Washowich T L, Williams S C, Richardson L A, Simmons G E, Dao N V, Allen T W, Hammet G C, Morris M J
Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
J Digit Imaging. 1997 Feb;10(1):34-9. doi: 10.1007/BF03168548.
The purpose of this study was to compare the detection of interstitial lung abnormalities on video display workstation monitors between radiologists experienced with video image interpretation and radiologists who lack this experience. Twenty-four patients with interstitial lung abnormalities documented by high-resolution computed tomography (HRCT) and lung biopsy, and 26 control patients with no history of pulmonary disease or a normal HRCT and normal chest radiographs were studied. Images were acquired using storage phosphor digital radiography and displayed on 1,640 x 2,048 pixel resolution video monitors. Five board-certified radiologists evaluated the images in a blinded and randomized manner by using a six-point presence of abnormality grading scale. Three radiologists were from 1 to 4 years out of residency and considered to be experienced workstation monitor readers with between 1 to 3 years of video monitor image interpretation. For the inexperienced readers, one radiologist had no prior experience with reading images from a video monitor and was direct out of residency, and the other radiologist had less than 4 months of intermittent exposure and was 1 year out of residency. Sensitivity and specificity were determined for individual readers. Positive predictive values, negative predictive values, accuracy, and receiver-operating curves were also generated. A comparison was made between experienced and inexperienced readers. For readers experienced with video monitor image interpretation, the sensitivity ranged from 87.5% to 92%, specificity from 69% to 92%, positive predictive value (PPV) from 73% to 87.5%, negative predictive value (NPV) from 87% to 90%, and accuracy from 80% to 88%. For inexperienced readers, these values were sensitivity 58%, specificity 50% to 65%, PPV 52% to 61%, NPV 56.5% to 63%, and accuracy 54% to 62%. Comparing image interpretation between experienced and inexperienced readers, there were statistically significant differences for sensitivity (P < .01), specificity (P < .01), PPV (P < .05), NPV (P < .05), accuracy (P < .05), and area under the receiver operator curve (Az) (P < .01). Within the respective experienced and inexperienced groups, no statistical significant differences were present. Our results show that digitally acquired chest radiographs displayed on high-resolution workstation monitors are adequate for the detection of interstitial lung abnormalities when the images are interpreted by radiologists experienced with video image interpretation. Radiologists inexperienced with video monitor image interpretation, however, cannot reliably interpret images for the detection of interstitial lung abnormalities.
本研究的目的是比较有视频图像解读经验的放射科医生与缺乏该经验的放射科医生在视频显示工作站监视器上对间质性肺异常的检测情况。研究了24例经高分辨率计算机断层扫描（HRCT）和肺活检证实有间质性肺异常的患者，以及26例无肺部疾病史、HRCT和胸部X线片正常的对照患者。图像采用存储磷光体数字X线摄影采集，并显示在分辨率为1640×2048像素的视频监视器上。5名获得委员会认证的放射科医生采用六点异常存在分级量表，以盲法和随机方式对图像进行评估。3名放射科医生已完成住院医师培训1至4年，被认为是有经验的工作站监视器阅片者，有1至3年的视频监视器图像解读经验。对于缺乏经验的阅片者，一名放射科医生此前没有从视频监视器上阅读图像的经验，刚完成住院医师培训，另一名放射科医生有不到4个月的间歇性接触经验，已完成住院医师培训1年。确定了每位阅片者的敏感性和特异性。还生成了阳性预测值、阴性预测值、准确性和受试者操作曲线。对有经验和缺乏经验的阅片者进行了比较。对于有视频监视器图像解读经验的阅片者，敏感性范围为87.5%至92%，特异性为69%至92%，阳性预测值（PPV）为73%至87.5%，阴性预测值（NPV）为87%至90%，准确性为80%至88%。对于缺乏经验的阅片者，这些值分别为敏感性58%，特异性50%至65%，PPV 52%至61%，NPV 56.5%至63%，准确性54%至62%。比较有经验和缺乏经验的阅片者的图像解读情况，在敏感性（P<.01）、特异性（P<.01）、PPV（P<.05）、NPV（P<.05）、准确性（P<.05）和受试者操作曲线下面积（Az）（P<.01）方面存在统计学显著差异。在各自有经验和缺乏经验的组内，不存在统计学显著差异。我们的结果表明，当由有视频图像解读经验的放射科医生解读时，显示在高分辨率工作站监视器上的数字采集胸部X线片足以检测间质性肺异常。然而，缺乏视频监视器图像解读经验的放射科医生不能可靠地解读图像以检测间质性肺异常。
