Krom Aaron J, Wickham Fred, Hall Margaret L, Navalkissoor Shaunak, McCool Daniel, Burniston Maria
Department of Anaesthesia, Hadassa Hebrew University School of Medicine, Hadassah University Hospital, Jerusalem, Israel.
Nucl Med Commun. 2013 Jan;34(1):78-85. doi: 10.1097/MNM.0b013e32835afb45.
Reducing the radiation dose and scanning time of diagnostic tests is often desirable. One method uses image enhancement software such as Pixon, which processes lower-count scans and aims to produce high-quality images. However, it is essential that diagnostic accuracy is not compromised. We compared the level of agreement between clinicians using standard scans, with half-count and Pixon-enhanced half-count scans. Bone scans from 150 patients referred to diagnose metastatic disease were degraded by a process of Poisson-preserving binomial resampling to generate equivalent half-count scans and then processed by Pixon software to recreate 'original' high-quality scans. Two experienced clinicians reported the scans in a randomized, blinded manner for metastatic disease (yes/no) and assigned a confidence level to this diagnosis. Levels of agreement between clinicians were calculated for the full-count, half-count, and Pixon-enhanced half-count scans and between scanning methods for each clinician. Agreement between clinicians for standard full-count scans was 92% (±4%, κ=0.80), compared with 92% (±4%, κ=0.79) for half-count scans and 87% (±5%, κ=0.70) for Pixon-processed half-count scans. Agreement for a single clinician viewing full-count versus half-count scans was 95% (±2%, κ=0.88), similar to the agreement for a single clinician viewing full-count versus Pixon-processed half-count scans (95%, ±2%, κ=0.88). With respect to confidence in diagnosis, 127 full-count scans were scored in the highest category, compared with 98 half-count and 88 Pixon-processed half-count scans. Switching to half-count scanning does not introduce more diagnostic disagreement than is already present between clinicians. However, clinicians feel less confident reporting half-count scans. The Pixon enhancement step improved neither objective diagnostic agreement nor clinician confidence.
减少诊断检查的辐射剂量和扫描时间通常是很有必要的。一种方法是使用图像增强软件，如Pixon，该软件可处理低计数扫描并旨在生成高质量图像。然而，至关重要的是不能损害诊断准确性。我们比较了使用标准扫描、半计数扫描和Pixon增强半计数扫描的临床医生之间的一致性水平。对150例因诊断转移性疾病而转诊的患者的骨扫描进行泊松保留二项式重采样处理，以生成等效的半计数扫描，然后用Pixon软件处理以重建“原始”高质量扫描。两位经验丰富的临床医生以随机、盲法的方式报告扫描结果，判断是否存在转移性疾病（是/否），并为该诊断指定置信水平。计算了全计数、半计数和Pixon增强半计数扫描之间临床医生的一致性水平，以及每位临床医生不同扫描方法之间的一致性水平。临床医生对标准全计数扫描的一致性为92%（±4%，κ=0.80），半计数扫描为92%（±4%，κ=0.79），Pixon处理的半计数扫描为87%（±5%，κ=0.70）。一位临床医生查看全计数扫描与半计数扫描的一致性为95%（±2%，κ=0.88），类似于一位临床医生查看全计数扫描与Pixon处理的半计数扫描的一致性（95%，±2%，κ=0.88）。关于诊断的置信度，127次全计数扫描被评为最高类别，相比之下，半计数扫描为98次，Pixon处理的半计数扫描为88次。切换到半计数扫描不会比临床医生之间已存在的分歧引入更多的诊断分歧。然而，临床医生对报告半计数扫描的信心较低。Pixon增强步骤既没有提高客观诊断一致性，也没有提高临床医生的信心。
