数字化X线摄影胸片与高仟伏胸片在尘肺病诊断中的一致性分析

目的 研究数字化X线摄影(digital radiography,DR)胸片和高仟伏胸片在尘肺病诊断中的一致性,探讨DR胸片用于尘肺病诊断的可行性.方法 随机选择25例某煤矿接尘工人,同时拍摄DR胸片和高仟伏胸片,在Philips Essenta DR机上对密度和对比度等图像后处理参数进行设置以确保DR胸片质量.将50张胸片随机分号并确保DR胸片和高仟伏X线胸片不同号,由6名具有尘肺病诊断资格的医师对两种胸片进行肓法独立阅片,比较两种胸片的一致性.结果 25例研究对象分别拍摄的DR胸片和高仟伏胸片质量均为优良片.6名读片者之间(共15对)诊断一致性比较,高仟伏胸片诊断,尘肺期别上有12对读片者的一致率超过68％,总体密集度上有11对渎片者的一致率超过68％;DR胸片诊断,尘肺期别上有13对读片者的一致率超过60％,在总体密集度上,有14对读片者的一致率超过60％.两种胸片在判定尘肺期别的一致率为72％,κ值为0.69(95％CI:0.46～0.92);总体密集度的一致率为80％,κ值为0.78(95％CI:0.61 ～0.95).结论 在保证胸片质量和降低读片差异的前提下,DR胸片和高仟伏胸片在尘肺病诊断上有较好的一致性.

The analysis of consistency between digital radiography and high-kV chest radiographs in diagnosis pneumoconiosis

Objective To study the consistency between DR and high-kV chest radiographs in diagnosis of pneumoconiosis and to explore the feasibility of DR chest radiograph in the diagnosis of pneumoconiosis.Methods Twenty five coal miners were examined with DR and high-kV chest radiographs at the same time.Image post-processing parameters(density,contrast,etc.)were set to ensure the quality of DR chest radiograph in Philips Essenta DR machine.In order to avoid the repetitive numbers,50 chest radiographs were numbered at random.Pneumoconiosis diagnosis was conducted by six independent certified occupational physicians of pneumoconiosis by blind method.The consistency between 2 kinds of chest films was assessed.Results All chest radiographs(25 cases,50 chest films)were excellent.The diagnosis results of six readers on the 15 pairs of DR and high-kV chest radiographies were summarized.For high-kV chest radiographs,the consistency of pneumoconiosis classification for 12 pairs of readers was more than 68 ％,the consistency of total density for 11 pairs of readers was more than 68 ％.For DR chest radiographs,the consistency of pneumoconiosis classification for 13pairs of readers was more than 60 ％,the consistency of total density for 14 pairs of readers was more than 60 ％.The consistency of pneumoconiosis classification between two chest radiographs was 72 ％(value: 0.69,95％CI:0.46～0.92),the consistency of total density between two chest radiographs was 80％(value: 0.78,95％CI: 0.61～0.95).Conclusion When the chest radiograph quality was good and the difference of reading films was low,there was a good consistency of pneumoconiosis diagnosis between DR chest radiographs and high-kV chest radiographs.