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The middling tendency in reading chest films for pneumoconiosis: an important source of bias and variability
Abstract:
The tendency for readers of chest films of the pneumoconioses to place films in the middle of the International Labour Office (ILO) categories of profusion (eg, 1/1, 2/2) was described by Morgan et al [1974], who saw this tendency as a possible source of bias. The present study reexamines the middling tendency in relation to bias and variability by comparing duplicate readings of chest films for pneumoconiosis. Readings of trained lay persons were compared to professional readings of the same films and readings of professional readers were compared with each other. Reasons for the middling tendency, which include the use of standard middle films and the instructions given to users of the classification, are suggested and possible solutions are proposed.
Insights
Readers often favor middle categories when classifying pneumoconiosis chest films, potentially introducing bias. This study investigates this "middling tendency" to improve diagnostic accuracy for occupational lung diseases.
Area of Science:
- Radiology
- Occupational Medicine
- Public Health
Background:
- The International Labour Office (ILO) classification system is standard for pneumoconiosis diagnosis.
- Previous research by Morgan et al. (1974) identified a tendency for readers to select middle profusion categories (e.g., 1/1, 2/2).
- This "middling tendency" was suspected as a potential source of bias in pneumoconiosis assessment.
Purpose of the Study:
- To re-examine the "middling tendency" in pneumoconiosis chest film readings.
- To assess the relationship between this tendency, diagnostic bias, and inter-reader variability.
- To identify factors contributing to the middling tendency and propose solutions.
Main Methods:
- Comparative analysis of duplicate chest film readings for pneumoconiosis.
- Comparison of readings by trained laypersons versus professional radiologists.
- Comparison of readings among multiple professional radiologists.
Main Results:
- The study quantifies the extent of the "middling tendency" in current pneumoconiosis film readings.
- Analysis reveals the impact of this tendency on diagnostic consistency and potential bias.
- Factors such as the use of standard "middle" reference films and classification instructions are implicated.
Conclusions:
- The "middling tendency" in pneumoconiosis film interpretation is a significant factor affecting diagnostic reliability.
- Understanding and mitigating this tendency is crucial for accurate occupational lung disease assessment.
- Recommendations are provided to address reader bias and improve the consistency of ILO classification.