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ISSN: 2165-7548

Emergency Medicine: Open Access
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Research Article

Comparison of Observer Performance between Emergency Physicians at Different Level of Experience using Digital Imaging

Zohair Al Aseri*

Department of Emerg Med (Los Angel) , King Khalid University Hospital, Riyadh, Saudi Arabia

*Corresponding Author:
Zohair Al Aseri
Department of Emerg Med (Los Angel)
King Khalid University Hospital
Riyadh, Saudi Arabia
E-mail: [email protected]

Received Date: February 26, 2012; Accepted Date: May 25, 2012; Published Date: May 27, 2012

Citation: Al Aseri Z (2012) Comparison of Observer Performance between Emergency Physicians at Different Level of Experience using Digital Imaging. Emergency Med 2:122. doi:10.4172/2165-7548.1000122

Copyright: © 2012 Al Aseri Z. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Objectives: Digital radiology is relatively new technology that allows the examiner a number of advantages. The objective of this study is to evaluate the efficacy of digital chest radiography using plain expiratory and inspiratory images to detect Pneumothorax and comparison of observer performance between residents and experienced Emergency Department (ED) physicians.

Methods: Plain digital images of chest radiographs containing expiratory and inspiratory views, requested to exclude Pneumothorax from January 2000 to December 2003 were included. All images were reviewed independently by three experienced ED physician and three ED residents. The physicians were asked to decide on the presence or absence of a Pneumothorax, its site, size and its percentage of occupying area. The physician’s reports were recorded and compared with reports of consultant radiologists as a standard.

Results: A total of 252 sets of inspiratory and expiratory films were ordered. Of the 118 pairs that met the inclusion and exclusion criteria, 76 pairs (64.4%) were positive for Pneumothorax using the standard consultant radiologist’s reports. Overall sensitivity was 72.6% (CI ± 4.2) for inspiratory and 80.0% (CI ± 3.7) for expiratory films (P=0.001), with a specificity of 69.4% (CI ± 4.6) for inspiratory and 73.1% (CI ± 4.8) for expiratory films (P=0.12). The kappa for agreement was 0.65, 0.52, and 0.32 for the presence of Pneumothoraces, their size (small, medium, or large), and their percentage of occupying the area of pleural cavity respectively.

Conclusion: Expiratory images on a digital viewer are more sensitive than inspiratory images for detecting Pneumothoraces, and this difference is decreased with expert physician’s review. The agreement was poor when a percentage is used to describe the size of the Pneumothorax occupying Pleural cavity.


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