Evaluation of the efficacy of the guideline on reading CT images of malignant pleural mesothelioma with reference CT films for improving the proficiency of radiologists.

PURPOSE: To assess the efficacy of the developed guideline on reading CT images of malignant pleural mesothelioma for improving radiologists' reading proficiency. MATERIALS AND METHODS: Three radiologists independently read the CT films of 22 cases including definite mesothelioma and non-mesothelioma cases at two times before and after studying the malignant pleural mesothelioma CT Guideline. The sensitivity and specificity for mesothelioma were calculated and compared between the 1st and 2nd trials. The kappa statistics was examined for agreement with experts for mesothelioma probability and for mesothelioma features recorded by three radiologists. RESULTS: After studying the mesothelioma CT Guideline, the sensitivity for mesothelioma shown by the three radiologists at the 2nd trial was 100%, 100% and 80%, which were higher than 80%, 85% and 60% at the 1st trial, respectively. The average kappa for agreement between radiologists and experts on dichotomized mesothelioma probability were 0.69 (good) at the 2nd trial vs. 0.38 (fair) at the 1st trial. The average kappa for the agreement with experts for each of 7 features by three radiologists were 0.52-0.80 at the 2nd trial, which were significantly higher than 0.34-0.58 at the 1st trial (Wilcoxon Signed Rank Test: P<0.01), and as to five features "unilateral pleural effusion", "nodular pleural thickening", "tumoral encasement of lung", "mediastinal pleural thickening", and "diminished lung", they achieved good agreement with average kappa of 0.61-0.80. CONCLUSION: The developed mesothelioma CT Guideline was suggested to have substantial effect in improving the radiologists' proficiency for reading CT images of mesothelioma, and may contribute to accurate diagnosis of mesothelioma.

Efficacy of computed tomography-guided fine needle aspiration in diagnosis of lung mass by trained internists.

OBJECTIVE: To determine the efficacy of Computed Tomography (CT)-guided fine needle Aspiration (FNA) in diagnosis of lung masses by trained internists including factors affecting the adequacy of specimens and occurrence rate of complications. MATERIAL AND METHOD: 96 patients, aged 25-86 years old underwent CT-guided FNA of thoracic lesions by internists who had been trained for this procedure at the Central Chest Institute of Thailand during March 2007-2008. Demographic data, procedure success and adequacy of specimens for cytological evaluation were summarized including other factors-size and depth of lesion, condition of emphysema and complications of procedure. RESULTS: Success of procedure was 97.9%. Adequacy of specimen was 94.7%. Occurrence of pneumothorax was 19 out of 96 cases (19.8%). And 1 case needed to insert inter costal drainage (1.1%). Hemoptysis after procedure was 1.06%. Besides, larger than 3 cm in diameter of lesion presented satisfied specimens more than that of the smaller one. Pneumothorax is the most common complication, which revealed a statistically significant with emphysema around mass. CONCLUSION: FNA is an effective and useful tool in diagnosis of pulmonary lesions for trained internists. Success of procedure and adequacy of specimen for cytological evaluation are considerably high and low complications occurred.

Development of a guideline on reading CT images of malignant pleural mesothelioma and selection of the reference CT films.

PURPOSE: International experts developed a guideline on reading CT images of malignant pleural mesothelioma for radiologists and physicians. It is intended that it act as a supplement to the current International Classification of HRCT for Occupational and Environmental Respiratory Diseases. METHODS: The research literatures on mesothelioma CT features were systematically reviewed. Ten mesothelioma CT features were adopted into the guideline prepared according to experts' opinion. The terminology of mesothelioma CT features and mesothelioma probability were agreed by consensus of experts. The CT reference films for each mesothelioma feature were selected based on agreement by experts from 22 definite mesothelioma cases confirmed pathologically and immunohistochemically. To support the validity of the mesothelioma probability, 4 experts' readings of CT films from 57 cases with or without mesothelioma were analyzed by kappa statistics between the experts; sensitivity and specificity for mesothelioma were also assessed. RESULTS: The mesothelioma CT Guideline was developed, providing the terminology of CT features and the mesothelioma probability, the judgement of severity, the distribution of mesothelioma, and the revised CT reading sheet including mesothelioma items. The CT reference films with ten mesothelioma typical features were selected. The average linearly and quadratically weighted kappa of the agreement on the 4-point scale mesothelioma probability were 0.58 and 0.71, respectively. The average sensitivity and specificity for mesothelioma were 93.2% and 65.6%, respectively. CONCLUSION: The evidence-based mesothelioma CT Guideline developed may serve as a good educational tool to facilitate physicians in recognising mesothelioma and improve their proficiency in diagnosis of mesothelioma.

Diagnosing pneumonia in rural Thailand: Digital cameras versus film digitizers for chest radiograph teleradiology.

BACKGROUND: Accurate surveillance for pneumonia requires standardized classification of chest radiographs. Digital imaging permits rapid electronic transfer of data to radiologists, and recent improvements in digital camera technology present high quality, yet cheaper, options. METHODS: We evaluated the comparative utility of digital camera versus film digitizer in capturing chest radiographs in a pneumonia surveillance system in rural Thailand using a panel of radiologists; the gold standard was the hard-copy radiograph. We calculated sensitivity and specificity and conducted a receiver operator characteristics (ROC) analysis. RESULTS: Of the 192 radiographs from patients with clinical pneumonia, 166 (86%) were classified as pneumonia on the hard copies. Sensitivity and specificity for identifying pneumonia were 89% and 73% for the camera and 90% and 65% for the digitizer. In the ROC analysis, there was no statistically significant difference in the area under the curve (camera, 0.86; film digitizer, 0.91, p = 0.29). The digital camera set cost 965 dollars compared to 3000 dollars for the film digitizer. CONCLUSION: Detection of pneumonia was not measurably compromised by using digital cameras compared with film digitizers. The 3-fold lower cost of the digital camera makes this technology an affordable and widely accessible alternative for surveillance systems, vaccine trials, and perhaps clinical use.