煤工尘肺高千伏胸片和DR胸片对比研究分析

Comparative analysis on the high kilovoltage chest radiographs and digital radiography chest radiographs in diagnosis of coal workers' Pneumoconiosis

目的探讨煤工尘肺高千伏X线胸片和数字化X线摄影（digital Radiography,DR）胸片诊断结果的一致性,评估DR在尘肺病诊断中的应用价值。方法对来自某煤炭矿业集团的104例井下接尘工人行高千伏胸片及DR检查,患者均为男性,年龄35~70岁,平均接尘工龄9~40 a。3名诊断医师分别对104例接尘工人高千伏胸片及DR片进行肺内小阴影形态、密集度及分期诊断,对数据进行一致性检验,一致性评价采用一致率和平方加权Kappa（K）表示。结果①高千伏X线胸片和DR胸片在判断尘肺病肺内小阴影形态方面的一致性诊断率为61.54%,其中p、q、s、t一致率分别为15.63%,79.69%,1.56%,3.13%;不一致诊断率为38.46%,其中差异较大的是p/q,占比77.5%。②高千伏胸片和DR在判断尘肺病肺内结节总体密集度方面的一致性诊断率为81.75%,其中0、1、2、3级一致率分别为11.76%,61.18%,24.71%,2.35%,不一致诊断率为18.27%,其中DR过高诊断率约占52.63%,过低诊断率约为47.37%。③高千伏胸片与DR胸片诊断尘肺病的一致率为81.73%,Kpappa=0.714,P〈0.05。其中,观察对象、壹、贰、叁期分别占11.54%、36.54%、32.69%、0.96%。DR相对金标准高千伏X射线胸片诊断的煤工尘肺壹期过低诊断率为7/51（13.37%）,过高诊断率为6/51（11.76%）;DR相对高千伏X射线胸片诊断的煤工尘肺贰期过低诊断率为2/40（5%）,过高诊断率为0%;观察对象和叁期诊断一致率为100%。结论①煤工尘肺高千伏X线胸片和DR胸片在判断小阴影形态方面有较好一致性,但在p或q小阴影形态判断上容易出现差异;②煤工尘肺高千伏X射线胸片和DR胸片在判断尘肺病总体密度上有很好一致性,但两种检查方法在判断总体密集度为0或1时容易出现判断差异;③煤工尘肺高千伏X射线胸片和DR胸片在分期结果的诊断上有很好的一致性。④DR在煤工尘肺诊断中有较好的临床应用价值。

[ Objective ] To discuss the consistence between Digital Radiography （DR） and high kilovoltage （high-kV） chest radio- graphs in diagnosis of coal workers＇ pneumoconiosis, evaluate the application value of DR chest radiograph in diagnosis of pneumoconiosis. [ Methods] 104 coal workers selected from a Coal Mining Group were examined by high-kV and DR chest radiographs. The patients were all men; the range of their age was from 35 to 70 years old,the average was （51.74 ±9.30} years old; the length of exposure to dust was 9 ~ 40 years,the average was （ 24.74 ± 13.30） years. The shape, intensity and stages of small opacity of high-kV and DR chest radiographs of 104 coal workers were diagnosed by three diagnostic physicians. The data was checked consistency, which were evaluated by the concordance rate and Kappa（K）. [ Results] （~）The diagnosis consistency of the small opacity shape between DR and bigh-kV chest radiographs was 61.54%, among the concordance rate of p, q, s and t were 15.63%, 79. 69%, 1.56% and 3.13% respectively. The inconsistent diagnostic rate was 38.46%, among the difference of p/q was larger （77.5%）. （1）The diagnosis consistency of the intensity of pulmonary nodules between DR and high-kV chest radiographs was 81.75%, among the concordance rate of the grade 0,1,2 and 3 were 11.76%, 61.18%, 24.71%, and 2.35%. The inconsistent diagnostic rate was 18.27%, among high diagnostic rate of DR was 52.63% and low diagnostic rate was 47.37%. （3）The consistency of DR and high-kV chest radiographs in diagnosing the stage of pneumoconiosis was 81.73% and the value of Kappa was 0. 714 （ P 〈0.05 ）, among the observation object, stage Ⅰ , Ⅱand Ⅲ accounted for 11.54%, 36.54%, 32.69% and 0.96% respectively. Compared to the gold standard of high-kV chest radiographs, the low diagnostic rate of DR in diagnosing the stage Ⅰ of pneumoconiosis was 7/51 （ 13.72% ）, and the high diagnostic rate was 6/51 （ 11.76% }. The low diagnostic rate of stage Ⅱ was 2/40（5% }, and the high diagnostic rate was 0%. The diagnosis consistency of observation object and stage Ⅲ was 100%. [ Conclusion] （1）There is a better consistency of DR and high-kV chest radiographs in diagnosing the shape of small opacity, but there are differences in diagnosing the shape of p or q small opacity. （2）There is a good consistency of DR and high-kV chest radiographs in diagnosing the overall density of pneumoconiosis, but there are differences of two methods in diagnosing the density which is 0 or 1. （3）There is a good consistency of DR and high-kV chest radiographs in diagnosing the stage of pneumoconiosis. （4）The method of DR has the better application value in diagnosing the pneumoconiosis.