Effect of Picture Archiving and Communication System Image Manipulation on the Agreement of Chest Radiograph Interpretation in the Neonatal Intensive Care Unit.
OBJECTIVE
Variability in image interpretation has been attributed to differences in the interpreters' knowledge base, experience level, and access to the clinical scenario. Picture archiving and communication system (PACS) has allowed the user to manipulate the images while developing their impression of the radiograph. The aim of this study was to determine the agreement of chest radiograph (CXR) impressions among radiologists and neonatologists and help determine the effect of image manipulation with PACS on report impression.


METHODS
Prospective cohort study included 60 patients from the Neonatal Intensive Care Unit undergoing CXRs. Three radiologists and three neonatologists reviewed two consecutive frontal CXRs of each patient. Each physician was allowed manipulation of images as needed to provide a decision of "improved," "unchanged," or "disease progression" lung disease for each patient. Each physician repeated the process once more; this time, they were not allowed to individually manipulate the images, but an independent radiologist presets the image brightness and contrast to best optimize the CXR appearance. Percent agreement and opposing reporting views were calculated between all six physicians for each of the two methods (allowing and not allowing image manipulation).


RESULTS
One hundred percent agreement in image impression between all six observers was only seen in 5% of cases when allowing image manipulation; 100% agreement was seen in 13% of the cases when there was no manipulation of the images.


CONCLUSIONS
Agreement in CXR interpretation is poor; the ability to manipulate the images on PACS results in a decrease in agreement in the interpretation of these studies. New methods to standardize image appearance and allow improved comparison with previous studies should be sought to improve clinician agreement in interpretation consistency and advance patient care.
Department of Diagnostic Imaging, University of Toronto, Toronto, Canada.
Denise A
DA
Castro
Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada.
Asad Ahmed
AA
Naqvi
Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada.
Elizabeth
E
Vandenkerkhof
Department of Pediatrics and Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada.
Michael P
MP
Flavin
Department of Diagnostic Imaging, University of Toronto, Toronto, Canada.
David
D
Manson
Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada.
Donald
D
Soboleski
Agreement and consistency in interpretation; Neonatal Intensive Care Unit; chest radiograph; manipulation of images; picture archiving and communication system