Hafeez Anam, Nadeem Naila, Iqbal Junaid, Qureshi Aneeqa, Shakeel Asad, Zafar Uffan
Radiology, Civil Hospital Sanghar, Sanghar, PAK.
Radiology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2022 Sep 27;14(9):e29672. doi: 10.7759/cureus.29672. eCollection 2022 Sep.
Introduction Pneumothorax is a common medical emergency and has potentially life-threatening consequences, so it is important for radiology residents and consultants to know its radiographic appearance so that timely diagnosis and appropriate management can be done. Patients with pneumothorax have nonspecific complaints, and clinical examinations are not confirmatory. The chest X-ray is easily available and has high accuracy in the detection of pneumothorax. The aim of this study is to determine the agreement between the on-call radiology resident and the attending radiologist in the diagnosis of pneumothorax on chest radiographs. Materials and methods This cross-sectional study was performed in the Department of Radiology at Aga Khan University Hospital, Karachi. After approval from the ethical review committee (ERC), the study was carried out. A total of 174 patients were included in the study. The resident interpreting the radiograph commented on the pneumothorax and recorded it on the "Comments" section of the picture archiving and communication system (PACS). Further entries were made in the department's "Panic Logbook." Subsequently, the final report by the attending radiologist was tallied, and the decision of both the resident and the attending radiologist regarding the presence or absence of pneumothorax was compared for interobserver agreement. Results Of the 174 patients, 139 (79.9%) were male and 35 (20.1%) were female. The mean age of the patients was 45.6 ± 12.4 years. Pneumothorax was reported by the resident in 164 (94.25%) cases, while the attending radiologist reported it in 167 (96%) cases. The remaining 4% of cases were ultimately diagnosed on a CT scan of the chest performed at the request of the primary team; they were too small to be detected on a chest radiograph. The most common side involved was the right side, with 112 (64.4%) cases, followed by the left side with 55 (31.6%) and both sides with five (2.9%), while in two cases, pneumothorax was not reported by the resident and the attending radiologist. The position of the pneumothorax was as follows: apex in 80 (46%), base in 56 (32.2%), and along the lateral border of the lung in 93 (53.4%). Concordance between the resident and the radiologist was found to be 92.5% (kappa = 0.20; p = 0.008). Stratification for age, gender, the position of pneumothorax, and the level of residency was also carried out. Conclusion In our setting, there was a high level of agreement (92.5%) between the resident and the attending radiologist in reporting pneumothorax on chest radiographs (kappa = 0.20; p = 0.008).
引言
气胸是一种常见的医疗急症，可能会导致危及生命的后果，因此对于放射科住院医师和会诊医师来说，了解其影像学表现非常重要，以便能够及时进行诊断和恰当处理。气胸患者的症状不具特异性，临床检查也无法确诊。胸部X线检查容易获得，且在气胸检测方面具有较高的准确性。本研究的目的是确定值班放射科住院医师与会诊放射科医师在胸部X线片诊断气胸方面的一致性。
材料与方法
本横断面研究在卡拉奇阿迦汗大学医院放射科进行。经伦理审查委员会（ERC）批准后开展了该研究。共有174例患者纳入研究。解读X线片的住院医师对气胸情况进行评论，并记录在图像存档与通信系统（PACS）的“评论”部分。同时在科室的“紧急日志”中做进一步记录。随后，核对会诊放射科医师的最终报告，并比较住院医师与会诊放射科医师关于气胸是否存在的判断，以评估观察者间的一致性。
结果
174例患者中，男性139例（79.9%），女性35例（20.1%）。患者的平均年龄为45.6±12.4岁。住院医师报告气胸的有164例（94.25%），会诊放射科医师报告气胸的有167例（96%）。其余4%的病例最终是应原诊疗团队要求进行胸部CT扫描后确诊的；这些气胸在胸部X线片上太小而无法检测到。最常受累的一侧是右侧，有112例（64.4%），其次是左侧，有55例（31.6%），双侧受累的有5例（2.9%），而有2例住院医师与会诊放射科医师均未报告气胸。气胸的位置如下：肺尖部80例（46%），肺底部56例（32.2%），沿肺外侧缘93例（53.4%）。住院医师与放射科医师之间的一致性为92.5%（kappa=0.20；p=0.008）。还对年龄、性别、气胸位置和住院医师级别进行了分层分析。
结论
在我们的研究环境中，住院医师与会诊放射科医师在胸部X线片报告气胸方面的一致性较高（92.5%）（kappa=0.20；p=0.008）。
