title: The predictive value and inter-observer variability of donor chest radiograph interpretation in lung transplantation.
abstract: OBJECTIVE
  Currently the relationship between the evaluation of the donor chest radiograph and the final disposition of potential donor lungs is unknown, yet potential lung donors receive frequent x-rays. We sought to clarify the role donor chest radiographs and donor lung acceptability.
  
  
  METHODS
  We conducted a retrospective review of 84 potential organ donors. Radiographs were reviewed separately by three thoracic surgeons and three pulmonologists and either accepted or rejected with no other information. Data was analyzed by Kappa statistic to judge inter-observer variance and it was compared to actual outcome to determine predictive value.
  
  
  RESULTS
  The Kappa statistics for observer agreement was 0.149 among the surgeons, 0.510 among the pulmonologists, and 0.336 overall, representing slight, moderate and fair agreement respectively. The reviewers' decisions to accept or reject a lung concurred with the actual clinical outcome 64.2% of the time. The positive predictive value of an accept decision was found to be 78.3% and the negative predictive value of a reject decision was 36.3%.
  
  
  CONCLUSIONS
  This study suggests that evaluation of the donor chest x-ray is a highly subjective process and demonstrated the limited role the radiograph presently holds in the determination of organ suitability.
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Bolton
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
authors.forename: Marvin C
authors.initials: MC
authors.lastname: Borja
authors.forename: Patrice
authors.initials: P
authors.lastname: Becker
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Orens
authors.forename: Charles
authors.initials: C
authors.lastname: Wiener
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D016022:Case-Control Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D016040:Lung Transplantation; D015588:Observer Variation; D011237:Predictive Value of Tests; D015272:Pulmonary Medicine; D011859:Radiography; D012189:Retrospective Studies; D013903:Thoracic Surgery; D009927:Tissue and Organ Procurement