Zellweger J P, Heinzer R, Touray M, Vidondo B, Altpeter E
University Medical Outpatient Department, University Hospital, Lausanne, Switzerland.
Int J Tuberc Lung Dis. 2006 Oct;10(10):1123-6.
To assess the intra-observer and overall agreement in the interpretation of chest X-rays (CXRs) performed for detecting tuberculosis (TB) among immigrants in Switzerland.
Four hundred digitalised CXRs from the files of immigrant registration centres were selected and read twice in random order by three readers. The readers had to assess (1) if the picture was normal or abnormal; (2) if an abnormality was suggestive of TB; and (3) if the suspicion of TB needed an immediate examination (potentially smear-positive TB). The intra-observer and overall agreements were expressed as kappa with standard error.
Due to losses for technical reasons, 377 of the 400 pictures were analysed. The intra-observer agreement was 0.39-0.90 for any abnormality, and 0.60-0.82 for TB needing an urgent examination. The overall agreements were: 0.55 (all three readers) and 0.84 (two best readers) for any abnormality, and 0.64 (all three readers) and 0.80 (two best readers) for active TB.
The intra-observer and overall agreements for the detection of abnormalities on digitalised CXRs and for the presence of possible active TB depend on the reader's experience. It was good between experienced readers and fair between and within the inexperienced reader.
评估瑞士移民中用于检测肺结核（TB）的胸部X光片（CXR）解读的观察者内一致性和总体一致性。
从移民登记中心的档案中选取400张数字化胸部X光片，由三名阅片者按随机顺序阅读两次。阅片者必须评估：（1）片子是否正常或异常；（2）异常是否提示肺结核；（3）对肺结核的怀疑是否需要立即检查（可能为涂片阳性肺结核）。观察者内一致性和总体一致性以带有标准误差的kappa值表示。
由于技术原因导致部分丢失，对400张片子中的377张进行了分析。对于任何异常情况，观察者内一致性为0.39 - 0.90，对于需要紧急检查的肺结核，观察者内一致性为0.60 - 0.82。总体一致性为：对于任何异常情况，三位阅片者的一致性为0.55，两位最佳阅片者的一致性为0.84；对于活动性肺结核，三位阅片者的一致性为0.64，两位最佳阅片者的一致性为0.80。
数字化胸部X光片中异常情况的检测以及可能存在的活动性肺结核的观察者内一致性和总体一致性取决于阅片者的经验。经验丰富的阅片者之间一致性良好，经验不足的阅片者之间及自身的一致性一般。
