Taylor Stuart A, Halligan Steve, Burling David, Morley Simon, Bassett Paul, Atkin Wendy, Bartram Clive I
Department of Intestinal Imaging, St. Mark's Hospital, Watford Road, Northwick Park, London HA1 3UJ, UK.
Eur Radiol. 2004 Jun;14(6):1025-33. doi: 10.1007/s00330-004-2262-z. Epub 2004 Feb 10.
The purpose of this paper was to investigate the effect of radiologist experience and increasing exposure to CT colonography on reader performance. Three radiologists of differing general experience (consultant, research fellow, trainee) independently analysed 100 CT colonographic datasets. Readers had no prior experience of CT colonography and received feedback and training after the first 50 cases from an independent experienced radiologist. Diagnostic performance and reporting times were compared for the first and second 50 datasets and compared with the results of a radiologist experienced in CT colonography. Before training only the consultant reader achieved statistical equivalence with the reference standard for detection of larger polyps. After training, detection rates ranged between 25 and 58% for larger polyps. Only the trainee significantly improved after training ( P=0.007), with performance of other readers unchanged or even worse. Reporting times following training were reduced significantly for the consultant and fellow ( P<0.001 and P=0.03, respectively), but increased for the trainee ( P<0.001). In comparison to the consultant reader, the odds of detection of larger polyps was 0.36 (CI 0.16, 0.82) for the fellow and 0.36 (CI 0.14, 0.91) for the trainee. There is considerable variation in the ability to report CT colonography. Prior experience in gastrointestinal radiology is a distinct advantage. Competence cannot be assumed even after directed training via a database of 50 cases.
本文旨在研究放射科医生的经验以及增加CT结肠成像检查经历对阅片表现的影响。三位具有不同总体经验的放射科医生（顾问医生、研究员、实习生）独立分析了100份CT结肠成像数据集。阅片者此前没有CT结肠成像检查经验，在完成前50例病例后，接受了来自一位独立的经验丰富的放射科医生的反馈和培训。对前50份和后50份数据集的诊断表现和报告时间进行了比较，并与一位有CT结肠成像检查经验的放射科医生的结果进行了对比。在培训前，只有顾问医生在检测较大息肉方面达到了与参考标准的统计学等效性。培训后，较大息肉的检测率在25%至58%之间。只有实习生在培训后有显著提高（P=0.007），其他阅片者的表现没有变化甚至更差。培训后，顾问医生和研究员的报告时间显著缩短（分别为P<0.001和P=0.03），但实习生的报告时间增加了（P<0.001）。与顾问医生相比，研究员检测较大息肉的几率为0.36（可信区间0.16, 0.82），实习生为0.36（可信区间0.14, 0.91）。在报告CT结肠成像检查结果的能力方面存在相当大的差异。胃肠道放射学方面的既往经验是一个明显的优势。即使通过50例病例数据库进行定向培训后，也不能假定具备相应能力。
