直读数字式摄影应用于尘肺病诊断的可行性研究

Feasibility Study of Direct Digital Radiography in Pneumoconiosis Diagnosis

[目的]研究直读数字式摄影(DR)和传统胶片-增感屏(FSR)摄影对尘肺病小阴影形态和密集度辨识的可比性与一致性,评估直接读出DR胸片摄影技术在尘肺病诊断中的可行性和技术关键。[方法]以204名尘肺病人和31名粉尘作业工人为研究对象,同期拍摄FSR片和DR片,对FSR片和从显示器直接读取DR片的胸片质量、小阴影形态、肺区小阴影密集度和大阴影的检出率进行比较分析。[结果]FSR废片率明显较DR高(P<0.001);两种胸片在判定肺区小阴影密集度上有较好的一致性(κ=0.77),从上肺区(κ=0.82)、中肺区(κ=0.75)到下肺区(κ=0.68)一致性略有降低;两种胸片对小阴影形态的判定没有明显差异(FSR 93.2%,DR 90.0%,P>0.05);对大阴影的识别表现一致(22.9%,44/192)。[结论]DR胸片质量优于FSR胸片,在尘肺病小阴影形态、密集度的判定和大阴影的识别上与FSR相似。

[Objective] To evaluate technical key points and applicability of direct digital radiography（DR）images in identification of pneumoconiosis,we compared the shape/size and profusion of small opacities between film screen radiography（FSR）and DR technique.[Methods] We enrolled 204 pneumoconiosis patients and 31 workers exposed to dust with FSR and DR images obtained,compared image quality,small opacity profusion and shape,large opacity identification between these two modalities.[Results] Significantly more FSR images were unacceptable for classification purposes compared to DR images（P 0.001）.The inter-modality agreement of small opacities was good with a weighted kappa（κ）of 0.77.The inter-modality agreement was high in the upper zones（κ = 0.82）,intermediate in the middle zones（κ = 0.75）and low in the lower zones（κ = 0.68）.The identification of small opacities was close（93.2% FSR and 90.0% DR）and the distributions of shape between FSR and DR did not significantly differ（P 0.05）.A complete agreement was achieved in the recognition of large opacities between modalities with 22.9%（44/192）of radiographs classified as having at least one large opacity in the same 44 subjects.[Conclusion] DR images with soft copy display are equivalent or superior to FSR technique with respect to the image quality and the recognition/ classification of small parenchymal lung opacities.