TITLE:
Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult
AUTHORS:
Marie Laure Gharingam, Boniface Moifo, Eric Walter Pefura Yone, André Pascal Kengne, Jean Roger Moulion Tapouh, Annick Laure Edzimbi, Georges Nguefack-Tsague, Samuel Nko’o Amvene
KEYWORDS:
Chest Radiography; Interpretation Scheme; Tuberculosis; Micro Nodules; Cavitations; Agreement
JOURNAL NAME:
Open Journal of Medical Imaging,
Vol.4 No.1,
March
7,
2014
ABSTRACT: Purpose: The complexity of chest radiography (CXR) is a
source of variability in its interpretation. We assessed the effect of an
interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis.
Methods: The study was conducted in Yaounde (Cameroon).
Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in
medical imaging) interpreted 47 frontal CXR twice two months apart without (R1)
and with (R2) the aid of an interpretation grid. We focused on the detection of
micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n
= 7). Results: The average score for accurate detection of elementary
lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and
52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the
highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average
score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis
improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer
agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1)
than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly
variable with a modest improvement for the diagnosis of tuberculosis in R2.
Conclusion: Standardized interpretation scheme improved the
detection of CXR anomalies and diagnosis of tuberculosis. It significantly
improved inter-observer’s agreement in diagnosing tuberculosis but not in
detecting most lesions.