尘肺病诊断分期中两种DR胸片阅读方法的比较

Comparison of two kinds of reading methods in chest DR for the diagnosis and classification of pneumoconiosis

目的探讨不同阅读方式下数字化X线胸片(DR)对尘肺病诊断分期的影响。方法回顾分析98例同时拍摄高仟伏X线胸片和DR片的粉尘作业人员图像,由两名有尘肺病诊断资质的执业医师采用双盲法分别进行DR图像的软、硬读片。以高仟伏阅读结果作为标准,评价两种DR读片方式的差异及两名阅读者的一致性。结果在DR图像小阴影分布、形态/大小、密集度、大阴影或小阴影聚集等方面,硬读片判断的准确性略高于软读片,两名阅读者的一致性较好;在DR片诊断分期方面,两名阅片者软、硬读片的一致性均较好(Kappa值=0.509、0.899,P<0.001),硬读片的准确性高于软读片,二者的差异有统计学意义(P<0.001)。结论采用不同方式阅读DR胸片对尘肺病的诊断分期有影响。

Objective To explore the effect of different reading mode on digital chest radio- graph （DR） for the diagnosis and classification of pneumoconiosis. Methods A retrospective analysis of 98 cases of workers exposed to dust were done whose DR images were taken at the same time of high kV X-ray films. Two diagnostic qualified practitioners read soft copy and hard copy DR images with double blind method respectively. As the standard of high KV read- ing, the differences of soft, hard reading manner on DR images and inter-reader agreement were evaluated. Results In small shadow distribution, shape/size, profusion, large shadows or small shadow aggregation, the accuracy of reading DR hard copy was slightly higher than soft copy, and the consistency of two readers was better; In the diagnosis and staging, whether soft or hard manner, the consistency of two readers was better （ Kappa value = 0. 509, 0. 899, P 〈 0. 001 ）, the accuracy of hard reading was higher than that of soft reading, which had significantly statistical differences （ P 〈 0. 001 ）. Conclusion Different ways of reading DR chest film affect the diagnosis and staging of pneumoconiosis.