No Spectators in a Pandemic: A Comparison of Radiologists, Radiology Residents, and CT Technicians in Interpreting Chest CT Scans for COVID-19

Objective: To compare the diagnostic accuracy of radiology trainees, CT technicians, and radiologists in interpreting chest CT scans for the detection of COVID-19. Methods: Retrospective data were analyzed from 269 reading assessments of chest CT scans for COVID-19. These were conducted by 160 radiologists, 41 radiology residents, and 68 CT technicians from diverse countries and performed online using DetectedX software between March 30, 2020, and January 1, 2022. The readers examined and assessed realistic, de-identified, digital chest CT images-15 positive and 15 negative for COVID-19. Information about the readers' clinical roles (radiologist, radiology resident, or CT technician) was collected alongside measures of their performance in distinguishing between positive and negative cases (sensitivity, specificity, and ROC AUC). The data were evaluated with Kruskal-Wallis tests to identify any differences in performance between the roles. Post hoc comparisons using Bonferroni-corrected Dunn's tests were then used to identify any significant pairwise differences. Results: Statistically significant differences were observed in specificity (p < 0.001) and ROC AUC (p < 0.001) when comparing the three groups. In the pairwise comparisons, differences in specificity were only found between CT technicians and radiologists (p = 0.001), while ROC AUC was significantly different between CT technicians and radiologists (p = 0.001) and between CT technicians and radiology trainees (p = 0.016). No statistically significant differences were observed in sensitivity (p = 0.309) between the groups. Conclusions: The study identifies both diagnostic potential and areas for improvement for radiology residents and CT technicians. Notably, the performance of residents mirrored that of radiologists, underscoring their crucial role in early case management. However, while CT technicians demonstrated comparable sensitivity, their specificity and ROC AUC were lower, highlighting an opportunity for targeted training to enhance their ability to differentiate COVID-19 from other pathologies.