张镏琢, 梁实, 李智民. 1990—2018年我国尘肺病诊断读片差异的中文文献研究[J]. 职业卫生与应急救援, 2019, 37(5): 420-424, 452. DOI: 10.16369/j.oher.issn.1007-1326.2019.05.006
引用本文: 张镏琢, 梁实, 李智民. 1990—2018年我国尘肺病诊断读片差异的中文文献研究[J]. 职业卫生与应急救援, 2019, 37(5): 420-424, 452. DOI: 10.16369/j.oher.issn.1007-1326.2019.05.006
ZHANG Liuzhuo, LIANG Shi, LI Zhimin. Deviation of X-ray diagnosis of pneumoconiosis in China: a literature review from 1990 to 2018[J]. Occupational Health and Emergency Rescue, 2019, 37(5): 420-424, 452. DOI: 10.16369/j.oher.issn.1007-1326.2019.05.006
Citation: ZHANG Liuzhuo, LIANG Shi, LI Zhimin. Deviation of X-ray diagnosis of pneumoconiosis in China: a literature review from 1990 to 2018[J]. Occupational Health and Emergency Rescue, 2019, 37(5): 420-424, 452. DOI: 10.16369/j.oher.issn.1007-1326.2019.05.006

1990—2018年我国尘肺病诊断读片差异的中文文献研究

Deviation of X-ray diagnosis of pneumoconiosis in China: a literature review from 1990 to 2018

  • 摘要:
    目的 系统分析尘肺病诊断中读片差异情况及其产生的原因,为制定干预措施,提高尘肺病诊断准确性提供依据。
    方法 检索1990年1月1日-2018年12月31日我国关于尘肺病诊断读片相关研究的中文文献,确定评价指标,遴选相关文献并进行系统分析。
    结果 共检索出331篇中文文献,其中有16篇文献符合遴选要求,发表时间为1991-2014年。研究内容大多是上级诊断机构专家对被抽取的诊断机构已诊断为尘肺病的胸片进行读片,部分是诊断专业人员个人自身复读,对两组或两次读片结果进行对比分析,指标包括尘肺病分期、总体密集度,各肺区小阴影密集度和形态,是否存在小阴影聚集、大阴影、胸膜病变等;评价指标以符合率为主。前后两次读片时,集体两次读片符合率(85.9%~94.0%)高于个人两次读片符合率(15%~64%);不同集体读片符合率大多在60%以上,最高84.2%,最低40.0%。读片者的职称和专业、小阴影特征(包括形态和密集度)、胸片质量等均会对读片结果产生影响。
    结论 无论是集体诊断还是个人阅片,读片差异都是普遍存在的,应采取必要的干预措施,保证尘肺病诊断更加科学、准确和权威。

     

    Abstract:
    Objective A systematic review of studies published in Chinese journals reporting deviation in pneumoconiosis diagnosis was conducted, to explore the main reasons and to improve diagnostic quality in the future.
    Methods The original articles related to pneumoconiosis diagnosis published in Chinese journals during the period from Jan 1, 1991 to Dec 31, 2018 in the various database were searched and selected by defined evaluation index, and reviewed systematically.
    Results A total of 16 appropriate articles were found from 331 articles, and the study time varied from 1991 to 2014. Most studies were that experts from superior diagnostic institutions re-read the chest X-ray films that have been diagnosed with pneumoconiosis by the sampled diagnostic institutions, some were re-read by diagnostic professionals themselves, and the results of the two readings were compared and analyzed. The analysis indicators included the pneumoconiosis stage, the form of small shadows, the intensity, the density of small shadows in each lung area, clustering of small shadows or large shadow, and pleural lesions. The consistent rate was the major evaluation indicator. The consistent rate of two times reading by the group reading (85.9%-94.0%) was higher than individual reading (15%-64%). The consistent rate of diagnosis made by group members varied 40.0%-84.2% and mostly higher than 60%. The major factors affecting the consistency included the professional level of diagnostic experts (e.g., professional title and specialty), the quality of radiograph, and the typical characteristics (e.g., shape of small shadows, intensity and density in each lung area).
    Conclusion The deviation in diagnosis of pneumoconiosis always exist, regardless of group reading or individual reading. The necessary training should be taken to ensure the quality of diagnosis.

     

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