 Good afternoon everyone, I am Dr. Vignesh from Fathamala Medical College. I will be presenting my paper and the title will be the Curious of Interpretation of CT Scans of Brain by Residents in an Emergency Setting. Coming to the need for the study, in the present age, a great number of hospitals possess CT scan machines and moreover patients have better access to medical health care system. CT Heads has become an essential basic investigation for most patients that present to the casualty with symptoms perturbed to the heads are an example of stroke and trauma. However, the increase in the number of CT heads being performed, there is no significant price in the number of radiologists and a non-availability of radiology consultants and working hours to counter it, necessitating the study. Coming to the aim, to emphasize the role of radiology residents in the evolution of an emergency CT scan of the brain in an institute with a dedicated emergency medicine department. Coming to objectives, to assess the accuracy of radiology residents in the interpretation of CT heads and to assess the accuracy of general medicine as well as the general surgery residents in the interpretation of CT heads. Coming to the materials and methods, so this was a retrospective study done over a period of two months from June to July 2021 and three residents each from the general medicine and general surgeries department with a minimum of one year of working and casualty department were made to interpret the CT brains and the performer was filled. So after which three radiology residents with a minimum of one year exposure to reporting of CT heads will be made to interpret the same CT heads. So coming to the inclusion criteria, so here we included the patients of all ages presenting to the casualty with the history of trauma to the head and patients presenting to the casualty with symptoms and signs such as two of CBA and patients presenting to casualty with symptoms and signs such as two of raised intracanal hypertension, so intracanal pressure. Coming to the exclusion criteria, patients who are uncooperative for the CT scans causing motion artifacts and hence difficulty in the interpretation and patients presenting to the casualty with no issue of suggestion of CBA or raised ICT. So then the results will be compared with that of the Gold standard which in this study is a radiology consultant with a five experience in the field. So based on the inclusion and exclusion criteria, 140 cases were selected and here is a in out of 140 cases 64 were normal cases and may have 10 cases of acute infarct and 14 cases of chronic infarct and nine cases of EDH and 13 cases of SDH and four cases of SAH and 14 cases of intrapanical memory and nine cases of contusions, five cases of cerebral edema and seven cases of mass lesion. Coming to the data analysis, so the curious of each variable and kappa statistics was calculated using the SPSS software following which the graphical representations were made of statistical values and analyzed. So all the images acquired in our study was done from the 16th slice multi-director G bright speed CT machine and all images were non-contrast axial images. So coming to the representative images, so following are a few images we show where in the residence misdiagnosed the cases. So patient ST was provided in all the cases. So as you can see in the image, so there's an isodence mass lesion. So here in this CT scan all the residents of medicine and surgery department in the study reported as an abnormal power could not identify the etiology. So it was reported as an isodence mass lesion by all all radiology residents. On the image we hear the patient passenger history of trauma and two surgery residents are non-medicine resident report this as a mass lesion and it was correctly diagnosed by a radiology resident as a contusion. In the image it was diagnosed as a bifrontal EDH. The majority of the residents including one radiology resident missed the left EDH while the correctly diagnosing the right frontal extradural hemorrhage. So in the image D it's intraparent criminal hemorrhage. Although in our study we observed good results in the direction of intraparent criminal hemorrhage, this image was wrongly diagnosed by two medicine and two surgery residents as mass lesions. Again we have a few representative images. In this first is the isodence subdural hemorrhage. So majority of the residents reported this as abnormal but however could not report the cause. And the image B is the normal CT brain and one surgery and non-medicine resident reported this as a subdural hemorrhage and the image C is the right subdural hemorrhage and the left frontal subarchnodemorrhage. So all the residents of the medicine and surgery missed the left frontal subarchnodemorrhage in this case. And then the image D is the left temporal EDH. So only one surgery resident could detect the left temporal hemorrhage. So over all the radiological residents are correctly diagnosed. So in the image on the left side is the acute infarct. So all the non-radiology residents missed this acute infarct in the left lentiform nucleus in this particular image. And the image B is the mass lesion and only one medicine a non-radiology resident could diagnose this as a mass lesion. So coming to the results. So here there's a graphical representation of the normal CT scan accuracy interpretation by the various residents radiology medicine as well as surgical PG. And here we have a graphical representation of a infarct accuracy of detecting infarcts by all three residents in this bar graph. So here in this we have an accuracy of interpretation of acute infarct by various residents out of which radiology PG residents have a 97% of diagnosing acute infarct. And in chronic infarct as well radiology PG has accuracy of 100% while medicine and surgical compared with medicine and surgical residents it was very low compared to the surgery. And this is the graphical deposition of the hemorrhage and ADH of various residents by all three radiology radiological medicine and surgical residents. And this is the graphical deposition of SDH versus SAH accuracy interpretation. And this is a graphical deposition of the intraparent chemo as well as the contusion accuracy interpretation. And this is a graphical deposition of accuracy interpretation by of mass lesion and edema by all three residents. And these are the Kappa statistics of all all the CT images taken and diagnosed by the residents. So this is for medicine residents in the Kappa statistics and this is for the surgical residents of the Kappa statistics of various CT scans. So coming to the discussion so the accuracy of interpretation of CT heads by the general medicine and surgeon surgery residents are found to be lower when compared to that of radiology residents. So in the interpretation of inforbs hemorrhages mass lesions and cerebral edema the accuracy was again noted to be in the lower in general medicine and surgical residents. However the accuracy deduction of chronic inforbs was found to be better in comparison to the detection of acute inforbs among non- radiology residents. So the accuracy deduction of acute inforbs and cerebral edema was found to be lower amongst the radiological residents in comparison to the other abnormalities. So amongst the different types of hemorrhages intraparent hemorrhage and the most of the subdural hemorrhages had the best deduction rates in comparison to the radiology residents and subarachnoid hemorrhage isolance solutions and conditions at the worst detection rates in comparison to the radiology residents. So to conclude the role of radiology resident in the casualties re-emphasized in the ABO study especially in the medical institutions without a dedicated emergency department. However there is a need for training program for the residents working in a casualty in order to improve their accuracy in the interpretation of CT brains and hence improve the patient care and reduce the waiting period of the patient in the casualty department. So at the end of the study we conclude that the casualty department can be successful and run smoothly only with a good team and a communication skill. These are my references.