Author(s)

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

Department of Medical Imaging and Radiation Therapy, The University of Yaoundé I, Yaoundé, Cameroon.
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon.
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon; Department of Internal Medicine and Specialties, The University of Yaoundé I, Yaoundé, Cameroon; Service of Pulmonology, Yaounde Jamot Hospital, Yaounde, Cameroon.
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon; Department of Medical Imaging and Radiation Therapy, The University of Yaoundé I, Yaoundé, Cameroon.
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon; Department of Public Health, The University of Yaoundé I, Yaoundé, Cameroon.
South African Medical Research Council & University of Cape Town, Cape Town, South Africa.

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.

Chest Radiography; Interpretation Scheme; Tuberculosis; Micro Nodules; Cavitations; Agreement

Laure Gharingam, M. , Moifo, B. , Walter Pefura Yone, E. , Pascal Kengne, A. , Roger Moulion Tapouh, J. , Laure Edzimbi, A. , Nguefack-Tsague, G. and Nko’o Amvene, S. (2014) Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult. Open Journal of Medical Imaging, 4, 23-30. doi: 10.4236/ojmi.2014.41004.