CT colonography: accuracy of initial interpretation by radiographers in routine clinical practice.
ABSTRACT To investigate performance of computed-assisted detection (CAD)-assisted radiographers interpreting computed tomography colonography (CTC) in routine practice.
Three hundred and three consecutive symptomatic patients underwent CTC. Examinations were double-read by trained radiographers using primary two-dimensional/three-dimensional (2D/3D) analysis supplemented by "second reader" CAD. Radiographers recorded colonic neoplasia, interpretation times, and patient management strategy code (S0, inadequate; S1, normal; S2, 6-9 mm polyp; S3, > or = 10 mm polyp; S4, cancer; S5, diverticular stricture) for each examination. Strategies were compared to the reference standard using kappa statistic, interpretation times using paired t-test, learning curves using logistic regression and Pearson's correlation coefficient.
Of 303 examinations, 69 (23%) were abnormal. CAD-assisted radiographers detected 17/17 (100%) cancers, 21/28 (72%) polyps > or = 10 mm and 42/60 (70%) 6-9 mm polyps. The overall agreement between radiographers and the reference management strategy was good (kappa 0.72; CI: 0.65, 0.78) with agreement for S1 strategy in 189/211 (90%) exams; S2 in 19/27 (70%); S3 in 12/19 (63%); S4 in 17/17 (100%); S5 in 5/6 (83%). The mean interpretation time was 17 min (SD = 11) compared with 8 min (SD = 3.5) for radiologists. There was no learning curve for recording correct strategies (OR 0.88; p = 0.12) but a significant reduction in interpretation times, mean 14 and 31 min (last/first 50 exams; -0.46; p < 0.001).
Routine CTC interpretation by radiographers is effective for initial triage of patients with cancer, but independent reporting is currently not recommended.
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ABSTRACT: OBJECTIVE: To compare computed tomographic colonography (CTC) performance of four trained radiographers with the CTC performance of two experienced radiologists. METHODS: Four radiographers and two radiologists interpreted 87 cases with 40 polyps ≥6 mm. Sensitivity, specificity, and positive predictive value (PPV) were assessed on a per-patient basis. On a per-polyp basis, sensitivity was calculated according to the respective size categories (polyps ≥6 mm as well as polyps ≥10 mm). RESULTS: Overall per-patient sensitivity for polyps ≥6 mm was 76.2 % (95 % CI 61.4-91.0) and 76.2 % (95 % CI 61.7-90.6), for the radiographers and radiologists, respectively. Overall per-patient specificity for polyps ≥6 mm were 81.4 % (95 % CI 73.7-89.2) and 81.1 % (95 % CI 73.8-88.3) for the radiographers and the radiologists, respectively. For the radiographers, overall per-polyp sensitivity was 60.3 % (95 % CI 50.3-70.3) and 60.7 % (95 % CI 42.2-79.2) for polyps ≥6 mm and ≥10 mm, respectively. For the radiologists, overall per polyp sensitivity was 59.2 % (95 % CI 46.4-72.0) and 69.0 % (95 % CI 48.1-89.6) for polyps ≥6 mm and ≥10 mm, respectively. CONCLUSION: Radiographers with training in CT colonographic evaluation achieved sensitivity and specificity in polyp detection comparable with that of experienced radiologists. MAIN MESSAGES : • The diagnostic accuracy of trained radiographers was comparable to that of experienced radiologists. • The use of radiographers in reading CTC examinations is acceptable, however radiologists would still be necessary for the evaluation of extracolonic findings. • Skilled non-radiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal.06/2013; 4(4). DOI:10.1007/s13244-013-0260-x
- 03/2011; 2(2):96-104. DOI:10.1136/fg.2009.000380
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ABSTRACT: To assess the performance of radiographers in CT colonography (CTC) after a tele-training programme, supervised by 2 experienced radiologists. Five radiographers underwent training in CTC using a tele-training programme mainly based on the interpretation of 75 training cases performed in the novice department. To evaluate the educational performance, each radiographer was tested on 20 test cases with 27 lesions >6mm (12: 6-9 mm; 15: >10mm). Sensitivity, specificity and PPV for polyps ≥ 6 mm and ≥ 10 mm were calculated with point estimates and 95% confidence interval (95% CI). The results were compared by comparing 95% CI with a 5% significance level. In the training cases overall per-polyp sensitivity was 57% (95% CI 46.1-67.9) and 69.1% (95% CI 50.6-87.5) for lesions ≥ 6 mm and ≥ 10 mm, respectively. Overall per patient sensitivity, specificity and PPV were 86.4% (95% CI 76.7-96.1), 85.4% (95% CI 77-93.9) and 78.3% (95% CI 64.9-91.7), respectively. In the test cases overall per-polyp sensitivity was 80.7% (95% CI 69.5-92) and 94.7% (95% CI 85.6-100 ×) for lesions ≥ 6 mm and ≥ 10 mm, respectively. Overall per patient sensitivity, specificity and PPV were 92.9% (95% CI 83.1-100 ×), 64% (95% CI 13.1-100 ×) and 87.8% (95% CI 71.7-100 ×), respectively. There was a statistically significant improvement in per-polyp sensitivity for lesions ≥ 6 mm in the test cases. No statistically significant differences were found in per patient sensitivity, specificity and PPV, but there was an improvement. This training programme based on tele-training obtained good performance of radiographers in detecting tumoral lesions in CTC.European journal of radiology 03/2011; 81(5):851-6. DOI:10.1016/j.ejrad.2011.02.028 · 2.16 Impact Factor