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Inter-rater concordance in the classification of COVID-19 in chest X-ray images using the RANZCR template for
Peter O'Reilly1, Dania Abu Awwad1, Sarah Lewis2
1Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown NSW 2050, Australia.
Introduction:
The Royal Australian and New Zealand College of Radiologists (RANZCR) has developed a reporting template to assist in the categorization of COVID-19 in chest X-ray (CXR) images and the levels of COVID-19 infection. Whilst CXRs are reported by radiologists, radiographers are often the first to assess the CXRs, and have the potential to support immediate triaging of patients with COVID-19. However, inter-reader concordance in the use of this reporting template remains underexplored.
Methods:
70 CXR examinations comprising of the four categories in the RANZCR chest X-ray (CXR) COVID-19 reporting template were used for the study. These included: 'typical' (for COVID-19) (n = 30); 'indeterminate' (for COVID-19) (n = 20); 'other diagnoses favoured' (n = 10) and 'normal' (n = 10). These images were independently categorised using the RANZCR reporting template by three cohorts of readers: 12 radiologists, 13 registered radiographers, and 12 final-year radiography students. A Weighted Kappa (κw) was used to evaluate inter-reader agreement within and between the cohort of readers.
Results:
Radiologists demonstrated fair (κw = 0.32) to substantial (κw = 0.77) inter-reader agreement, and their overall inter-reader was moderate (κw = 0.56). Registered radiographers demonstrated no (κw = -0.01) to moderate agreement (κw = 0.59), and their overall agreement was fair (κw = 0.31). Fourth year student radiographers demonstrated slight (κw = 0.004) to substantial (κw= 0.8) agreement, with a moderate (κw = 0.47) overall agreement among final year student radiographers.
Conclusion:
There are wide variations in the classification of the CXRs using the RANZCR reporting template. Overall, radiologists exhibit superior concordance in CXR categorization using the COVID-19 reporting template. Radiographers demonstrate wide variability, highlighting the need for enhanced education and training to standardise the triaging of these patients undergoing CXR imaging for COVID-19 symptoms.
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Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...