Evaluation of a training program for detection of carotid artery calcifications on panoramic radiographs

Objective. Td evaluate the effectiveness of the American Academy of Oral and Maxillofacial Radiology-sponsored training packet for identification of carotid artery calcifications on panoramic radiographs. Study design. Two examiners, who completed the training (trainees), examined 778 panoramic radiographs. The sample included 298 men, with a mean age of 66, and 480 women, with a mean age of 68. Findings were compared with those obtained by an oral and maxillofacial radiologist. A kappa statistic was used to determine agreement between the 2 trainees. The positive predictive value (PPV) of the program was estimated by comparing the trainees rating of disease status with an expert in case identification. Results. Examiners 1 and 2 identified 99 and 78 positive cases, respectively. A kappa statistic of 0.87 (95% Cl, 0.81-0.92) was obtained, indicating good interexaminer agreement. The expert identified 27 positive cases, resulting in a PPV of 34.6% (95% Cl, 24.4-46.3). Conclusion. Although the training packet offers valuable training, it does not provide a high PPV, suggesting the need to modify it or to seek an expert opinion before classification of a patient as having calcification on a panoramic radiograph.