From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L., L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative Health Services-Clinical Trials and Biostatistics (M.P.J.), and Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905; and Department of Quantitative Health Services-Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Fla (R.E.C.).
Radiology. 2023 Feb;306(2):e220266. doi: 10.1148/radiol.220266. Epub 2022 Oct 4.
Background Substantial interreader variability exists for common tasks in CT imaging, such as detection of hepatic metastases. This variability can undermine patient care by leading to misdiagnosis. Purpose To determine the impact of interreader variability associated with reader experience, image navigation patterns (eg, eye movements, workstation interactions), and eye gaze time at missed liver metastases on contrast-enhanced abdominal CT images. Materials and Methods In a single-center prospective observational trial at an academic institution between December 2020 and February 2021, readers were recruited to examine 40 contrast-enhanced abdominal CT studies (eight normal, 32 containing 91 liver metastases). Readers circumscribed hepatic metastases and reported confidence. The workstation tracked image navigation and eye movements. Performance was quantified by using the area under the jackknife alternative free-response receiver operator characteristic (JAFROC-1) curve and per-metastasis sensitivity and was associated with reader experience and image navigation variables. Differences in area under JAFROC curve were assessed with the Kruskal-Wallis test followed by the Dunn test, and effects of image navigation were assessed by using the Wilcoxon signed-rank test. Results Twenty-five readers (median age, 38 years; IQR, 31-45 years; 19 men) were recruited and included nine subspecialized abdominal radiologists, five nonabdominal staff radiologists, and 11 senior residents or fellows. Reader experience explained differences in area under the JAFROC curve, with abdominal radiologists demonstrating greater area under the JAFROC curve (mean, 0.77; 95% CI: 0.75, 0.79) than trainees (mean, 0.71; 95% CI: 0.69, 0.73) ( = .02) or nonabdominal subspecialists (mean, 0.69; 95% CI: 0.60, 0.78) ( = .03). Sensitivity was similar within the reader experience groups ( = .96). Image navigation variables that were associated with higher sensitivity included longer interpretation time ( = .003) and greater use of coronal images ( < .001). The eye gaze time was at least 0.5 and 2.0 seconds for 71% (266 of 377) and 40% (149 of 377) of missed metastases, respectively. Conclusion Abdominal radiologists demonstrated better discrimination for the detection of liver metastases on abdominal contrast-enhanced CT images. Missed metastases frequently received at least a brief eye gaze. Higher sensitivity was associated with longer interpretation time and greater use of liver display windows and coronal images. © RSNA, 2022
背景 在 CT 成像等常见任务中，读者之间存在很大的变异性，例如检测肝转移。这种可变性可能通过导致误诊而损害患者护理。目的 确定与读者经验、图像导航模式（例如，眼球运动、工作站交互）以及在增强腹部 CT 图像上漏诊的肝转移灶的注视时间相关的读者间变异性对对比度增强腹部 CT 图像的影响。材料与方法 在 2020 年 12 月至 2021 年 2 月期间在一家学术机构进行的单中心前瞻性观察性试验中，招募了读者来检查 40 项增强腹部 CT 研究（8 项正常，32 项包含 91 个肝转移灶）。读者划定了肝转移灶并报告了信心。工作站跟踪了图像导航和眼球运动。使用 Jackknife 替代自由响应接收器操作特征 (JAFROC-1) 曲线下面积和每转移灶灵敏度来量化性能，并将其与读者经验和图像导航变量相关联。使用 Kruskal-Wallis 检验评估 JAFROC 曲线下面积的差异，然后使用 Dunn 检验，使用 Wilcoxon 符号秩检验评估图像导航的影响。结果 招募了 25 名读者（中位数年龄为 38 岁；IQR，31-45 岁；19 名男性），包括 9 名腹部放射科专家、5 名非腹部放射科专家和 11 名高级住院医师或研究员。读者经验解释了 JAFROC 曲线下面积的差异，腹部放射科医生的 JAFROC 曲线下面积（平均，0.77；95%CI：0.75，0.79）大于培训生（平均，0.71；95%CI：0.69，0.73）（=0.02）或非腹部专业放射科医生（平均，0.69；95%CI：0.60，0.78）（=0.03）。在读者经验组内，灵敏度相似（=0.96）。与更高灵敏度相关的图像导航变量包括更长的解释时间（=0.003）和更多使用冠状图像（<0.001）。注视时间对于至少 71%（377 个中的 266 个）和 40%（377 个中的 149 个）的漏诊转移灶至少为 0.5 和 2.0 秒。结论 腹部放射科医生在腹部增强 CT 图像上检测肝转移的能力表现出更好的辨别力。漏诊的转移灶经常会受到至少短暂的注视。更高的灵敏度与更长的解释时间以及更多地使用肝脏显示窗口和冠状图像相关。©RSNA，2022
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