Young M, Marrie T J
Department of Medicine, Dalhousie University, Halifax, Nova Scotia.
Arch Intern Med. 1994;154(23):2729-32. doi: 10.1001/archinte.1994.00420230122014.
Previous studies have found considerable interobserver variability in the roentgenographic diagnosis of pneumonia. In this study we determined the impact of experience on interobserver variability in the interpretation of chest roentgenograms of patients with pneumonia and defined the characteristics of chest roentgenograms interpreted as pneumonia by all groups.
The chest roentgenograms of 15 consecutive patients with a clinical and roentgenographic diagnosis of pneumonia were read by a convenience sample of 10 first-year and 20 fourth-year medical students, 21 medical residents, and 21 staff physicians from the department of medicine. Three board-certified radiologists served as the gold standard. The majority rule decision and logistic regression analysis were used to analyze agreement among the various groups of observers.
Agreement with the majority decisions of the gold-standard radiologists on the presence or absence of pneumonia for all observations of the various groups were as follows: original radiologist, 87%; first-year medical students, 59%; fourth-year medical students, 54%; medical residents, 66%; and attending staff, 72%. Chest roentgenograms with dense lobar or segmental opacities were generally interpreted as pneumonia by all observers. Patchy opacities caused major disagreements and were usually read as not being due to pneumonia. Bronchopneumonia was not diagnosed by any of the observers. Air bronchograms, atelectasis, and chronic obstructive lung disease were usually not recognized by the nonradiologists.
There is considerable interobserver variability in the roentgenographic diagnosis of pneumonia. This variability does not improve with increasing experience. Dense lobar or segmental opacities are uniformly recognized as pneumonia while patchy opacities result in a variety of interpretations.
先前的研究发现，在肺炎的X线诊断中，观察者之间存在相当大的差异。在本研究中，我们确定了经验对肺炎患者胸部X线片解读中观察者间差异的影响，并明确了所有组均解读为肺炎的胸部X线片的特征。
选取15例临床及X线诊断为肺炎的连续患者的胸部X线片，由10名一年级医学生、20名四年级医学生、21名住院医师和21名内科 staff physicians组成的便利样本进行阅片。3名获得委员会认证的放射科医生作为金标准。采用多数规则决策和逻辑回归分析来分析不同观察组之间的一致性。
对于各观察组的所有观察结果，与金标准放射科医生关于是否存在肺炎的多数决策的一致性如下：原放射科医生为87%；一年级医学生为59%；四年级医学生为54%；住院医师为66%；主治 staff physicians为72%。所有观察者通常将有致密叶或节段性实变的胸部X线片解读为肺炎。斑片状实变导致了主要分歧，通常被解读为不是由肺炎引起的。所有观察者均未诊断出支气管肺炎。非放射科医生通常未识别出空气支气管征、肺不张和慢性阻塞性肺疾病。
在肺炎的X线诊断中存在相当大的观察者间差异。这种差异不会随着经验的增加而改善。致密的叶或节段性实变均被一致认为是肺炎，而斑片状实变则导致了多种解读。
