Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Centre for Medical Imaging, University College London, UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
Eur Radiol. 2023 Mar;33(3):2096-2104. doi: 10.1007/s00330-022-09172-w. Epub 2022 Oct 25.
To quantify reader agreement for the British Society of Thoracic Imaging (BSTI) diagnostic and severity classification for COVID-19 on chest radiographs (CXR), in particular agreement for an indeterminate CXR that could instigate CT imaging, from single and paired images.
Twenty readers (four groups of five individuals)-consultant chest (CCR), general consultant (GCR), and specialist registrar (RSR) radiologists, and infectious diseases clinicians (IDR)-assigned BSTI categories and severity in addition to modified Covid-Radiographic Assessment of Lung Edema Score (Covid-RALES), to 305 CXRs (129 paired; 2 time points) from 176 guideline-defined COVID-19 patients. Percentage agreement with a consensus of two chest radiologists was calculated for (1) categorisation to those needing CT (indeterminate) versus those that did not (classic/probable, non-COVID-19); (2) severity; and (3) severity change on paired CXRs using the two scoring systems.
Agreement with consensus for the indeterminate category was low across all groups (28-37%). Agreement for other BSTI categories was highest for classic/probable for the other three reader groups (66-76%) compared to GCR (49%). Agreement for normal was similar across all radiologists (54-61%) but lower for IDR (31%). Agreement for a severe CXR was lower for GCR (65%), compared to the other three reader groups (84-95%). For all groups, agreement for changes across paired CXRs was modest.
Agreement for the indeterminate BSTI COVID-19 CXR category is low, and generally moderate for the other BSTI categories and for severity change, suggesting that the test, rather than readers, is limited in utility for both deciding disposition and serial monitoring.
• Across different reader groups, agreement for COVID-19 diagnostic categorisation on CXR varies widely. • Agreement varies to a degree that may render CXR alone ineffective for triage, especially for indeterminate cases. • Agreement for serial CXR change is moderate, limiting utility in guiding management.
量化英国胸成像学会（BSTI）对胸部 X 线（CXR）诊断和严重程度分类的读片者一致性，特别是对可能引发 CT 成像的不确定 CXR 的一致性，包括单幅图像和配对图像。
20 名读片者（四组，每组 5 人）——胸部顾问（CCR）、普通顾问（GCR）、专科住院医师（RSR）放射科医生和传染病临床医生（IDR）——对来自 176 名符合指南的 COVID-19 患者的 305 张 CXR（129 对；2 个时间点）进行 BSTI 分类和严重程度评估，以及改良的 COVID-放射学评估肺水肿评分（Covid-RALES）。使用两种评分系统，计算与两位胸部放射科医生共识相比，（1）需要 CT（不确定）与不需要 CT（典型/可能，非 COVID-19）的分类的百分比一致性；（2）严重程度；以及（3）配对 CXR 上的严重程度变化。
所有组的不确定类别与共识的一致性均较低（28-37%）。对于其他三个读片者群体，其他 BSTI 类别中经典/可能的一致性最高（66-76%），而 GCR 为 49%。对于正常的一致性，所有放射科医生均相似（54-61%），但 IDR 较低（31%）。对于 GCR，严重 CXR 的一致性较低（65%），而其他三个读片者群体为 84-95%。对于所有组，配对 CXR 之间的变化一致性较低。
对于不确定的 BSTI COVID-19 CXR 类别，一致性较低，对于其他 BSTI 类别和严重程度变化，一致性通常为中等，表明该测试，而不是读片者，在决定处置和连续监测方面均存在局限性。
在不同的读片者群体中，CXR 上 COVID-19 诊断分类的一致性差异很大。
一致性在一定程度上可能使 CXR 单独用于分诊效果不佳，特别是对于不确定的病例。
系列 CXR 变化的一致性适中，限制了其在指导管理方面的实用性。
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