Ekpo E U, Hogg P, Wasike E, McEntee M F
Faculty of Health Sciences, The University of Sydney, Discipline of Medical Radiation Sciences, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia; Faculty of Health Sciences, University of Calabar, Department of Radiography and Radiological Sciences, PMB 1115 Calabar, Nigeria.
Directorate of Radiography, Center for Health Science Research, University of Salford, UK; Center for Health Science Research, Karolinska Institute, Stockholm, Sweden.
Radiography (Lond). 2017 Nov;23(4):337-342. doi: 10.1016/j.radi.2017.05.014. Epub 2017 Jun 13.
Subjective methods of mammographic breast density (MBD) assessment are prone to inter-reader variability. This work aims to assess the impact of a short self-directed, experiential learning intervention on radiographers' reproducibility of MBD assessment.
The study used two sets of images (test and learning intervention) containing left craniocaudal and left mediolateral oblique views. The test set had MBD ratings from Volpara™ and radiologists using the fourth edition Breast Imaging and Data Systems (BI-RADS). Seven radiographers rated the MBD of the test set before and after a self-directed learning intervention using the percentage descriptors in the fourth edition BI-RADS Atlas. The inter-reader agreement, the agreement between radiographers and Volpara™ as well as radiologists, was assessed using a Weighted Kappa (к).
Overall, radiographers' inter-reader agreement (к) was substantial (0.79; 95% CI: 0.70-0.87) before the intervention and almost perfect (0.84; 95% CI: 0.77-0.90) after the intervention. Before the intervention, radiographers demonstrated fair agreement with radiologists (0.24; 95% CI: -0.46-0.61) and Volpara™ (0.24; 95% CI: -0.41-0.59). A fair but slightly improved agreement was also observed between radiographers and radiologists (0.31; 95% CI: -0.33-0.64) as well as Volpara™ (0.28; 95% CI: -0.34-0.61) after the intervention.
Findings demonstrate that a short duration self-directed, experiential learning intervention reduces inter-reader differences in MBD classification, but has a negligible impact on improving the agreement between inexperienced and expert readers.
乳腺钼靶密度（MBD）评估的主观方法容易出现不同阅片者之间的差异。本研究旨在评估一项简短的自我指导式体验学习干预对放射技师MBD评估再现性的影响。
本研究使用了两组图像（测试组和学习干预组），包含左侧头尾位和左侧内外斜位视图。测试组有来自Volpara™和放射科医生使用第四版乳腺影像报告和数据系统（BI-RADS）的MBD评级。七名放射技师在使用第四版BI-RADS图谱中的百分比描述符进行自我指导学习干预前后，对测试组的MBD进行了评级。使用加权kappa（к）评估阅片者之间的一致性、放射技师与Volpara™以及放射科医生之间的一致性。
总体而言，干预前放射技师之间的阅片者一致性（к）较高（0.79；95%置信区间：0.70 - 0.87），干预后几乎达到完美（0.84；95%置信区间：0.77 - 0.90）。干预前，放射技师与放射科医生（0.24；95%置信区间：-0.46 - 0.61）以及Volpara™（0.24；95%置信区间：-0.41 - 0.59）的一致性一般。干预后，放射技师与放射科医生（0.31；95%置信区间：-0.33 - 0.64）以及Volpara™（0.28；95%置信区间：-0.34 - 0.61）之间也观察到了一般但略有改善的一致性。
研究结果表明，短期的自我指导式体验学习干预可减少MBD分类中阅片者之间的差异，但对提高经验不足和专家阅片者之间的一致性影响可忽略不计。
