Establishment of clinical safety in monitor diagnosis of breast cancer from the viewpoint of medical image perception

(1)使用乳房假体评估乳房x线摄影质量控制的观察者间一致性。11名放射科医生通过四种观看方法解读了一张乳房幻像（CIRS Model X）：(1)原始屏幕胶片（SF），(2)数字化胶片图像的软拷贝读取，(3)使用成像板（FCR）的计算机放射摄影硬拷贝读取，(4)FCR软拷贝读取。11名放射科医生使用3分制量表来判断幻影的每个项目。在“质量”描绘方面，FCR的kappa值显著低于SF （p<0.05）。检测“微钙化”的kappa值差异无统计学意义。然而，FCR硬拷贝阅读的“微钙化”评分明显低于其他三种观看方法（p<0.05）。观察方式会影响影像的判断，FCR乳房x线影像的质量控制应特别注意观察条件。(2)采用四分制对6名放射科医生和20名放射科技术人员对100个乳腺肿块（50个为良性，50个为恶性）进行解读，评估内部回声对乳腺超声图像的意义。复读50例。美国的图像被修改，使内部回声不可见，用Adobe Photoshop涂上黑色。ROC分析显示，原始US图像与修改US图像的诊断性能差异有统计学意义（p<0.05）。在原始图像和修改后的图像中，后回波Kappa值最高，晕回波Kappa值最低。光晕和腺体表面重现性较好，后回声和D/W较好。内部回波对乳腺病变的图像感知具有重要意义。缺少内部回声会降低乳腺超声的诊断效能。

(1)Interobserver agreement in quality control of mammography was evaluated using a breast phantom. Eleven radiologists interpreted a breast phantom image (CIRS Model X) by four viewing methods : (1)original screen-film (SF), (2)soft-copy reading of the digitized film image, (3)hard-copy reading of computed radiography using imaging plate (FCR), and (4)soft-copy reading of FCR. 11 radiologists judged each item of the phantom using a three-point rating scale. With regard to "mass" depiction, kappa value of FCR was significantly lower than that of SF (p<0.05). There was no significant difference in kappa value for detecting "microcalcifications". However, score of "microcalcifications" by FCR hard-copy reading was significantly lower than that by the other three viewing methods (p<0.05). Viewing methods could affect the judgment of the phantom image, and special attention to viewing conditions are recommended for quality control of FCR mammogram.(2)Significance of internal echoes at interpretation of breast US image was evaluated 100 breast masses (50 benign,50 malignant) were interpreted by 6 radiologists and 20 radiological technologists using a four-point rating scale. Double reading was done in 50 cases. US images were modified to make the internal echoes invisible by painting with black color using the Adobe Photoshop. ROC analysis showed a significant difference in diagnostic performance between the original US images and modified US images (p<0.05). Kappa value of posterior echoes was highest whereas that of halo showed the lowest value in both the original and modified images. Reproducibility in halo and gland surface was fair, and that in posterior echoes and the D/W was good. The internal echoes are important for image perception of breast lesions. Lack of internal echoes should degrade the diagnostic performance of breast US.