Reading and interpretation of chest X-ray in adults with community-acquired pneumonia

Abstract

Introduction: Traditional reading of chest X-rays usually has a low prognostic value and poor agreement. Objective: This study aimed to determine the interobserver and intraobserver agreement using two reading formats in patients with community-acquired pneumonia, and to explore their association with etiology and clinical outcomes. Methods: A pulmonologist and a radiologist, who were blind to clinical data, interpreted 211 radiographs using a traditional analysis format (type and location of pulmonary infiltrates and pleural findings), and a quantitative analysis (pulmonary damage categorized from 0 to 10). For both, the interobserver and intraobserver agreement was estimated (Kappa statistic and intraclass correlation coefficient). The latter was assessed in a subsample of 25 radiographs three months after the initial reading. Finally, the observers made a joint reading to explore its prognostic usefulness via multivariate analysis. Results: Seventy-four chest radiographs were discarded due to poor quality. With the traditional reading, the mean interobserver agreement was moderate (0.43). It was considered good when the presence of pleural effusion, and the location of the infiltrates in the right upper lobe and both lower lobes, were evaluated; moderate for multilobar pneumonia; and poor for the type of infiltrates. The mean intraobserver agreement for each reviewer was 0.71 and 0.5 respectively. The quantitative reading had an agreement between good and excellent (interobserver 0.72, intraobserver 0.85 and 0.61). Radiological findings were neither associated to a specific pathogen nor to mortality. Conclusion: In patients with pneumonia, the interpretation of the chest X-ray, especially the smallest of details, depends solely on the reader.

Speed and accuracy of mobile BlackBerry Messenger to transmit chest radiography images from a small community emergency department to a geographically remote referral center

“…Most variation in CXR interpretation occurred on non-urgent, less objective features such as cardiomegaly, hyperinflation, or atelectasis. Prior studies examining the inter-rater reliability among certified radiologists have reported wide variations in results 18–22 and agreements in our study appeared higher. Reliable and validated methods of comparing original with texted images do not currently exist.…”

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016

“…In einer Studie wiesen 21 % der Patienten mit einer im Verlauf gesicherten Diagnose einer Pneumonie im initialen Röntgenthoraxbild kein Infiltrat auf [41]. Zudem besteht bei leicht-bis mittelgradigen Pneumonien eine erhebliche Untersucherabhängigkeit hinsichtlich der Beurteilung von Infiltraten [44]. Bei stationären Patienten mit einer im Verlauf bestätigten Pneumonie, die initial kein radiologisches Korrelat hatten, ist die Letalität erhöht [45].…”

Determining the clinical significance of errors in pediatric radiograph interpretation between emergency physicians and radiologists

“…Earlier studies of inter-observer reliability among staff radiologists in diagnosing pneumonia on the basis of chest radiographs found a wide range of agreement, with Kappa values between 0.54 and 0.92. [16][17][18][19][20] This variation in interpretation suggests that with the added benefit of clinical findings, EPs may be more likely to make an accurate diagnosis.…”