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 endemi...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 (0.81). 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.展开更多
Objective To assess inter-observer variations of pulmonary nodule marking in routine clinical chest digital radiograph (DR) softcopy reading by using a lung nodule computer toolkit.Methods A total of 601 chest posteri...Objective To assess inter-observer variations of pulmonary nodule marking in routine clinical chest digital radiograph (DR) softcopy reading by using a lung nodule computer toolkit.Methods A total of 601 chest posterior-anterior DR images were randomly selected from routine outpatient screening in Peking Union Medical College Hospital. Two chest radiologists with experience more than ten years were first asked to read the images and mark all suspicious nodules independently by using computer toolkit IQQA-Chest, and to indicate the likelihood for each nodule detected. They were also asked to draw the boundary of the identified nodule manually on an enlarged region of interest, which was instantly analyzed by IQQA-Chest. Two sets of diagnostic reports, including the marked nodules, likelihood, manually drawn boundaries, quantitative measurements, and radiologists’ names, were automatically generated and stored by the computer system. One week later, the two radiologists read the same images together by using the same computer toolkit without referring to their previous reading results. Marking procedure was the same except that consensus was reached for each suspicious region. Statistical analysis tools provided in the IQQA-Chest were used to compare all the three sets of reading results.Results In the independent readings, Reader 1 detected 409 nodules with a mean diameter of 12.4 mm in 241 patients, and Reader 2 detected 401 nodules with a mean diameter of 12.6 mm in 253 patients. In the consensus reading, a total of 352 nodules with a mean diameter of 12.4 mm were detected in 220 patients. Totally, 42.3% of Reader 1’s and 45.1% of Reader 2’s marks were confirmed by the consensus reading. About 40% of each reader’s marks agreed with the other. There were only 130 (14.4%) out of the total 904 unique nodules were confirmed by both readers and the consensus reading. Moreover, 5.6% (51/904) of the marked regions were rated identical likelihood in all three readings. Statistical analysis showed significant differences between Readers 1 and 2, and between consensus and Reader 2 in determining the likelihood of the marks (P<0.01), but not between consensus and Reader 1. No significant difference in terms of size was observed in nodule segmentation between either two of the three readings. Conclusion Large variations in nodule marking and nodule-likelihood determination but not in nodule size were observed between experts as well as between single-person reading and consensus reading.展开更多
Introduction: To investigate the inter-observer and inter-modality variabilities of two imaging guided equipments—cone-beam computed tomography (CBCT) and ultrasound (US) in kidney stereotactic body radiotherapy. Met...Introduction: To investigate the inter-observer and inter-modality variabilities of two imaging guided equipments—cone-beam computed tomography (CBCT) and ultrasound (US) in kidney stereotactic body radiotherapy. Methods: A renal metastasis case implanted with three gold anchor fiducial markers was firstly scanned by US to acquire a 3-dimension US image and followed by 4-dimension CBCT in every fraction. Seven observers retrospectively registered the pre-treatment images with the corresponding reference images based on the gold markers. Registration uncertainty of the observers between two imaging modalities was evaluated. Results: The uncertainties over whole treatment course in CBCT were 0.88 mm, 1.94 mm and 0.86 mm in lateral, longitudinal and vertical directions respectively;while 0.8 mm, 0.97 mm and 1.36 mm were found in US. Conclusion: The greatest uncertainty was found in longitudinal direction in CBCT due to the fact that the respiration motion is the most rigorous in cranial-caudal direction. In US, since the probe was hold almost in upright position, the strong echo in vertical direction was attributed to the greatest uncertainty for such direction.展开更多
<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-sta...<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-stage prostate cancer, and it is believed that the plan quality and treatment outcome are associated with contour accuracy of both the target and organs-at-risk (OAR). The purposes of this study are to 1) assess geometric and dosimetric uncertainties due to inter-observer contour variabilities and 2) evaluate the effectiveness of geometric indicators to predict target dosimetry in prostate radiotherapy. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Twenty prostate patients were selected for this retrospective study. Five experienced clinicians created unique structure sets containing prostate, seminal vesicles, bladder, and rectum for each patient. A fully automated script and knowledge-based planning routine were utilized to create standardized and unbiased plans that could be used to evaluate changes in isodose distributions due to inter-observer variability in structure segmentation. Plans were created on a “gold-standard” structure set, as well as on each of the user-defined structure sets. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Inter-observer variability of contours during structure segmentation was very low for clearly defined organs such as the bladder but increased for organs without well-defined borders (prostate, seminal vesicles, and rectum). For plans generated with the user-defined structure sets, strong/moderate correlations were observed between the geometric indicators for target structure agreement and target coverage for both low-risk and intermediate-risk patient groups, while OAR indicators showed no correlation to final dosimetry. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Target delineation is crucial in order to maintain adequate dosimetric coverage regardless of the associated inter-observer uncertainties in OAR contours that had a limited impact upon final dosimetry.</span></span>展开更多
Aims & Objectives: Aim of the study was to evaluate inter-observer variability in interpretation of Gallium-68 labeled Prostate Specific Membrane Antigen sub-type 11 (68Ga-PSMA-11) Positron Emission Tomography-Com...Aims & Objectives: Aim of the study was to evaluate inter-observer variability in interpretation of Gallium-68 labeled Prostate Specific Membrane Antigen sub-type 11 (68Ga-PSMA-11) Positron Emission Tomography-Computed Tomography PET_CT scan according to Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. Method and Materials: Forty-four consecutive patients of prostate cancer were prospectively studied between the duration of January 2021 to June 2021 at Institute of Nuclear Medicine and Oncology (INMOL), Lahore. All PET-CT scans were assessed by a researcher and 3 nuclear physicians and divided into two groups, interpreted in two phases. In the first phase, each group independently evaluated the scans while in the second phase, a consensus meeting was held and all the cases with discordance were discussed. Cohen’s Kappa test was used to measure interobserver variability with the cut-off of K’s alpha Results: The study showed 41 out of 44 scans with positive PSMA findings while 03 scans were negative for any PSMA avid disease. In the first phase of image analysis, the level of agreement was slight in T stage (Kappa = 0.068, p = 0.65), moderate in the miN stage (Kappa = 0.46, p = 0.02) and substantial in miM stage (Kappa = 0.77, p ≤ 0.001) was seen. For PSMA score, overall agreement was substantial agreement (Kappa = 0.64, p Conclusion: Remarkable inter-observer agreement was seen in PROMISE criteria.展开更多
Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagn...Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）展开更多
AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea bre...AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori -uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings:regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS:Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases:uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION:The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.展开更多
There have been multiple NOD2/CARD15 genotype- phenotype analyses undertaken in patients with Crohn’s disease since the gene’s discovery in 2001. This review focuses on the major published series based upon their si...There have been multiple NOD2/CARD15 genotype- phenotype analyses undertaken in patients with Crohn’s disease since the gene’s discovery in 2001. This review focuses on the major published series based upon their size and on the presence of specific clinical and genetic information provided in the published material from 2001 to 2005. Twelve studies provided raw data to carry out comparisons of disease location while ten studies included analysis of NOD2/CARD15 genotypes. NOD2/CARD15 variant frequency in ileal disease did not differ significantly among studies, whereas a comparison of disease location demonstrated highly significant differences among studies. Meta-analysis confirmed significant associations between NOD2/CARD15 variants and both ileal and ileocolonic disease locations, and with both stricturing and penetrating forms of disease behavior. This review underlines the significant phenotypic differences that exist among populations, including similar ethnic groups, and has demonstrated the need for further studies of patients with long-term “inflammatory” Crohn’s disease.展开更多
AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive p...AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.展开更多
Objective：To research on consistency of identifying solitary pulmonary masses with CT. Methods：Three observers with different working backgrounds in imaging diagnosis individually interpreted the same group images o...Objective：To research on consistency of identifying solitary pulmonary masses with CT. Methods：Three observers with different working backgrounds in imaging diagnosis individually interpreted the same group images of solitary pulmonary mass, by 12 indexes of objective signs. The differences in interpretation resulted in ante- and post-interpretations were assessed by the x^2 test. The agreement of two interpretations from the same observer was confirmed with the kappa test. A double-blind method was adopted for analysis. Results：The agreement rates of ante- and post-interpreting from the three observers were respectively 82.65%（486/588） 80.27%（472/ 588） and 84.86% （499/588） while their interpreting results were generally accordant without significant difference（x^2 = 4.975, df= 2, P= 0.083） however there was difference between the observer 2 and observer 3（x^2 = 4.875, df= 1, P = 0.027）. There were five indexes with k 〉 0.40 of ante- and post-interpreting results of the three observers, including clarity of nodule borderline, presence of sentus, uniformity of density, existence of cavity and calcification in pathological region, among them, the agreement rate of interpreting borderline and cavity was higher（k 〉 0.07）; the blood vessel convergence poorer（0 〈 k ≤ 0.40）; the other six CT signs of interpretation were slightly different. Conclusion：The ability to identify solitary pulmonary mass was inconsistent, and needs to be improved further.展开更多
Objective To evaluate and reduce inter-observer variations in the detection and characterization of pulmonary nodules on digital radiograph （DR） chest images. Methods Two hundreds and thirty-two new posterior-anteri...Objective To evaluate and reduce inter-observer variations in the detection and characterization of pulmonary nodules on digital radiograph （DR） chest images. Methods Two hundreds and thirty-two new posterior-anterior DR chest images were collected from out-patient screening patients. Consensus was reached by two experienced radiologists on the marking, rating, and segmentation of small actionable nodules ranged from 5 to 15 mm in diameter using a computer-aided diagnosis （CAD） system. Both their own nodule findings and the computer＇s automatic nodule detection results were analyzed to make the consensus. Nodules identified together with corresponding likelihood rating and segmentation results were referred as ＂Gold Stand- ard＂. Two un-experienced radiologists were asked to first mark and characterize suspicious nodules independently, then were allowed to consult the computer nodule detection results and change their decisions. Results Large inter-observer variations in pulmonary nodule identification and characterization on DR chest images were observed between un-experienced radiologists. Un-expefienced radiologists could greatly benefit from the CAD system, including substantial decrease of inter-observer variation and improvement of nodule detection rates. Moreover, radiologists with different levels of skillfulness could achieve similar high level performance after using the CAD system. Conclusion The CAD system shows a high potential for providing a valuable assistance to the examination of DR chest images.展开更多
Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this pros...Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this prospective study was to evaluate whether this study method might be eligible in studies aiming at radiation dose reduction. Sinus CT scans were chosen as a model because of the high variation of the radiological anatomy of surgically important sinonasal structures. We hypothesized that 3 mm-slice-thick reconstruction CT had poor reproducibility. Methods: 59 CRS patients underwent routine multi-detector sinus CT (CT<sub>MD</sub>). CT<sub>3mm</sub> was reconstructed from CT<sub>MD</sub> data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CT<sub>MD</sub> and CT<sub>3mm</sub> (intra-observer reproducibility), and between three observers (inter-observer reproducibility) by using Cohen’s kappa. Results: The inter-observer agreement was moderate (kappa 0.4 - 0.6, p < 0.01) in the majority of structures of CT<sub>3mm</sub> scans. The intra-observer reproducibility of CT<sub>3mm</sub> scans was very good in most structures, however, it was poor in important structures such as frontal and spheno-ethmoid recess, lamina papyracae, and location of optic nerve or anterior ethmoidal artery. The grade of surgeon’s confidence of CT<sub>3mm</sub> in comparison to CT<sub>MD</sub> was lower (kappa 0.2 - 0.4, P < 0.05). Conclusion: This methodology might have some use in studies aiming at radiation dose reduction. As was expected, 3 mm-slice-thick reconstruction CT had poor reproducibility and surgeon’s confidence. More recent methods such as cone beam computed tomography scans have nowadays more relevant dose reduction potential.展开更多
BACKGROUND Syngeneic orthotopic tumor models offer an optimal functional tumor–immune interface for hepatocellular carcinoma research.Yet,unpredictable growth kinetics and spontaneous regression pose major obstacles....BACKGROUND Syngeneic orthotopic tumor models offer an optimal functional tumor–immune interface for hepatocellular carcinoma research.Yet,unpredictable growth kinetics and spontaneous regression pose major obstacles.Efficient induction protocols and continuous monitoring are therefore essential.Routine exploratory surgeries are ethically untenable,making non-invasive imaging modalities attractive alternatives.High-resolution magnetic resonance imaging and microcomputed tomography deliver detailed insights but incur substantial equipment costs,radiation risks,time demands,and require specialized expertise—challenges that limit their routine use.In contrast,ultrasound(US)imaging emerges as a cost-effective,radiation-free,and rapid approach,facilitating practical and ethical longitudinal assessment of tumor progression in preclinical studies.AIM To optimize the orthotopic hepatocellular carcinoma model and evaluate the potential of US imaging for accurate and cost-effective tumor monitoring.METHODS Hepatocellular carcinoma was induced in 28 Sprague Dawley rats by implanting 5×10^(6) N1S1 cells into the left lateral hepatic lobe.Tumor progression was monitored weekly via US.Upon reaching 100-150 mm^(3),an experimental group(n=14)received Sorafenib(40 mg/kg)orally on alternate days for 28 days;efficacy was compared to untreated controls.US accuracy was validated against micro-computed tomography,gross caliper measurements and histopathological analysis.Reliability and operator proficiency in US assessment were also evaluated.RESULTS US images procured 7-day post-surgery revealed a well-defined hypoechoic nodule at the left liver lobe tip,confirming successful tumor induction(mean volume 130±39 mm^(3)).Only three animals exhibited spontaneous regression by week 2,underscoring the model’s stability.Sorafenib treatment elicited a marked tumor reduction(678±103 mm^(3))vs untreated control(6005±1760 mm^(3)).US assessment demonstrated robust intra and interobserver reproducibility with high sensitivity and specificity for tumor detection.Moreover,US derived volumes correlated strongly with gross caliper measurements,histopathological analysis,and microcomputed tomography imaging,validating its reliability as a non-invasive monitoring tool in preclinical hepatocellular carcinoma studies.CONCLUSION The results demonstrate that US imaging is a reliable,cost-effective,and animal sparing approach with an easy tomaster protocol,enabling monitoring of tumor progression and therapeutic response in orthotopic liver tumor models.展开更多
Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial...Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.展开更多
文摘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 (0.81). 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.
文摘Objective To assess inter-observer variations of pulmonary nodule marking in routine clinical chest digital radiograph (DR) softcopy reading by using a lung nodule computer toolkit.Methods A total of 601 chest posterior-anterior DR images were randomly selected from routine outpatient screening in Peking Union Medical College Hospital. Two chest radiologists with experience more than ten years were first asked to read the images and mark all suspicious nodules independently by using computer toolkit IQQA-Chest, and to indicate the likelihood for each nodule detected. They were also asked to draw the boundary of the identified nodule manually on an enlarged region of interest, which was instantly analyzed by IQQA-Chest. Two sets of diagnostic reports, including the marked nodules, likelihood, manually drawn boundaries, quantitative measurements, and radiologists’ names, were automatically generated and stored by the computer system. One week later, the two radiologists read the same images together by using the same computer toolkit without referring to their previous reading results. Marking procedure was the same except that consensus was reached for each suspicious region. Statistical analysis tools provided in the IQQA-Chest were used to compare all the three sets of reading results.Results In the independent readings, Reader 1 detected 409 nodules with a mean diameter of 12.4 mm in 241 patients, and Reader 2 detected 401 nodules with a mean diameter of 12.6 mm in 253 patients. In the consensus reading, a total of 352 nodules with a mean diameter of 12.4 mm were detected in 220 patients. Totally, 42.3% of Reader 1’s and 45.1% of Reader 2’s marks were confirmed by the consensus reading. About 40% of each reader’s marks agreed with the other. There were only 130 (14.4%) out of the total 904 unique nodules were confirmed by both readers and the consensus reading. Moreover, 5.6% (51/904) of the marked regions were rated identical likelihood in all three readings. Statistical analysis showed significant differences between Readers 1 and 2, and between consensus and Reader 2 in determining the likelihood of the marks (P<0.01), but not between consensus and Reader 1. No significant difference in terms of size was observed in nodule segmentation between either two of the three readings. Conclusion Large variations in nodule marking and nodule-likelihood determination but not in nodule size were observed between experts as well as between single-person reading and consensus reading.
文摘Introduction: To investigate the inter-observer and inter-modality variabilities of two imaging guided equipments—cone-beam computed tomography (CBCT) and ultrasound (US) in kidney stereotactic body radiotherapy. Methods: A renal metastasis case implanted with three gold anchor fiducial markers was firstly scanned by US to acquire a 3-dimension US image and followed by 4-dimension CBCT in every fraction. Seven observers retrospectively registered the pre-treatment images with the corresponding reference images based on the gold markers. Registration uncertainty of the observers between two imaging modalities was evaluated. Results: The uncertainties over whole treatment course in CBCT were 0.88 mm, 1.94 mm and 0.86 mm in lateral, longitudinal and vertical directions respectively;while 0.8 mm, 0.97 mm and 1.36 mm were found in US. Conclusion: The greatest uncertainty was found in longitudinal direction in CBCT due to the fact that the respiration motion is the most rigorous in cranial-caudal direction. In US, since the probe was hold almost in upright position, the strong echo in vertical direction was attributed to the greatest uncertainty for such direction.
文摘<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-stage prostate cancer, and it is believed that the plan quality and treatment outcome are associated with contour accuracy of both the target and organs-at-risk (OAR). The purposes of this study are to 1) assess geometric and dosimetric uncertainties due to inter-observer contour variabilities and 2) evaluate the effectiveness of geometric indicators to predict target dosimetry in prostate radiotherapy. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Twenty prostate patients were selected for this retrospective study. Five experienced clinicians created unique structure sets containing prostate, seminal vesicles, bladder, and rectum for each patient. A fully automated script and knowledge-based planning routine were utilized to create standardized and unbiased plans that could be used to evaluate changes in isodose distributions due to inter-observer variability in structure segmentation. Plans were created on a “gold-standard” structure set, as well as on each of the user-defined structure sets. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Inter-observer variability of contours during structure segmentation was very low for clearly defined organs such as the bladder but increased for organs without well-defined borders (prostate, seminal vesicles, and rectum). For plans generated with the user-defined structure sets, strong/moderate correlations were observed between the geometric indicators for target structure agreement and target coverage for both low-risk and intermediate-risk patient groups, while OAR indicators showed no correlation to final dosimetry. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Target delineation is crucial in order to maintain adequate dosimetric coverage regardless of the associated inter-observer uncertainties in OAR contours that had a limited impact upon final dosimetry.</span></span>
文摘Aims & Objectives: Aim of the study was to evaluate inter-observer variability in interpretation of Gallium-68 labeled Prostate Specific Membrane Antigen sub-type 11 (68Ga-PSMA-11) Positron Emission Tomography-Computed Tomography PET_CT scan according to Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. Method and Materials: Forty-four consecutive patients of prostate cancer were prospectively studied between the duration of January 2021 to June 2021 at Institute of Nuclear Medicine and Oncology (INMOL), Lahore. All PET-CT scans were assessed by a researcher and 3 nuclear physicians and divided into two groups, interpreted in two phases. In the first phase, each group independently evaluated the scans while in the second phase, a consensus meeting was held and all the cases with discordance were discussed. Cohen’s Kappa test was used to measure interobserver variability with the cut-off of K’s alpha Results: The study showed 41 out of 44 scans with positive PSMA findings while 03 scans were negative for any PSMA avid disease. In the first phase of image analysis, the level of agreement was slight in T stage (Kappa = 0.068, p = 0.65), moderate in the miN stage (Kappa = 0.46, p = 0.02) and substantial in miM stage (Kappa = 0.77, p ≤ 0.001) was seen. For PSMA score, overall agreement was substantial agreement (Kappa = 0.64, p Conclusion: Remarkable inter-observer agreement was seen in PROMISE criteria.
基金Supported by the Korea Institute of Oriental Medicine,Republic of Korea(No.K15111)
文摘Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）
基金Supported by A Grant from the National Center for Global Health and Medicine
文摘AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori -uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings:regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS:Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases:uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION:The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.
基金Supported by A VIDI grant from the Netherlands Organiza-tion for Scientific Research(NWO,to Weersma RK),No.016.136.308an AGIKO grant from the Netherlands Organiza-tion for Scientific Research(NWO to Visschedijk MC),No.92.003.577MLDS grant of the Dutch Digestive Foundation,No.WO 11-72(to Alberts R)
文摘AIM: To validate the Montreal classification system for Crohn’s disease (CD) and ulcerative colitis (UC) within the Netherlands.
文摘There have been multiple NOD2/CARD15 genotype- phenotype analyses undertaken in patients with Crohn’s disease since the gene’s discovery in 2001. This review focuses on the major published series based upon their size and on the presence of specific clinical and genetic information provided in the published material from 2001 to 2005. Twelve studies provided raw data to carry out comparisons of disease location while ten studies included analysis of NOD2/CARD15 genotypes. NOD2/CARD15 variant frequency in ileal disease did not differ significantly among studies, whereas a comparison of disease location demonstrated highly significant differences among studies. Meta-analysis confirmed significant associations between NOD2/CARD15 variants and both ileal and ileocolonic disease locations, and with both stricturing and penetrating forms of disease behavior. This review underlines the significant phenotypic differences that exist among populations, including similar ethnic groups, and has demonstrated the need for further studies of patients with long-term “inflammatory” Crohn’s disease.
文摘AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.
文摘Objective：To research on consistency of identifying solitary pulmonary masses with CT. Methods：Three observers with different working backgrounds in imaging diagnosis individually interpreted the same group images of solitary pulmonary mass, by 12 indexes of objective signs. The differences in interpretation resulted in ante- and post-interpretations were assessed by the x^2 test. The agreement of two interpretations from the same observer was confirmed with the kappa test. A double-blind method was adopted for analysis. Results：The agreement rates of ante- and post-interpreting from the three observers were respectively 82.65%（486/588） 80.27%（472/ 588） and 84.86% （499/588） while their interpreting results were generally accordant without significant difference（x^2 = 4.975, df= 2, P= 0.083） however there was difference between the observer 2 and observer 3（x^2 = 4.875, df= 1, P = 0.027）. There were five indexes with k 〉 0.40 of ante- and post-interpreting results of the three observers, including clarity of nodule borderline, presence of sentus, uniformity of density, existence of cavity and calcification in pathological region, among them, the agreement rate of interpreting borderline and cavity was higher（k 〉 0.07）; the blood vessel convergence poorer（0 〈 k ≤ 0.40）; the other six CT signs of interpretation were slightly different. Conclusion：The ability to identify solitary pulmonary mass was inconsistent, and needs to be improved further.
文摘Objective To evaluate and reduce inter-observer variations in the detection and characterization of pulmonary nodules on digital radiograph （DR） chest images. Methods Two hundreds and thirty-two new posterior-anterior DR chest images were collected from out-patient screening patients. Consensus was reached by two experienced radiologists on the marking, rating, and segmentation of small actionable nodules ranged from 5 to 15 mm in diameter using a computer-aided diagnosis （CAD） system. Both their own nodule findings and the computer＇s automatic nodule detection results were analyzed to make the consensus. Nodules identified together with corresponding likelihood rating and segmentation results were referred as ＂Gold Stand- ard＂. Two un-experienced radiologists were asked to first mark and characterize suspicious nodules independently, then were allowed to consult the computer nodule detection results and change their decisions. Results Large inter-observer variations in pulmonary nodule identification and characterization on DR chest images were observed between un-experienced radiologists. Un-expefienced radiologists could greatly benefit from the CAD system, including substantial decrease of inter-observer variation and improvement of nodule detection rates. Moreover, radiologists with different levels of skillfulness could achieve similar high level performance after using the CAD system. Conclusion The CAD system shows a high potential for providing a valuable assistance to the examination of DR chest images.
文摘Background: After the failure of medical treatment, the surgery of chronic rhinosinusitis (CRS) is planned according to endoscopic and paranasal sinus computed tomography (CT) findings. Objective: The aim of this prospective study was to evaluate whether this study method might be eligible in studies aiming at radiation dose reduction. Sinus CT scans were chosen as a model because of the high variation of the radiological anatomy of surgically important sinonasal structures. We hypothesized that 3 mm-slice-thick reconstruction CT had poor reproducibility. Methods: 59 CRS patients underwent routine multi-detector sinus CT (CT<sub>MD</sub>). CT<sub>3mm</sub> was reconstructed from CT<sub>MD</sub> data-sets. Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. Agreement was studied between CT<sub>MD</sub> and CT<sub>3mm</sub> (intra-observer reproducibility), and between three observers (inter-observer reproducibility) by using Cohen’s kappa. Results: The inter-observer agreement was moderate (kappa 0.4 - 0.6, p < 0.01) in the majority of structures of CT<sub>3mm</sub> scans. The intra-observer reproducibility of CT<sub>3mm</sub> scans was very good in most structures, however, it was poor in important structures such as frontal and spheno-ethmoid recess, lamina papyracae, and location of optic nerve or anterior ethmoidal artery. The grade of surgeon’s confidence of CT<sub>3mm</sub> in comparison to CT<sub>MD</sub> was lower (kappa 0.2 - 0.4, P < 0.05). Conclusion: This methodology might have some use in studies aiming at radiation dose reduction. As was expected, 3 mm-slice-thick reconstruction CT had poor reproducibility and surgeon’s confidence. More recent methods such as cone beam computed tomography scans have nowadays more relevant dose reduction potential.
基金Supported by Amrita Vishwa Vidyapeetham Seed Grant,No.K-PHAR-24-722DST INSPIRE Fellowship,No.IF190226.
文摘BACKGROUND Syngeneic orthotopic tumor models offer an optimal functional tumor–immune interface for hepatocellular carcinoma research.Yet,unpredictable growth kinetics and spontaneous regression pose major obstacles.Efficient induction protocols and continuous monitoring are therefore essential.Routine exploratory surgeries are ethically untenable,making non-invasive imaging modalities attractive alternatives.High-resolution magnetic resonance imaging and microcomputed tomography deliver detailed insights but incur substantial equipment costs,radiation risks,time demands,and require specialized expertise—challenges that limit their routine use.In contrast,ultrasound(US)imaging emerges as a cost-effective,radiation-free,and rapid approach,facilitating practical and ethical longitudinal assessment of tumor progression in preclinical studies.AIM To optimize the orthotopic hepatocellular carcinoma model and evaluate the potential of US imaging for accurate and cost-effective tumor monitoring.METHODS Hepatocellular carcinoma was induced in 28 Sprague Dawley rats by implanting 5×10^(6) N1S1 cells into the left lateral hepatic lobe.Tumor progression was monitored weekly via US.Upon reaching 100-150 mm^(3),an experimental group(n=14)received Sorafenib(40 mg/kg)orally on alternate days for 28 days;efficacy was compared to untreated controls.US accuracy was validated against micro-computed tomography,gross caliper measurements and histopathological analysis.Reliability and operator proficiency in US assessment were also evaluated.RESULTS US images procured 7-day post-surgery revealed a well-defined hypoechoic nodule at the left liver lobe tip,confirming successful tumor induction(mean volume 130±39 mm^(3)).Only three animals exhibited spontaneous regression by week 2,underscoring the model’s stability.Sorafenib treatment elicited a marked tumor reduction(678±103 mm^(3))vs untreated control(6005±1760 mm^(3)).US assessment demonstrated robust intra and interobserver reproducibility with high sensitivity and specificity for tumor detection.Moreover,US derived volumes correlated strongly with gross caliper measurements,histopathological analysis,and microcomputed tomography imaging,validating its reliability as a non-invasive monitoring tool in preclinical hepatocellular carcinoma studies.CONCLUSION The results demonstrate that US imaging is a reliable,cost-effective,and animal sparing approach with an easy tomaster protocol,enabling monitoring of tumor progression and therapeutic response in orthotopic liver tumor models.
文摘Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.
