直接数字X线摄影与屏胶X摄影在尘肺病诊断中的对比

Comparison between direct digital radiography and screen-film radiography in diagnosis of early stage pneumoconiosis

目的研究直接数字X线摄影(DR)与屏胶X线摄影(SFR)在尘肺病诊断中的差异大小,为DR技术最终应用于尘肺诊断提供基础资料。方法 105例壹期确诊病例和30例接尘工人,同期拍摄DR和SFR胸片;依据国家尘肺病诊断标准(GBZ70—2009),对两者的胸片质量、小阴影形态及密集度进行判定,并对结果进行对比分析。结果 DR胸片中质量达到一级或二级的比例明显高于SFR胸片(P<0.001);两种胸片评价小阴影形态、总体密集度、诊断分期结果的一致性处于中等水平(kappa值分别为0.73、0.48、0.53);限定两种胸片均为一级片后,相应的kappa值提高至0.77、0.64、0.67。两种胸片各肺区小阴影密集度结果(P<0.001)及小阴影密集度1/0(含)以上肺区数(P=0.006)差异均有统计学意义。结论 DR胸片较SFR胸片具有显著的质量优势,有良好的应用前景,但需制订基于DR技术的尘肺病标准片。

Objective To survey the difference between digital radiography（DR）and screen-film radiography（SFR）in diagnosis of patients with stage-Ⅰ pneumoconiosis or dust exposed workers,thereby provide some basic data for the application of DR in diagnosis of pneumoconiosis.Methods 105 patients with stage-Ⅰ pneumoconiosis and 30 dust exposed workers were selected for DR and SFR examination,the image quality,small opacity types（shape and size）and their profusion in DR and SFR were assessed according to National Diagnostic Criteria of Pneumoconiosis（GBZ70—2009）.Results Compared with SFR,more DR images reached quality class Ⅱ（P〈0.001）,the coincidence rate between DR and SFR images in assessing small opacity types（shape and size）（κ=0.73）,overall profusion（κ=0.48）and classification（κ=0.53）.If the image quality of both DR and FSR was limited to class Ⅰ,the κ values were risen to 0.77,0.64 and 0.67 respectively.Additionally,there were also some significant differences in judgment of small opacity profusion（P〈0.001）and the number of zones with higher small opatity prafusion（1/0 and above）（P=0.006）.Conclusion The results suggested that DR has better image quality and a great potential for application in diagnosis of pneumoconiosis,therefore,a new DR standard images and techniques for pneumoconiosis diagnosis should be well prepared.