Interpreting Complexity: How Senior Clinical Fellows Approach Challenging Cardiothoracic Imaging Cases - A Qualitative Study

Abstract

OBJECTIVES

To explore how senior clinical fellows in cardiothoracic radiology approach complex imaging cases in routine clinical practice, with secondary objectives of understanding how they manage diagnostic uncertainty, the factors influencing their decision-making, and the development of confidence and independence during fellowship.

METHODOLOGY

A qualitative descriptive study was conducted involving seven senior clinical fellows in cardiothoracic radiology at Liverpool Heart and Chest Hospital, Liverpool, UK, between January 2026 and March 2026. Participants were selected using purposive sampling based on relevant clinical experience. Data were collected through face-to-face interviews using a structured questionnaire containing open-ended and Likert-scale questions. Qualitative interview data were analysed using Braun and Clarke’s six-phase thematic analysis framework.

RESULTS
Five major themes emerged, including supportive environment in decision-making, importance of clinical details, diagnostic uncertainty, decision-making under stress, and experiential learning. Fellows reported that consultant supervision, support and multidisciplinary discussions were essential for managing uncertainty. Limited clinical information and ambiguous imaging findings increased diagnostic difficulty. Clinical demands, particularly in unstable patients, influenced decision-making. Furthermore, experience and literature review improved confidence over time.

CONCLUSION

Decision-making in complex cardiothoracic imaging involves managing uncertainty through senior Consultant support, mentorship, adequate clinical information, and experience, which together improve confidence in interpretation and patient care.