Thromb Haemost 1992; 68(03): 245-249
DOI: 10.1055/s-0038-1656357
Original Article
Schattauer GmbH Stuttgart

Ventilation-Perfusion Lung Scanning and the Diagnosis of Pulmonary Embolism: Improvement of Observer Agreement by the Use of a Lung Segment Reference Chart

Anthonie W A Lensing
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Edwin J R van Beek
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Christine Demers
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Monique M C Tiel-van Buul
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Valerie Yakemchuk
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Annemarie van Dongen
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Geoffrey Coates
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Jeffrey S Ginsberg
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Jack Hirsh
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Jan Wouter ten Cate
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
,
Harry R Büller
The Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, and Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands; and McMaster University, and the Hamilton Civic Hospitals Research Centre, Hamilton Ontario, Canada
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 23. Dezember 1991

Accepted after revision 09. April 1992

Publikationsdatum:
04. Juli 2018 (online)

Summary

Objective. To test the hypothesis that the systematic use of a lung segment reference chart can improve the inter- and intra-observer agreement for the interpretation of ventilation-perfusion lung scans.

Design. A randomized trial.

Study population. Ventilation-perfusion lung scans were obtained in a series of 220 consecutive patients with clinically suspected pulmonary embolism.

Intervention. Ventilation-perfusion scans were randomly allocated to one of two series each consisting of 110 ventilation-perfusion lung scans. The first series of lung scans was interpreted according to the routine diagnostic approach, and the second series was interpreted with the mandatory use of a lung segment reference chart on which observed ventilation and perfusion defects were drawn. The two nuclear medicine physicians agreed a priori on the diagnostic criteria of the classification scheme.

Measurements. Lung scans were classified as normal, non-high probability, or high probability for pulmonary embolism. The extent of disagreement between the nuclear medicine physicians (inter-observer disagreement) and the lack of internal consistency of each nuclear medicine physician (intra-observer disagreement) was assessed by the percentage disagreement and by kappa statistic.

Results. Inter-observer disagreement which was 20% in the first series, decreased significantly in the second series to 7%; P = 0.003. Intra-observer disagreement for the first series was 10% and 22% for the nuclear medicine physicians, respectively. Intra-observer disagreement for the second series of lung scans decreased significantly for one nuclear medicine physician (intra-observer disagreement, 0%; P <0.01), whereas intra-observer disagreement was reduced to 10% for the other nuclear medicine physician (P = 0.09).

Conclusion. Inter- and intra-observer disagreement were significantly reduced when two nuclear medicine specialists interpreted ventilation-perfusion lung scans according to the routine diagnostic approach plus the use of a lung segment reference chart. The use of the lung segment reference chart for the interpretation of lung scans is likely to improve the management of patients with clinically suspected pulmonary embolism.

 
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