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.
Highlights
In spite of numerous advances in cross-sectional thoracic imaging, chest radiography (CXR) remains the leading imaging modality for the exploration, diagnosis and monitoring of many chest diseases [1] [2]
Inspired by the Chest Radiography Reading and Recording System (CRRS) and Japan-Vietnam Chest x-ray Coding System (JVCS) reading systems [6] [9], we developed a new CXR interpretation scheme and assessed its effect on the detection of CXR anomalies and radiographic diagnosis of pulmonary tuberculosis in adults Cameroonians
Development of the Interpretation Grid A group comprising one experienced radiologist, one experienced pulmonologist, one final year specialist radiologist in training and one final year medical student developed the CXR interpretation grid based on an adaptation of the “Chest radiograph reading and recording system” CRRS [9] and “Japan-Vietnam CXR coding system” JVCs [6]
Summary
In spite of numerous advances in cross-sectional thoracic imaging, chest radiography (CXR) remains the leading imaging modality for the exploration, diagnosis and monitoring of many chest diseases [1] [2]. In most circumstances, it is the first-line imaging modality and frequently the only diagnostic imaging test used in patients with confirmed or suspected chest disease [1]-[4]. In most sub-Saharan Africa countries where TB is endemic, CXR is very often the only available or accessible chest imaging test [11] [12]. We are not aware of studies on the benefit of a CXR standardized interpretations grid in sub-Saharan African countries
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