Lange P, Balk-Møller S, Heckscher T, Kok-Jensen A, Viskum K
Bispebjerg Hospital, København.
Ugeskr Laeger. 1990 Nov 19;152(47):3524-7.
Assessment was undertaken of 165 x-ray photographs of the thorax originating from 165 men with varying degrees of exposure to asbestos: 37 were workers in an eternite factory, 65 insulation workers, 42 were plumbers and 21 were patients from the Lung Clinic in Bispebjerg Hospital. Assessment of the x-rays was carried out according to the directives established by the International Workers' Organisation (ILO) by three experienced specialists who had no knowledge of the individual person's exposure to asbestos or smoking habits. In order to investigate not only inter- but also intra observer variation, the three medical specialists described the material on two occasions with an interval of several days. Analysis of the descriptions revealed that there was considerable inter- and intra-observer variation in assessment of the changes caused by asbestos. Description of the parenchymatous changes was associated with slightly greater variation than description of the pleural changes. A partial analysis of smokers who had not had occupational exposure to asbestos showed a not inconsiderable occurrence (5-33%) of parenchymatous changes which could not be differentiated from changes caused by asbestos. It is concluded, that the diagnosis of pulmonary disease caused by asbestos should not be based on radiographic examination alone.
对165名不同程度接触石棉的男性的165张胸部X光照片进行了评估：其中37人是一家石棉水泥制品厂的工人，65人是绝缘材料工人，42人是水管工，21人是比斯佩比约格医院肺病诊所的患者。由三名经验丰富的专家根据国际劳工组织（ILO）制定的指示对X光片进行评估，这些专家对个人的石棉接触情况或吸烟习惯一无所知。为了不仅调查观察者之间的差异，还调查观察者内部的差异，这三名医学专家在相隔数天的两个时间点对这些资料进行了描述。对这些描述的分析表明，在评估石棉引起的变化时，观察者之间和观察者内部存在相当大的差异。对实质性变化的描述比对胸膜变化的描述差异略大。对未接触过职业性石棉的吸烟者的部分分析表明，存在一定比例（5%-33%）无法与石棉引起的变化区分开来的实质性变化。得出的结论是，石棉所致肺部疾病的诊断不应仅基于影像学检查。
