背景:在疑似急性冠状动脉综合征的医院检查中纳入冠状动脉计算机断层扫描血管造影(CTA)需要适当的技能来解释这种影像学检查。放射科医师的技能可能会影响评估这些研究的观察者之间的共识。
目的:根据放射科医师对急诊急性胸痛和中低概率急性冠脉综合征患者进行冠脉CTA研究的经验,确定观察者之间的共识。
方法:我们研究了在冠状动脉CTA研究的紧急评估中观察者之间的一致性,其中使用CAD-RADS来记录发现。我们在总共8名评估员(4名主治医师和4名放射科住院医师)中创建了成对的观察者。我们根据他们的经验使用kappa系数来估计总体一致性和亚组之间的一致性。
结果:对于所有CAD-RADS,有经验的放射科医师和居民(k=0.627;95CI:0.436-0.826)以及所有观察者对(k=0.661;95CI:0.506-0.823)之间的一致性很高。在所有分析中,经验丰富的放射科医师组中的一致程度均大于居民组中的一致程度。对于整体CAD-RADS(k=0.950;95%CI:0.896-1)和CAD-RADS≥4(k=1),一致性很好;对于CAD-RADS≥3(k=0.754;95%CI:0.246-1.255),一致性较低。这些类别的居民协议分别为k=0.523,k=0.596和k=0.473。
结论:主治放射科医师对紧急冠状动脉CTA研究的评估意见一致。当居民与主治放射科医生配对时,协议较低。在急诊科实施冠状动脉CTA以及放射工作人员组织解释和报告此成像测试时,应考虑这些发现。
BACKGROUND: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists\' skills can affect the interobserver agreement in evaluating these studies.
OBJECTIVE: To determine the interobserver agreement according to radiologists\' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome.
METHODS: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience.
RESULTS: The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively.
CONCLUSIONS: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.