title: Variability in interpretation of chest radiographs among Russian clinicians and implications for screening programmes: observational study.
abstract: OBJECTIVE
  To determine variability in interpretation of chest radiographs among tuberculosis specialists, radiologists, and respiratory specialists.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tuberculosis and respiratory disease services, Samara region, Russian Federation.
  
  
  METHODS
  101 clinicians involved in the diagnosis and management of pulmonary tuberculosis and respiratory diseases.
  
  
  METHODS
  Interobserver and intraobserver agreement on the interpretation of 50 digital chest radiographs, using a scale of poor to very good agreement (kappa coefficient: < or = 0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81-1.00 very good).
  
  
  RESULTS
  Agreement on the presence or absence of an abnormality was fair only (kappa = 0.380, 95% confidence interval 0.376 to 0.384), moderate for localisation of the abnormality (0.448, 0.444 to 0.452), and fair for a diagnosis of tuberculosis (0.387, 0.382 to 0.391). The highest levels of agreement were among radiologists. Level of experience (years of work in the specialty) influenced agreement on presence of abnormalities and cavities. Levels of intraobserver agreement were fair.
  
  
  CONCLUSIONS
  Population screening for tuberculosis in Russia may be less than optimal owing to limited agreement on interpretation of chest radiographs, and may have implications for radiological screening programmes in other countries.
authors.affiliation: Health Protection Agency National Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's, King's, and St Thomas' Medical School, London.
authors.forename: Y
authors.initials: Y
authors.lastname: Balabanova
authors.forename: R
authors.initials: R
authors.lastname: Coker
authors.forename: I
authors.initials: I
authors.lastname: Fedorin
authors.forename: S
authors.initials: S
authors.lastname: Zakharova
authors.forename: S
authors.initials: S
authors.lastname: Plavinskij
authors.forename: N
authors.initials: N
authors.lastname: Krukov
authors.forename: R
authors.initials: R
authors.lastname: Atun
authors.forename: F
authors.initials: F
authors.lastname: Drobniewski
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000592:standards; D015588:Observer Variation; D015272:Pulmonary Medicine / Q000592:standards*; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000592:standards*; D012426:Russia; D018709:Statistics, Nonparametric; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging