Cruz D, Valentí C, Dias A, Seixas M, Schmitt F
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal.
Arch Pathol Lab Med. 2001 Nov;125(11):1430-5. doi: 10.5858/2001-125-1430-DIDFQA.
To demonstrate the feasibility of the use of digital images to document routine cases and to perform diagnostic quality assessment.
Pathologists documented cases by acquiring up to 12 digital images per case. The images were sampled at 25:1, 50:1, 100:1, 200:1, or 400:1 magnifications, according to adequacy in aiding diagnosis. After each acquisition, the referral pathologist marked a region of interest within each acquired image in order to evaluate intrinsic redundancy. The extrinsic redundancy was determined by counting the unnecessary images. Cases were randomly selected and reviewed by one pathologist. The quality of each image, the possibility of accomplishing a diagnosis based on images, and the degree of agreement was evaluated.
During routine practice, 1469 cases were documented using 3902 images. Most of the images were acquired at higher power magnifications. From all acquired cases, 143 cases and their 373 related images were randomly selected for review. In 88.1% (126/143) of reviewed cases, it was possible to accomplish the diagnosis based on images. In 30.2% (38/126) of these cases, the reviewer considered that the diagnosis could be accomplished with fewer images. The referral pathologist and the reviewer found intrinsic redundancy in 57.8% and 54.5% of images, respectively.
Our results showed that digital image documentation to perform diagnostic quality assessment is a feasible solution. However, owing to the impact on routine practice, guidelines for acquisition and documentation of cases may be needed.
证明使用数字图像记录常规病例并进行诊断质量评估的可行性。
病理学家通过为每个病例采集多达12张数字图像来记录病例。根据辅助诊断的充分性，图像以25:1、50:1、100:1、200:1或400:1的放大倍数进行采样。每次采集后，会诊病理学家在每个采集的图像中标注感兴趣区域，以评估内在冗余度。外在冗余度通过计算不必要的图像数量来确定。随机选择病例并由一名病理学家进行复查。评估每张图像的质量、基于图像做出诊断的可能性以及一致程度。
在常规实践中，使用3902张图像记录了1469个病例。大多数图像是在高倍放大下采集的。从所有采集的病例中，随机选择143个病例及其373张相关图像进行复查。在88.1%（126/143）的复查病例中，可以基于图像做出诊断。在这些病例中，30.2%（38/126）的复查者认为用更少的图像就能做出诊断。会诊病理学家和复查者分别在57.8%和54.5%的图像中发现了内在冗余。
我们的结果表明，用于进行诊断质量评估的数字图像记录是一种可行的解决方案。然而，由于对常规实践有影响，可能需要病例采集和记录的指南。
