Double reading of barium enemas: is it necessary?
OBJECTIVE
The purpose of our study was to determine the effectiveness, clinical impact, and feasibility of double reading barium enemas.


METHODS
Independent double readings of 1,003 consecutive barium enemas (822 double- and 181 single-contrast examinations) were prospectively performed. From this pool of 1,003 examinations, 994 were included in our study. Examinations showing at least one polyp or carcinoma 5 mm or larger were considered to have positive results. For combined readings, results were considered positive if either of the two interpreters reported finding a polyp or carcinoma. A McNemar test was used to compare the first reader's results with the combined results of the first and second readers. Results were retrospectively correlated with endoscopic or surgical results in 360 patients, and agreement between first and combined readings and endoscopic results was determined.


RESULTS
Adding a second reader increased the number of positive results on examinations from 249 to 315 (p < 0.0001) and resulted in potential alteration of clinical treatment in 98 patients (9.9%). Sensitivity of the first and combined readings for detection of all lesions was identical, 76.3% (95% CI, 65.4-87.1%). Specificity decreased from 91.0% (95% CI, 87.9-94.3%) for the first reading to 86.4% (95% CI, 82.2-90.0%) for the combined reading. The overall measurement of agreement decreased from a kappa value of 61.8 (95% CI, 51.2-72.4%) for the first reading to 52.9 (95% CI, 42.2-63.6%) for the combined reading. The second reading required an average of 3.3 min. Sensitivity for the detection of adenocarcinomas was 100%.


CONCLUSIONS
Although feasible, double reading of barium enemas does not improve sensitivity for detection of polyps and produces a higher false-positive rate.
Canon
Cheri L
CL
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA. ccanon@uabmc.edu
Smith
J Kevin
JK
Morgan
Desiree E
DE
Jones
Brian C
BC
Fell
Sean C
SC
Kenney
Philip J
PJ
Ferrante
Dino
D
Lockhart
Mark E
ME
Westfall
Andrew O
AO
Koehler
Robert E
RE
D000328:Adult; D001466:Barium Sulfate; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004733:Enema / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media; D001466:Barium Sulfate