Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Boniface Moifo; Eric Walter Pefura-Yone; Georges Nguefack-Tsague; Marie Laure Gharingam; Jean Roger Moulion Tapouh; André-Pascal Kengne; Samuel Nko’o Amvene

doi:10.4236/ojmi.2015.53018

Home > Journals > Medicine & Healthcare > OJMI

OJMI> Vol.5 No.3, September 2015

Share This Article:

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area ()

Abstract Full-Text HTML XML

Download as PDF (Size:319KB) PP. 143-149

DOI: 10.4236/ojmi.2015.53018 2,953 Downloads 3,730 Views Citations

Author(s) Leave a comment

Boniface Moifo^1,2*, Eric Walter Pefura-Yone^1,3,4, Georges Nguefack-Tsague^1,5, Marie Laure Gharingam¹, Jean Roger Moulion Tapouh², André-Pascal Kengne⁶, Samuel Nko’o Amvene^1,2

Affiliation(s)

¹Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon.
²Department of Radiology and Radiation Oncology, FMBS, Yaoundé, Cameroon.
³Department of Internal Medicine and Specialties’, FMBS, Yaoundé, Cameroon.
⁴Service of Pneumology A, Jamot Hospital of Yaoundé, Yaoundé, Cameroon.
⁵Department of Public Health, FMBS, Yaoundé, Cameroon.
⁶South African Medical Research Council & University of Cape Town, Cape Town, South Africa.

ABSTRACT

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (<0.0), poor agreement (0.0 - 0.20), fair (0.21 - 0.40), moderate (0.41 - 0.60), good (0.61 - 0.80), excellent (>0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (－0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

KEYWORDS

Inter-Observer Variability, Concordance, Pulmonary Tuberculosis, Nodules, Caverns, Lung Cancer, Chest Radiography, Kappa

Cite this paper

Moifo, B. , Pefura-Yone, E. , Nguefack-Tsague, G. , Gharingam, M. , Tapouh, J. , Kengne, A. and Amvene, S. (2015) Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area. Open Journal of Medical Imaging, 5, 143-149. doi: 10.4236/ojmi.2015.53018.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Remy, J., Remy-Jardin, M., Bonnel, F., Masson, P. and Mastora, I. (2001) L’interprétation d’une radiographie thoracique revue et corrigée par la tomodensitométrie. Journal de Radiologie, 82, 1067-1679.

[2]	Gonsu Fotsin, J., Blackett Ngu, K., Ndjitoyap Ndam, E.C., Youmbissi, J.T., Simo Moyo, J. and Malonga, E. (1990) La radiographie thoracique pré-opératoire à l’Hôpital Central de Yaoundé: Etude analytique de 1969 clichés. Médecine d’Afrique Noire, 37, 310-313.

[3]	Moifo, B., Tambe, J., Pefura Yone, E.W., Zeh, O.F., Gonsu Kamga, J.E. and Gonsu Fotsin, J. (2012) Assessing the Role of Routine Chest Radiography in Asymptomatic Students During Registration at a University in an Endemic Area of Tuberculosis. Annals of Tropical Medicine and Public Health, 5, 419-422. http://dx.doi.org/10.4103/1755-6783.105122

[4]	Neossi Guena, M., Moifo, B., Pefura Yone, E.W., Mankaa Wankie, M., Rémy-Jardin, M., Rémy, J., et al. (2011) Influence des protocoles d’examen sur la qualité et les performances diagnostiques d’une TDM thoracique: Expérience du service d’imagerie thoracique du CHRU de Lille (France). Journal Africain d’Imagerie Médicale, 6, 277-289.

[5]	Sakurada, S., et al. (2012) Inter-Rater Agreement in the Anormal Chest X-Ray Findings for Tuberculosis between Two Asian Countries. BMC Infectious Disease, 12, 1-8. http://dx.doi.org/10.1186/1471-2334-12-31

[6]	Cascade, P.N., Kazerooni, E.A., Gross, B.H., Quint, L.E., Silver, T.M., Bowerman, R.A., Pernicano, P.G. and Gebremariam, A. (2001) Evaluation of Competence in the Interpretation of Chest Radiographs. Academic Radiology, 8, 315- 321. http://dx.doi.org/10.1016/S1076-6332(03)80500-7

[7]	Armato III, S.G., McNitt-Gray, M.F., Reeves, A.P., Meyer, C.R., McLennan, G., et al. (2007) The Lung Image Database Consortium (LIDC): An Evaluation of Radiologist Variability in the Identification of Lung Nodules on CT Scans. Academic Radiology, 14, 1409-1421. http://dx.doi.org/10.1016/j.acra.2007.07.008

[8]	Den Boon, S., Bateman, E.D., Enarson, A.D., Borgdorff, N.W., Verver, S., Lombard, C.J., et al. (2005) Development and Evaluation of a New Chest Radiograph Reading and Recording for Epidemiological Surveys of Tuberculosis and Lung Disease. International Journal of Tuberculosis and Lung Disease, 9, 1088-1096.

[9]	Graham, S., Das Gupta, K., Hidvegi, R.J., Hanson, R., Kosiuk, J., Al Zahrani, K., et al. (2002) Chest Radiograph Abnormalities Associated with Tuberculosis: Reproductility and Yield of Active Cases. International Journal of Tuberculosis and Lung Disease, 6, 137-142.

[10]	Balabanova, Y., Cocker, R., Fedorin, I., Zakharova, S., Plavinskij, S., Krukov, N., et al. (2005) Variability in Inter- pretation of Chest Radiographs among Russian Clinicians and Implications for Screening Programmes: Observational Study. British Medical Journal, 331, 1-4. http://dx.doi.org/10.1136/bmj.331.7513.379

[11]	Lorentz Quekel, G.B.A., Alphons Kessels, G.H., Reginald, G. and Engelshoven, M.J.V. (2001) Detection of Lung Cancer on the Chest Radiograph: A Study on Observer Performance. European Journal of Radiology, 39, 111-116. http://dx.doi.org/10.1016/S0720-048X(01)00301-1

[12]	Hopstaken, R.M., Witbraad, T., Van Engelshoven, J.M.A. and Dinant, G. (2004) Inter-Observer Variation in the Interpretation of Chest Radiographs for Pneumonia in Community-Acquired Lower Respiratory Tract Infections. Clinical Radiology, 58, 478-481.

[13]	Cherian, T., Mulholland, E.K., Carlin, J.B., Ostensen, H., Amin, R., de Campo, M., et al. (2005) Standardized Interpretation of Paediatric Chest Radiographs for the Diagnosis of Pneumonia in Epidemiological Studies. Bulletin of the World Health Organization, 191, 353-359.

[14]	van Cleeff, M.R., Kivihya-Ndugga, L.E., Meme, H., Odhiambo, J.A. and Klatser, P.R. (2005) The Role and Performance of Chest X-Ray for the Diagnosis of Tuberculosis: A Cost-Effectiveness Analysis in Nairobi, Kenya. BMC Infectious Diseases, 5, 111. http://dx.doi.org/10.1186/1471-2334-5-111

[15]	Kumar, N., Bhargava, S.K., Agrawal, C.S., George, K., Karki, P. and Baral, D. (2005) Chest Radiographs and Their Reliability in the Diagnosis of Tuberculosis. Journal of Nepal Medical Association, 44, 138-142.

[16]	OMS (2013) Global Tuberculosis Report 2012. http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf

[17]	Boulahbal, F. and Chaulet, P. (2004) La tuberculose en Afrique: Epidémiologie et mesures de lutte. Médecine Tropi- cale, 64, 224-228.

[18]	Blum, A., Feldmann, L., Brester, F., Jouanny, P., Briançon, S. and Régert, D. (1995) Intérêt du calcul du coefficient Kappa dans l’évaluation d’une méthode d’imagerie. Journal of Radiology, 7, 441-443.

[19]	Fermanian, J. (1984) Mesure de l’accord entre deux juges. Cas qualitatif. Revue d’Epidémiologie et de Santé Publique, 32, 140-147.

[20]	Anthony Viera, J. and Garrett, J.M. (2005) Understanding Interobserver Agreement: The Kappa Statistic. Family Medicine, 37, 360-363.

[21]	Sim, J. and Wright, C.C. (2005) The Kappa Statistic in Reliability Studies: Interpretation, and Sample Size Require- ments. Physical Therapy, 85, 257-268.

[22]	Whitley, E. and Ball, J. (2002) Sample Size Calculations. Critical Care, 6, 335-341. http://dx.doi.org/10.1186/cc1521

[23]	Landis, J.R. and Koch, G. (1977) The Measurement of Observer Agreement for Categorical Data. Biometrics, 33, 159- 174. http://dx.doi.org/10.2307/2529310

[24]	Abubakar, I., Story, A., Lipman, M., Bothamley, G., Van Hest, R., Andrews, N., et al. (2010) Diagnosis Accuracy of Digital Chest Radiograph for Pulmonary Tuberculosis in a UK Urban Population. European Respiratory Journal, 35, 689-692. http://dx.doi.org/10.1183/09031936.00136609

[25]	Zteou, B., Ghadouani, F., Tizniti, S., Mahla, H., Amara, B., Elbiaze, M. and Benjelloun, M.C. (2007) La tuberculose thoracique dans sa forme typique et atypique. SFR 2007. http://pe.sfrnet.org/Data/ModuleConsultationPoster/pdf/2007/1/8156b94b-1ee7-4896-9966-d3b8021dc2da.pdf

[26]	McAdams, H.P., Erasmus, J. and Winter, J.A. (1995) Radiologic Manifestations of Pulmonary Tuberculosis. Radio- logic Clinics of North America, 33, 655-678.

[27]	Dawson, R., Masuka, P., Edwards, D.J., Bateman, E.D., Bekker, L.G., Wood, R., et al. (2010) Chest Radiograph Reading and Recording System: Evaluation for Tuberculosis Screening in Patients with Advanced HIV. International Journal of Tuberculosis and Lung Disease, 14, 52-58.

[28]	Ralph, A.P., Ardian, M., Wiguna, A., Maguire, G.P., Becker, N.G., Drogumuller, G., et al. (2010) A Simple, Valid, Numerical Score for Grading Chest X-Ray Severity in Adult Smear-Positive Pulmonary Tuberculosis. Thorax, 65, 863-869. http://dx.doi.org/10.1136/thx.2010.136242