Franken E A, Berbaum K S, Brandser E A, D'Alessandro M P, Schweiger G D, Smith W L
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA.
AJR Am J Roentgenol. 1997 May;168(5):1349-52. doi: 10.2214/ajr.168.5.9129442.
We performed a field study and subsequent laboratory investigation of pediatric radiology at a small rural hospital. Our investigation had three components: to describe the characteristics of pediatric radiology in a rural primary care facility, to test the diagnostic accuracy of interpretation of pediatric images transmitted by teleradiology, and to compare relative diagnostic accuracy of general and pediatric radiologists who interpreted pediatric images at a rural institution.
All 196 pediatric radiographs obtained during a 4-month period comprised the database from which we determined practice characteristics. Reports of 153 unselected cases interpreted by general radiologists using teleradiology were compared with interpretation of the same cases by a pediatric radiologist who interpreted the original radiographs. Discrepant cases were further investigated by a receiver-operating-characteristic curve experiment in which general and pediatric radiologists interpreted each case twice: once viewing teleradiologic images and once viewing the original radiographs at another setting. We then compared interpretive accuracy of observers and techniques.
The pediatric radiographs were predominantly simple examinations for common acute disease, particularly pneumonia and fractures. Discrepancies of interpretation between teleradiology and original radiographs, which occurred in 13% of images, showed no significant difference in accuracy of interpretation for either teleradiologic images or original radiographs. Likewise, we found no significant advantage for accuracy of interpretation by general or pediatric radiologists. Receiver-operating-characteristic analysis of 18 discrepant cases showed slightly increased accuracy for interpretation of original radiographs by pediatric subspecialists.
Simple pediatric radiographs obtained at a rural primary care institution and transmitted by teleradiology can be adequately interpreted by general radiologists.
我们在一家小型乡村医院对儿科放射学进行了实地研究及后续实验室调查。我们的调查包括三个部分：描述乡村初级保健机构中儿科放射学的特征，测试远程放射学传输的儿科影像解读的诊断准确性，以及比较在乡村机构解读儿科影像的普通放射科医生和儿科放射科医生的相对诊断准确性。
在4个月期间获取的所有196张儿科X光片构成了我们用以确定实践特征的数据库。将普通放射科医生使用远程放射学解读的153例未筛选病例的报告，与解读原始X光片的儿科放射科医生对相同病例的解读进行比较。对存在差异的病例通过接受者操作特征曲线实验作进一步调查，在该实验中普通放射科医生和儿科放射科医生对每个病例解读两次：一次查看远程放射学影像，另一次在另一环境下查看原始X光片。然后我们比较观察者和技术的解读准确性。
儿科X光片主要是针对常见急性疾病的简单检查，尤其是肺炎和骨折。远程放射学影像与原始X光片之间的解读差异出现在13%的影像中，在远程放射学影像或原始X光片的解读准确性方面未显示出显著差异。同样，我们发现普通放射科医生或儿科放射科医生在解读准确性方面没有显著优势。对18例存在差异的病例进行的接受者操作特征分析显示儿科专科医生对原始X光片的解读准确性略有提高。
在乡村初级保健机构获取并通过远程放射学传输的简单儿科X光片，普通放射科医生能够进行充分解读。
