不同分辨率影像诊断显示器的选择对孤立性肺结节识读影响的初步研究  

A ROC study of detection accuracy of single pulmonary nodules by image diagnostic monitors with different resolution

作　　者：程勇[1] 张雪林[1] 陈卫国[1] 杨慧[1] 吴元魁[1] 段刚[1] 刘国清[1] 

机构地区：[1]南方医科大学附属南方医院放射科,广东广州510515

出　　处：《医学影像学杂志》2008年第5期481-485,共5页Journal of Medical Imaging

摘　　要：目的:通过对胸部DR影像上孤立性肺结节检出准确率的比较来评价PACS影像诊断工作站所应用的不同分辨率医用显示器的诊断效能。方法:选取经CT证实具有非钙化孤立性肺结节100例,多发肺结节24例和疑似病例15例。2位高年资医生和3位低年资医生通过2种显示器(Barco MGD521 MKII(2560×2048,75Hz)21in(lin=2.54cm)医用单色RCT和EIZO RadiForce G20(1200×1600,60Hz)21in医用单色LCD上分别使用或不使用放大后处理功能集中进行4次独立阅片,分别对胸片上是否有肺结节及结节个数进行判断,评价的标准采用5分法:肯定有、可能有、不确定、可能没有、肯定没有。数据结果采用SPSS13.0软件受试者工作特征(ROC)曲线法进行统计分析。结果:①采用放大后处理功能后,各位医师的诊断准确率都能得到一定程度的改善,尤其在低年资医师更明显,而高年资医师在Barco RCT上的变化很小;在各种情况下阅片,高年资医师的诊断准确率都明显高于低年资医师(P<0.05);②3位低年资医师使用EIZOLCD并加用放大功能,其平均Az值(Az=0.674)高于在Barco RCT上不加用放大功能时的平均Az值(Az=0.651),之间存在小的但具有统计学显著性意义的差别(P=0.044<0.05);而2位高年资医师的使用效果则相反。对所有医师而言,使用EIZO LCD加用放大功能(Az=0.702)与Barco RCT不加用放大功能(Az=0.703)的诊断效能无明显差别(P=0.475>0·05)。结论:①使用放大功能可以提高影像分辨率,进而提高诊断效能。相比于高年资医师而言,影像分辨率的增加更能改善低年资医师的诊断水平,并在一定程度上能减低诊断医师个体差别所造成的影响;②出于成本效益的考虑,科室可以安排低年资医师使用较低分辨率医用显示器完成初步诊断,但是要求常规使用放大后处理功能;高年资医师应使用标准分辨率的医用显示器以保证最终诊断结果的可靠性。Objective：The purpose of tiffs study was to assess the influence and diagnostic value of professional image diagnostic monitors with differem resolution used in PACS by determining the rate of detection of single pulmonary nodules （SPNs） on soft copy images of chest direct digital radiography. Methods： 100 chest radiographs showing a solitary noncalcified pulmonary nodule, 24 patients with multipulmonary nodules and 15 cases without pulmonary nodule were sclecteded for this study, and CT scans of the same patient served as the gold standard for the prescnee of pulmonary nodules. Two experienced radiologists and three residents interpreted 139 chest images four times by using diaonostic workstation monitors of PACS in two brands： Barco MGD521 MKⅡ （2,560 ×2,048 pixels,75Hz） 21 in professional RCT and EIZO RadiForee G20 （1,200 × 1,600 pixels,60Hz） 21 in professional LCD. Each time, the radiologists used one kind of display to interpret the images with image magnification or not and marked their confidence of the nodules, the presence or absence of SPNs was investigated with a five-point confidences rating scale： ① definitely positive; ② probably positive; ③ indeterminate;④ probably negative, and ⑤ definitely negative. The interpreting results were analyzed by SPSS 13.0 software-the receiver operating characteristic （ROC） curve. Results： ① The observer performance （Az values） of all radiologists increased with using magnification, especially for the residents. For experienced radiologists, the performance of Bareo RCT with or without magnification was comparable. In all monitors, the observer performance of experienced radiologists was higher titan that of residents （ P 〈 0.05） ; ② For residents, the performance on EIZO LCD with magnification （Az = 0.674） was superior to Bareo RCT withoutmagnification （Az = 0.651） （ P = 0.044 〈 0.05）. But for experienced radiologists, the performance was opposite. To all observers, there was no significant difference

关 键 词：孤立性肺结节 影像识读 显示器 分辨率 ROC曲线 数字化放射成像 

分 类 号：P563[天文地球—构造地质学] R445[天文地球—地质学]