远程眼底图像阅片培训在提升新疆维吾尔自治区眼科医师诊断能力中的应用  

Application of remote fundus image reading training in improving the diagnostic ability of ophthalmologists in Xinjiang Uygur Autonomous Region

作　　者：赵旭峰 马秀艳[2] 李雪静[2] 秦莉[2] 锁莉娜 马文萍 李仕豪 陈甲兴 杨亚新[3] 李新霞[3] 谢涛[3] 李娟[3] 熊元姗 巫志勇[4] 常志怀 房默文 王婷[4] 刘虹 马朋举 刘朋朋 冉静 杨棣 薛长乐 谢臻 范召 汪洋 雷鹏 黄庆江 李冰 冯时 韦张琬钰 毛亦爽 于伟泓 张林军[2] Zhao Xufeng;Ma Xiuyan;Li Xuejing;Qin Li;Suo Lina;Ma Wenping;Li Shihao;Chen Jiaxing;Yang Yaxin;Li Xinxia;Xie Tao;Li Juan;Xiong Yuanshan;Wu Zhiyong;Chang Zhihuai;Fang Mowen;Wang Ting;Liu Hong;Ma Pengju;Liu Pengpeng;Ran Jing;Yang Di;Xue Changle;Xie Zhen;Fan Zhao;Wang Yang;Lei Peng;Huang Qingjiang;Li Bing;Feng Shi;Wei Zhangwanyu;Mao Yishuang;Yu Weihong;Zhang Linjun(Department of Ophthalmology,Peking Union Medical College Hospital,Key Laboratory of Ocular Fundus Diseases,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Ophthalmology,Xinjiang Production and Construction Corps Hospital,Urumqi 830002,China;Department of Ophthalmology First Division Hospital of Xinjiang Production and Construction Corps,Aksu 843000,China;Department of Ophthalmology,Fourth Division Hospital of Xinjiang Production and Construction Corps,Yining 835000,China;Department of Ophthalmology,Eighth Division Hospital of Xinjiang Production and Construction Corps(Shihezi People's Hospital),Shihezi 832000,China;Department of Ophthalmology,Tenth Division Beitun Hospital of Xinjiang Production and Construction Corps,Beitun 831300,China;Department of Ophthalmology,First Division Aral Hospital of Xinjiang Production and Construction Corps,Aral 843300,China)

机构地区：[1]中国医学科学院北京协和医院眼科中国医学科学院眼底病重点实验室,北京100730 [2]新疆生产建设兵团医院眼科,乌鲁木齐830002 [3]新疆生产建设兵团第一师阿克苏医院眼科,阿克苏843000 [4]新疆生产建设兵团第四师医院眼科,伊宁835000 [5]新疆生产建设兵团第八师医院(石河子市人民医院)眼科,石河子832000 [6]新疆生产建设兵团第十师北屯医院眼科,北屯831300 [7]新疆生产建设兵团第一师阿拉尔医院眼科,阿拉尔843300

出　　处：《中华眼底病杂志》2024年第12期941-946,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：新疆兵团科学技术局重点领域科技攻关计划(2021AB021);科技部国家重点研发计划项目(2022YFB4702905);中央高水平医院临床科研专项(2022-PUMCH-C-061)。

摘　　要：目的探索利用线上阅片培训的远程医疗教育模式对提升新疆维吾尔自治区(以下简称“新疆地区”)眼科医师眼底疾病诊断能力的可行性与效果。方法建立新疆生产建设兵团系统师级医院-兵团医院-北京协和医院三级阅片培训体系。2022年6月至2023年1月连续收集自新疆地区兵团医院和兵团医疗系统内4家师级医院眼科的后极部彩色眼底像4159张。其中,高血压视网膜病变、糖尿病视网膜病变、渗出型年龄相关性黄斑变性(AMD)、萎缩型AMD、视网膜静脉阻塞分别为3073、651、43、186、206张。图像按病种比例均分为3轮次(初次、二次、末次)阅片的图像集。参与培训(以下简称“参训”)医师来自新疆地区兵团医院和兵团系统师级医院的15名眼科医师。其中,男性7名,女性8名;年龄(38.1±4.0)岁。职称正高级、副高级、中级、初级分别为1、6、5、3名;学历本科、硕士分别为13、2名。从事眼底病专科工作时间(9.6±3.3)年。第一轮标注前进行阅片系统培训,每轮阅片后由北京协和医院医师对阅片结果进行反馈和讲解。每轮次阅片间诊断一致率、灵敏度、特异性比较行成对样本t检验;参训医师诊断水平提高与职称、学历、年龄、眼底病专业工作时间的相关性行Spearman或Pearson相关性分析。结果所有参训医师均完成初次、二次、末次阅片。每一轮次阅片结束后均进行了阅片总结,时间2h。所有参训医师初次、二次、末次阅片的平均诊断一致率分别为53.0%、67.0%、75.0%;灵敏度和特异性分别为0.38、0.69、054和0.66、0.85、0.96。初次与末次阅片诊断一致率比较,差异有统计学意义(P<0.001);二次阅片灵敏度较初次阅片明显提高,末次阅片灵敏度较二次阅片明显下降,差异均有统计学意义(P<0.05);二次阅片较初次阅片、末次阅片较二次阅片的特异性明显提高,差异均有统计学意义(P<0.05)。参训医师�Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region(hereinafter referred to as"Xinjiang Region")in diagnosing fundus diseases.Methods The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established.From June 2022 to January 2023,4159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system.Among them,hypertensive retinopathy,diabetic retinopathy,exudative age-related macular degeneration(AMD),atrophic AMD and retinal vein occlusion were 3073,651,43,186 and 206 cases,respectively.The images were divided into 3 rounds(first,second and last)according to the proportion of diseases.The doctors who participated in the training(hereinafter referred to as the"training")were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system.There were 7 male and 8 female.Age was(38.1±4.0)years.The titles of senior,deputy senior,intermediate and junior are 1,6,5 and 3 respectively;Bachelor's degree and master's degree are 13 and 2 respectively.The working time of fundus disease specialty was(9.6±3.3)years.The film reading system training was conducted before the first round of labeling,and after each round of film reading,the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results.The diagnostic consistency,sensitivity and specificity were compared by paired sample t test.Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title,education,age and working hours of ocular fundus disease.Results All the participating doctors completed the first,second and last reading.After each round of film

关 键 词：眼底疾病 高血压相关视网膜病变 糖尿病视网膜病变 年龄相关性黄斑变性 远程医疗 影像诊断 

分 类 号：R77[医药卫生—眼科]