title: Quality assessment for CT colonography: validation of automated measurement of colonic distention and residual fluid.
abstract: OBJECTIVE
  The purpose of this study was to validate automated quality assessment (QA) software for CT colonography (CTC) by comparing results obtained with the software with results of interpretation by radiologists in the assessment of colonic distention and surface area obscured by residual fluid.
  
  
  METHODS
  CTC scans of 30 patients were selected retrospectively to span ranges of luminal distention (well distended to poorly distended) and surface area covered by residual fluid (high amount of coverage to low amount of coverage). We used QA software developed in our laboratory to automatically measure the mean distention of each of five colonic segments (ascending, transverse, descending, sigmoid, and rectum). Three experienced radiologists visually graded each scan for distention and fluid coverage. Distention and fluid scores for specific segments were assessed with Bland-Altman analysis (mean difference with 95% limits of agreement) and the weighted kappa test. Interobserver and intraobserver variability was determined with the weighted kappa test.
  
  
  RESULTS
  For distention scoring, the mean difference between radiologists and the QA software was 0.1% (95% limits of agreement, -25.6% and 25.9%). For fluid scoring, the mean difference was -0.6% (95% limits of agreement, -8.2% and 7.1%). There was moderate to good agreement (weighted kappa value, 0.50-0.78) between the radiologists' mean scores and the scores obtained with the QA software and for interreader and intrareader assessments of distention and fluid coverage.
  
  
  CONCLUSIONS
  Results with the QA software agreed with radiologists' assessment of colonic distention and residual fluid coverage but were a more objective assessment. Use of this QA software can help standardize two important factors, distention and residual fluid coverage, that affect the quality of CTC, reducing two known causes of poor CTC performance.
authors.affiliation: Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bldg. 10, Room 1C368X, Bethesda, MD 20892-1182, USA.
authors.forename: Keshav K
authors.initials: KK
authors.lastname: Deshpande
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Summers
authors.forename: Robert L
authors.initials: RL
authors.lastname: Van Uitert
authors.forename: Marek
authors.initials: M
authors.lastname: Franaszek
authors.forename: Linda
authors.initials: L
authors.lastname: Brown
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Dwyer
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.forename: J Richard
authors.initials: JR
authors.lastname: Choi
authors.forename: Perry J
authors.initials: PJ
authors.lastname: Pickhardt
mesh_terms: D000368:Aged; D000465:Algorithms; D003106:Colon / Q000000981:diagnostic imaging*; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D023881:Colonography, Computed Tomographic / Q000379:methods*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D012986:Software Validation