Loeb Mark B, Carusone Soo B Chan, Marrie Tom J, Brazil Kevin, Krueger Paul, Lohfeld Lynne, Simor Andrew E, Walter Stephen D
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
J Am Med Dir Assoc. 2006 Sep;7(7):416-9. doi: 10.1016/j.jamda.2006.02.004. Epub 2006 May 30.
To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia.
A cross-sectional reliability study.
Nursing homes and an acute care hospital.
Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections.
Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model.
On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76).
In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.
确定放射科医生对养老院获得性肺炎的移动胸部X光片解读的观察者间可靠性。
一项横断面可靠性研究。
养老院和一家急症护理医院。
四名放射科医生对从符合下呼吸道感染临床定义的养老院居民中获取的40张移动胸部X光片进行了评估。
要求放射科医生对X光片的质量、浸润的存在、形态和范围以及胸腔积液或腺病的存在进行解读。使用从双向随机效应模型得出的组内相关系数评估评分者间的可靠性。
放射科医生平均报告称，40张X光片中6张质量非常好或优秀，40张中有16张质量一般或较差。当将浸润的发现分为两类（0 = 无；1 = 可能、很可能或确定）时，所有4名放射科医生对37张胸部X光片中的21张达成了一致。浸润存在与否的组内相关系数为0.54（95%置信区间[CI] 0.38至0.69）。对于所有放射科医生都观察到浸润的14张X光片，胸腔积液存在的组内相关系数为0.08（95% CI -0.10至0.41），肺门腺病为0.54（95% CI 0.29至0.79），纵隔腺病为0.49（95% CI 0.21至0.76）。
总之，放射科医生对移动胸部X光片在确定浸润存在与否方面的观察者间一致性可判定为“一般”。治疗决策需要纳入临床发现，不应仅基于影像学发现做出。
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