Inter-Observer Agreement in the Interpretation of Low-Dose Chest CT Findings in COVID-19 Patients: Impact of Radiologist Experience and Radiation Dose Optimization
Keywords:
COVID-19; Low-dose chest CT; Inter-observer agreement; Radiation dose optimization; Radiologist experience; ALARA principle; Thoracic imagingAbstract
Background: As a result of the COVID-19 pandemic, chest computed tomography (CT) has become important for assessing pulmonary involvement in people with COVID-19, particularly if their reverse transcription polymerase chain reaction (RT-PCR) tests have been delayed or produced inconclusive results. Due to concerns about the potential for excessive cumulative radiation exposure, low-dose CT (LDCT) protocols have been implemented. The reliability of LDCT interpretation by different radiologists with varying levels of experience has also become an area of increasing interest and study.
Objective: The goal of this study was to evaluate how well radiologists agree with one another when interpreting LDCT findings in COVID-19 patients and to determine how much radiologist experience and optimizing the use of radiation influence the degree of diagnostic consistency.
Materials and Methods: This analytical study included confirmed COVID-19 patients who underwent LDCT of the chest. Images were obtained according to the ALARA principle using standardized LDCT protocols. Each observer with varying levels of experience in radiology independently evaluated predefined imaging characteristics, such as presence of a ground-glass opacity, consolidation, crazy paving pattern, inter-lobular septal thickening, fibrotic change, pleural abnormality, and distribution of lesions. Kappa statistics were used to assess inter-observer agreement.
Results: Major CT findings, including ground-glass opacities, consolidation, bilateral lung involvement, and peripheral distribution, showed substantial to near-perfect agreement. Subtle characteristics such as interlobular septal thickening and early fibrotic changes showed moderate agreement. When compared to junior radiologists, senior radiologists showed greater levels of agreement. Crucially, diagnostic reliability was not negatively impacted by lower radiation exposure.
Conclusion: With respectable inter-observer agreement, low-dose chest CT offers a dependable and repeatable evaluation of COVID-19-related lung abnormalities. Interpretive consistency is greatly influenced by radiologist experience, highlighting the significance of organized reporting and focused training. The regular application of optimized low-dose CT protocols to strike a balance between radiation safety and diagnostic accuracy is supported by these findings.
References
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296(2):E32–E40.
Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296(2):E115–E117.
Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Del Campo R, Ciapponi A, et al. False-negative results of initial RT-PCR assays for COVID-19: a systematic review. PLoS One. 2020;15(12):e0242958.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020;295(3):685–691.
Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020;215(1):87–93.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020;295(3):715–721.
Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407–4416.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–2284.
Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from diagnostic imaging. Circulation. 2007;116(11):1290–1305.
Kalra MK, Maher MM, Toth TL, Hamberg LM, Blake MA, Shepard JA, et al. Strategies for CT radiation dose optimization. Radiology. 2004;230(3):619–628.
McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 2015;276(3):637–653.
Willemink MJ, Noël PB. The evolution of image reconstruction for CT—from filtered back projection to artificial intelligence. Eur Radiol. 2019;29(5):2185–2195.
Dangis A, Gieraerts C, Bruecker YD, Janssen L, Valgaeren H, Obbels D, et al. Accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19. Radiology. 2020;297(3):E170–E180.
Kang Z, Li X, Zhou S. Recommendation of low-dose CT in the detection and management of COVID-19. Eur Radiol. 2020;30(8):4356–4357.
Zali A, Ghazali M, Alikhani M, Salimi J. Low-dose chest CT in the diagnosis of COVID-19 pneumonia: a prospective study. Eur Radiol. 2021;31(7):4991–5000.
Koo CW, Baliff JP, Torigian DA. Interobserver agreement in the interpretation of thoracic CT. Radiology. 2011;259(2):400–408.
Chassagnon G, Vakalopoulou M, Battistella E, Christodoulidis S, Hoang-Thi TN, Dangeard S, et al. AI-driven quantification, staging and outcome prediction of COVID-19 pneumonia. Med Image Anal. 2021;67:101860.
Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement. Radiology. 2020;296(1):172–180.
Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology. 2020;296(2):E46–E54.
Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C, et al. Chest CT features of COVID-19 in Rome, Italy. Radiology. 2020;296(2):E79–E85.
Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stöger L, Beenen L, et al. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19. Radiology. 2020;296(2):E97–E104.
Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America expert consensus document on reporting chest CT findings related to COVID-19. Radiology: Cardiothoracic Imaging. 2020;2(2):e200152.
Prokop M, Everdingen W, Rees Vellinga T. Standardized reporting of COVID-19 CT findings using CO-RADS. Radiology. 2020;296(2):E97–E104.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2024 International Journal of Engineering Science & Humanities
This work is licensed under a Creative Commons Attribution 4.0 International License.
