.912 for the in-training radiologist. Interobserver agreement was excellent, with Fleiss’ kappa of 0.864 (95% CI, 0.806-0.921).

Conclusion: CT showed high diagnostic performance for acute appendicitis across different levels of radiologist experience in this cohort. Junior and senior radiologists demonstrated slightly higher numerical accuracy than the in-training radiologist, mainly due to fewer false-negative interpretations. These findings suggest comparable CT diagnostic results among in-training, junior, and senior radiologists, while emphasizing the importance of careful assessment of subtle or atypical cases.

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