Department of Public Health Sciences, Clemson University, SC.
Department of Radiology, Prisma Health System, SC.
Curr Probl Diagn Radiol. 2021 May-Jun;50(3):321-327. doi: 10.1067/j.cpradiol.2020.01.008. Epub 2020 Jan 10.
While a growing number of research studies have reported the inter-observer variability in computed tomographic (CT) measurements, there are very few interventional studies performed. We aimed to assess whether a peer benchmarking intervention tool may have an influence on reducing interobserver variability in CT measurements and identify possible barriers to the intervention. In this retrospective study, 13 board-certified radiologists repeatedly reviewed 10 CT image sets of lung lesions and hepatic metastases during 3 noncontiguous time periods (T1, T2, T3). Each preselected case contained normal anatomy cephalad and caudal to the lesion of interest. Lesion size measurement under RECISTS 1.1 guidelines, choice of CT slice, and time spent on measurement were captured. Prior to their final measurements, the participants were exposed to the intervention designed to reduce the number of measurements deviating from the median. Chi-square test was performed to identify radiologist-dependent factors associated with the variability. The percent of deviating measurements during T1 and T2 were 20.0% and 23.1%, respectively. There was no statistically significant change in the number of deviating measurements upon the presentation of the intervention despite the decrease in percent from 23.1% to 17.7%. The identified barriers to the intervention include clinical disagreements among radiologists. Specifically, the inter-observer variability was associated with the controversy over the choice of CT image slice (P = 0.045) and selection of start-point, axis, and end-point (P = 0.011). Clinical disagreements rather than random errors were barriers to reducing interobserver variability in CT measurement among experienced radiologists. Future interventions could aim to resolve the disagreement in an interactive approach.
虽然越来越多的研究报告了计算机断层扫描（CT）测量中的观察者间变异性，但很少有介入性研究。我们旨在评估同行基准干预工具是否可能影响降低 CT 测量中的观察者间变异性，并确定干预的可能障碍。在这项回顾性研究中，13 名经过董事会认证的放射科医生在 3 个不连续的时间段（T1、T2、T3）内反复检查了 10 个肺部病变和肝转移的 CT 图像集。每个预选病例都包含感兴趣病变上下方的正常解剖结构。根据 RECIST 1.1 指南测量病变大小、选择 CT 切片和测量时间。在进行最终测量之前，参与者接受了旨在减少偏离中位数测量次数的干预。采用卡方检验确定与变异性相关的放射科医生依赖因素。T1 和 T2 期间偏离测量的百分比分别为 20.0%和 23.1%。尽管从 23.1%下降到 17.7%，但尽管干预措施显示出减少偏离测量的趋势，但偏离测量的数量并没有统计学上的显著变化。干预的障碍包括放射科医生之间的临床分歧。具体来说，观察者间变异性与对 CT 图像切片选择的争议有关（P=0.045）以及起始点、轴和终点的选择（P=0.011）。临床分歧而非随机误差是降低经验丰富的放射科医生 CT 测量中观察者间变异性的障碍。未来的干预措施可以旨在以互动的方式解决分歧。
