Robinson P J, Wilson D, Coral A, Murphy A, Verow P
Clinical Radiology Department, St James's University Hospital, Leeds, UK.
Br J Radiol. 1999 Apr;72(856):323-30. doi: 10.1259/bjr.72.856.10474490.
Skill mix and role extension initiatives have highlighted the difficulty of establishing quality standards for the accuracy of plain film reporting. An acceptable performance might be one which is indistinguishable from that of a group of experienced consultant radiologists. In order to assess the feasibility of setting such a standard, the variation between experienced observers must first be established. This study examines the variation found between three observers with the three major types of plain film examination. 402 plain film examinations (205 skeletal, 100 chest and 97 abdominal) performed on accident and emergency patients were reported retrospectively and independently by three experienced radiologists. The clinical data supplied on the request cards were available to the readers. Each examination was categorized by each reader as being normal, as showing significant abnormality relevant to the current clinical problem, or as showing insignificant or irrelevant abnormality. Concordance between all three readers was found in 51%, 61% and 74% of abdominal, chest and skeletal radiographs, respectively. Weighted kappa values confirmed that the level of agreement between pairs of observers was higher with skeletal radiographs (kappa w = 0.76-0.77) than with chest (kappa w = 0.63-0.68), or abdominal (kappa w = 0.50-0.78) examinations. However, the frequency of major disagreements (at least one reader reporting "normal" and one reporting "relevant abnormality") was similar for abdominal (11%), chest (12%) and skeletal (10%) radiographs. When the reports were reclassified into only two groups--either significantly abnormal or not--pairs of observers disagreed on 9-10% of skeletal, 11-19% of chest and 8-18% of abdominal cases. The average incidence of errors per observer was estimated to be in the range 3-6%. The magnitude of interobserver variation in plain film reporting is considerable, and must be taken into account when designing assessment techniques and setting quality standards for this activity.
技能组合与角色扩展举措凸显了为普通X线片报告准确性制定质量标准的难度。可接受的表现可能是与一组经验丰富的放射科顾问医生的表现难以区分的表现。为了评估设定此类标准的可行性，必须首先确定经验丰富的观察者之间的差异。本研究考察了三位观察者在三种主要类型普通X线检查中发现的差异。三位经验丰富的放射科医生对402例急诊患者的普通X线检查（205例骨骼检查、100例胸部检查和97例腹部检查）进行了回顾性独立报告。读者可以看到申请单上提供的临床数据。每位读者将每次检查分类为正常、显示与当前临床问题相关的显著异常或显示不显著或不相关的异常。在腹部、胸部和骨骼X线片中，三位读者之间的一致性分别为51%、61%和74%。加权kappa值证实，观察者之间的一致程度在骨骼X线片（kappa w = 0.76 - 0.77）方面高于胸部（kappa w = 0.63 - 0.68）或腹部（kappa w = 0.50 - 0.78）检查。然而，腹部（11%）、胸部（12%）和骨骼（10%）X线片中主要分歧（至少一位读者报告“正常”而另一位报告“相关异常”）的频率相似。当报告重新分类为仅两组——显著异常或不显著异常时，观察者在9 - 10%的骨骼病例、11 - 19%的胸部病例和8 - 18%的腹部病例上存在分歧。估计每位观察者的平均错误发生率在3 - 6%的范围内。普通X线片报告中观察者间差异的程度相当大，在设计评估技术和为此类活动设定质量标准时必须予以考虑。
