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- Title
Effectiveness of radiologist training in improving reader agreement for Lung-RADS 4X categorization.
- Authors
Kim, Hyungjin; Goo, Jin Mo; Kim, Tae Jung; Kim, Hyae Young; Gu, Guanmin; Gil, Bomi; Kim, Wooil; Park, Seon Young; Park, Junghoan; Park, Juil; Park, Harkhoon; Song, Wonkyu; Shin, Kyung Eun; Oh, Jiseon; Yoon, Sung Hyun; Lee, Sanghyup; Lee, Youkyung; Lim, Woo Hyeon; Jeong, Won Gi; Jung, Jung Im
- Abstract
Objectives: To identify the agreement on Lung CT Screening Reporting and Data System 4X categorization between radiologists and an expert-adjudicated reference standard and to investigate whether training led to improvement of the agreement measures and diagnostic potential for lung cancer. Methods: Category 4 nodules in the Korean Lung Cancer Screening Project were identified retrospectively, and each 4X nodule was matched with one 4A or 4B nodule. An expert panel re-evaluated the categories and determined the reference standard. Nineteen radiologists were asked to determine the presence of CT features of malignancy and 4X categorization for each nodule. A review was performed in two sessions, and training material was given after session 1. Agreement on 4X categorization between radiologists and the expert-adjudicated reference standard and agreement between radiologist-assessed 4X categorization and lung cancer diagnosis were evaluated. Results: The 48 expert-adjudicated 4X nodules and 64 non-4X nodules were evenly distributed in each session. The proportion of category 4X decreased after training (56.4% ± 16.9% vs. 33.4% ± 8.0%; p < 0.001). Cohen's κ indicated poor agreement (0.39 ± 0.16) in session 1, but agreement improved in session 2 (0.47 ± 0.09; p = 0.03). The increase in agreement in session 2 was observed among inexperienced radiologists (p < 0.05), and experienced and inexperienced reviewers exhibited comparable agreement performance in session 2 (p > 0.05). All agreement measures between radiologist-assessed 4X categorization and lung cancer diagnosis increased in session 2 (p < 0.05). Conclusion: Radiologist training can improve reader agreement on 4X categorization, leading to enhanced diagnostic performance for lung cancer. Key Points: • Agreement on 4X categorization between radiologists and an expert-adjudicated reference standard was initially poor, but improved significantly after training. • The mean proportion of 4X categorization by 19 radiologists decreased from 56.4% ± 16.9% in session 1 to 33.4% ± 8.0% in session 2. • All agreement measures between the 4X categorization and lung cancer diagnosis increased significantly in session 2, implying that appropriate training and guidance increased the diagnostic potential of category 4X.
- Subjects
RADIOLOGISTS; MULTIDETECTOR computed tomography; LUNG cancer; PULMONARY nodules
- Publication
European Radiology, 2021, Vol 31, Issue 11, p8147
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-021-07990-y