the accuracy of ultrasound and quality adjustment of the life expect- ancy. In newborns with a lumbosacral dimple (pretest probability of 3.8%), US was cost-saving. Sensitivity analysis demonstrated that MR imaging was the preferred strategy if the specificity and sensitivity of US were below 50% and 77%, respectively. Conclusion: Ultrasound was cost-effective in studying newborns with low risk of occult spinal dysraphism. However, if only life ex- pectancy (without quality adjustment) is considered, no imaging is the preferred strategy in newborns with a pilonidal sinus or new- borns of diabetic mothers.

06-36 Physician Reliabil i ty in the Interpretat ion of Cranial Computed Tomography in Stroke Pat ients Eligible for Thrombolyt ic Therapy Katie D. Vo, MD, Mallinckrodt Institute of Radiology, Saint Louis, MO, Daniel K. Kido, MD, Chung Y. Hsu, MD, PhD, Benjamin Littenherg, MD

Background and Purpose: Reliability assessment of a diagnostic test is an important but seldom-examined component of diagnostic technology assessment. Observer variation can be substantial and can lead to misdi- agnosis even when a test is very accurate. In this study, we assess physi- cian reliabifity in the interpretation of cramal CT scans of patients with hyperacute stroke. The hyperacute CT scan is used as a test model be- cause it is a simple and widely available modality and is an important screening tool for the assessment of patients with acute neurologic defi- cits for possible thrombolytic therapy.

Materials and Methods: Twenty baseline CT scans from patients who presented with acute neurologic deficits within 3 hours of onset were se- lected from our institution's stroke log. These scans had a broad range of interpretive difficulty and pathology, including 7 clear-cut early signs of infarct, 5 subtle early signs of infarct, 3 dense MCA signs, 1 obvious hemorrhage, 2 subtle hemorrhages (identified by MRI), 1 tumor, and 6 normal scans. The scans were evaluated by 13 physicians, including 4 staff neuroradiologists, 6 neuroradiology fellows, and 3 stroke neurolo- gists. The findings were classified into five categories for the presence or absence of early signs of ischemia, hemorrhage, dense MCA sign, other nonischemic cause for patient' s deficits, and contraindications for tPA. For each CT finding, ~ statistics were used to assess proportion of agreement among the readers.

Results: Kappa values for all five categories ranged from 0.21-0.48 for neuroradiology fellows, 0.15-0.45 for neuroradiology staff, 0.27-0.56 for the stroke neurologists, and 0.23-0.44 for all readers as a group. With regard to the presence or absence of hemorrhage, the ~: values were 0.28 for the neuroradiology staff, 0.48 for neuroradiology fellows. 0.56 for stroke neurologists, and 0.43 for all readers. For early CT find- ings of ischemia, the 1¢ values were 0.27 for the neuroradiology staff, 0.438 for the neuroradiology fellows, 0.33 for the stroke neurologists, and 0.37 for all readers.

Conelnsion: When taking the base rate into consideratmn, there was excellent agreement in discerning hemorrhage and poor agreement in recognizing early CT signs of ischemia within each specialty group and between groups.

07-37 Is Training in Conscious Sedation Adequate for Radi- ology Residents? Charles M. Heaton, MD, Medical University of South Carolina, Charleston, SC, LeoNe Gordon, MD, Jeanne G. Hill, MD

Purpose: To evaluate the level of resident responsibility and training in conducting conscious sedation procedures and to quantify and catego- rize the average monthly studies requiring resident-directed conscious sedation, relative to both the university and private program settings.

Materials and Methods: A survey was sent to the program direc- tors of over 200 diagnostic radiology residency programs accredited by the Accreditation Council for Continuing Graduate Medical Edu- cation. Results were placed into a database and analyzed.

Results: Responses were received from 72 programs (46 university, 16 private, 10 both/other). Forty-four programs (32 university, 6 pri- vate, 6 both/other) require residents to provide sedation for proce- dures. Resident supervision ranged from direct faculty oversight to complete independence. Only thirteen required specific training in techniques. Training varied widely (e.g., formal 103-hour course, single one-hour videotape and quiz, "self-training"). The average num- ber of monthly studies requiring sedation was 142 for all programs re- sponding (8107 studies from 57 programs providing numbers).

Conclusion: Present radiology residency curriculum provides minimal training in conscious sedation despite it being a large, integral part of everyday practice, with increasing pubhc awareness of poor outcomes. Formal curriculmn changes to emphasize training and competency may be indicated.

07-38 The Case-Based Teaching Radiology Conference for Residents: Benef icial Effect of Previewing and Using Answer Sheets Felix S. Chew, MD, Wake Forest University School of Medicine, Winston-Salem, NC Purpose: Radiology residents often experience the case-based teach- ing conference as an inquisition in which the moderator painfully ex- tracts observations, conclusions, and facts from a discussant while other attendees passively observe. This is frequently disliked by all par- ticipants. We hypothesized that such conferences could be improved by previewing cases and using answer sheets.

Materials and Methods: A monthly one-hour case-based skeletal radi- ology teaching conference was modified so that residents previewed 20 single-image cases for 45 seconds each while completing answer sheets. Directed by a moderator, residents then took turns discussing their re- sponses. Attendees completed evaluation forms.

Results: Five conferences were evaluated, and a total of 81 evaluations were received. The average response rate per conference was 90%. The evaluations indicated that the content was appropriate (96%), the format helped learning (98%), the new format was preferred to the traditional format (98%), and more such conferences were desired (99%). Evalua- tions also suggested that the requirement to commit to a diagnosis was beneficial, that there were greater levels of participation and engage- ment by all the attendees, and a greater number of cases were discussed.

Conclusion: Modifying case-based radiology teaching conferences by having participants preview cases and use answer sheets has positive educational benefits and is well received.

07-39 "All Pancreas": An Integrated Learning Tool Justin Tholany, MD, University of Massachusetts Medical Center, Worcester, MA, Chun-Sham Yam, PhD, Thomas M. Cummings, MD, Chetan D. Rajadhyaksha, Jay M. Colby, MD, Ashley Davidoff, MD

Purpose: "All Pancreas" is an interactive computerized learning tool that aims at providing extensive and in-depth coverage of information relating to the pancreas. Unique software has been developed to inte- grate radiology with pathology, surgery, and clinical medicine.

Materials and Methods: We have developed an imaging library of pancreatic disease that currently consists of over 1000 images, inte- grated with information relating to the basic and clinical sciences. This allows the user to access in-depth information on the pancreas

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