Purpose or Case Report: The purpose of this study is to identify how well radiology residents are able to diagnose gastrointestinal emergencies on ultrasound using a simulated emergency radiology call shift.
Methods & Materials: The Wisdom in Diagnostic Imaging SIMulation (WIDI SIM) is a computer aided simulation of an emergency imaging shift that has been rigorously tested and proven to be a reliable means for assessing resident preparedness to competently cover radiology call.

The residents are provided with a total of 65 cases of varying difficulty, across modalities, including normal studies which they interpret over 8 hours. The residents respond with free text, which is then scored using a robust grading rubric with a 10 -point scale. A score below a 5 equates to inability to diagnose a case. Over the past 6 years, the residents have been given pediatric ultrasound cases of hypertrophic pyloric stenosis (HPS), intussusception, acute appendicitis and portovenous gas.
Results: Over 1000 residents have participated in the SIM program since its inception in 2014. Resident participants include all years of radiology residency.

Ultrasound is the preferred imaging modality for evaluation of acute abdominal pain in the pediatric emergency room (ER). Commonly seen diagnoses include acute appendicitis, HPS, and intussusception. Portovenous gas on ultrasound, although a critical diagnosis is less often seen, but must be recognized by the on-call radiology resident.

Given the frequency of evaluation for appendicitis requested from the pediatric ER this concept was tested twice. A total of 383 resident test-takers were given a case of acute appendicitis on ultrasound. Almost 40% of resident test-taker underperformed with scores below 5. Only 17% of resident test-takers from a total of 201 residents underperformed in their interpretation of hypertrophic pyloric stenosis. Intussusception was also tested on this cohort of 201 resident test-takers with 14% unable to diagnose. Finally, the most difficult case – of portovenous gas was given to 351 resident-test takers of which 27% were able to recognize and elicit a work up for mesenteric ischemia.
Conclusions: Ultrasound diagnosis of pediatric gastrointestinal emergencies is of the upmost importance for the overnight radiology resident. 40% of radiology residents failed to diagnose acute appendicitis on ultrasound. This raises a concern for the potential of children coming to the ER overnight to be exposed to unnecessary radiation as computed tomography is often the next-step in diagnosis.