Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices

Our plain-English summary of Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices, by T. Tamura, Y. Kusaka, N. Suganuma, et al (Industrial Health, 2018).

The study

• Authors: T. Tamura, Y. Kusaka, N. Suganuma, K. Suzuki, P. Subhannachart, S. Siriruttanapruk, N. Dumavibhat, X. Zhang, P.K. Sishodiya, T.A. Thanh, K.G. Hering, J.E. Parker, E. Algranti, F.S. O'Connor, H. Shida, M. Akira
• Journal: Industrial Health
• Published: 2018;56(5):382-393
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Two hundred and thirty-three individuals read chest x-ray images (CXR) in the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) workshop. Their proficiency in reading CXR for pneumoconiosis was calculated using eight indices (X1-X8), as follows: sensitivity (X1) and specificity (X2) for pneumoconiosis; sensitivity (X3) and specificity (X4) for large opacities; sensitivity (X5) and specificity (X6) for pleural plaques; profusion increment consistency (X7); and consistency for shape differentiation (X8). For these eight indices, one-way analysis of variance (ANOVA) and Scheffe's multiple comparison were conducted on six groups, based on the participants' specialty: radiology, respiratory medicine, industrial medicine, public health, general internal medicine, and miscellaneous physicians. Our analysis revealed that radiologists had a significant difference in the mean scores of X3, X5, and X8, compared with those of all groups, excluding radiologists. In the factor analysis, X1, X3, X5, X7, and X8 constituted Factor 1, and X2, X4, and X6 constituted Factor 2. With regard to the factor scores of the six participant groups, the mean scores of Factor 1 of the radiologists were significantly higher than those of all groups, excluding radiologists. The two factors and the eight indices may be used to appropriately assess specialists' proficiency in reading CXR.

In plain English

This study analysed test results from the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) training course. The course ran 12 times between 2008 and 2014 in Thailand, Japan, Brazil and India; 233 people attended. The specialty comparison covered 193 physicians: 51 radiologists, 46 respiratory, 65 industrial, 9 public health, 14 general and 8 miscellaneous physicians. Each read a 60-film chest x-ray examination. Answers were scored against the answers of 12 NIOSH B readers using eight indices, including sensitivity and specificity for pneumoconiosis, large opacities and pleural plaques. Radiologists had significantly higher mean scores than other groups for sensitivity for large opacities (0.974), sensitivity for pleural plaques (0.919) and shape differentiation of small opacities (0.911). Miscellaneous physicians scored significantly lower for pleural plaque sensitivity (0.597). A factor analysis yielded two factors. The first was a sensitivity- and small parenchymal abnormality-related factor, which also covered profusion and shape consistency. The second was a specificity-related factor. Radiologists scored significantly higher on the first. The authors concluded that the two factors and eight indices may be usable for assessing proficiency in reading chest x-rays for pneumoconiosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of examination scores from a training course for reading chest x-rays under the ILO Classification. Mean scores were compared across specialty groups (one-way ANOVA with Scheffe's multiple comparison), and a factor analysis was run on the eight scoring indices.
• Who was studied: 233 participants in the AIR Pneumo Training Course, held 12 times between 2008 and 2014 in Thailand (four times), Japan (four), Brazil (three) and India (one). The specialty analysis included 193 physicians: 51 radiologists, 46 respiratory physicians, 65 industrial physicians, 9 public health physicians, 14 general physicians and 8 miscellaneous physicians.
• Exposure: Not a study of workers' exposure. Physicians read a 60-film chest x-ray examination set. Correct answers were set by 12 NIOSH B readers. The physicians were compared by medical specialty. The findings scored included small opacities, large opacities and pleural plaques.
• Main results:
  • In the multiple comparison, radiologists had significantly higher mean scores than the other groups for three indices: sensitivity for large opacities (X3, 0.974 ± 0.072), sensitivity for pleural plaque (X5, 0.919 ± 0.100) and consistency for shape differentiation of small opacities (X8, 0.911 ± 0.114). The corresponding means for all participants were 0.881 ± 0.182, 0.804 ± 0.196 and 0.834 ± 0.157.
  • In the miscellaneous physicians group, mean sensitivity for pleural plaque (X5) was significantly lower than in the other groups (0.597 ± 0.258).
  • The respiratory physicians, public health physicians and general physicians groups showed no significant difference in any of the eight indices.
  • The factor analysis found two factors with eigenvalues above one (4.071 and 1.044). Factor 1 was named sensitivity and small parenchymal abnormality related. It grouped sensitivity for pneumoconiosis, large opacities and pleural plaque, profusion increment consistency, and shape differentiation. Factor 2 was named specificity related. It grouped specificity for pneumoconiosis, large opacities and pleural plaque.
  • Radiologists had a mean Factor 1 score of 0.4570 ± 0.4397. This was significantly higher than in the other groups (ANOVA p = 0.0137).
• The authors' conclusion: The authors concluded that the scores of the two factors and the eight indices from the 60-film examination may be usable for assessing proficiency in reading chest x-rays for pneumoconiosis. They suggested that proficiency may be higher among radiologists than among other specialists.

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Pneumoconiosis, Pleural Plaques.

Related studies

• Effect of a two-hour training on physicians' skill in interpreting Pneumoconiotic chest radiographs — N.R. Ngatu, S. Suzuki, et al. (2010)
• Evaluation of the efficacy of the guideline on reading CT images of malignant pleural mesothelioma with reference CT films for improving the proficiency of radiologists — H. Zhou, T. Tamura, et al. (2013)
• Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities — T.C. Larson, D.B. Holiday, et al. (2012)
• Comparison of chest radiograph reading methods for assessing progress of pneumoconiosis over 10 years in Wittenoom crocidolite workers — N.H. de Klerk, A.W. Musk, et al. (1990)
• Development of a guideline on reading CT images of malignant pleural mesothelioma and selection of the reference CT films — H. Zhou, T. Tamura, et al. (2012)
• Talc pneumoconiosis: a report of six patients with postmortem findings — M. Kleinfeld, C.P. Giel, et al. (1963)

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