Intended for healthcare professionals


Variability in interpretation of chest radiographs among Russian clinicians and implications for screening programmes: observational study

BMJ 2005; 331 doi: (Published 11 August 2005) Cite this as: BMJ 2005;331:379
  1. Y Balabanova, research associate1,
  2. R Coker, senior lecturer6,
  3. I Fedorin, chief physician2,
  4. S Zakharova, chief physician3,
  5. S Plavinskij, professor4,
  6. N Krukov, professor5,
  7. R Atun, reader7,
  8. F Drobniewski, professor (francis.drobniewski{at}
  1. 1 Health Protection Agency National Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's, King's, and St Thomas' Medical School, London
  2. 2 Samara Regional Tuberculosis Service, Samara Oblast Dispensary, Samara, Russia
  3. 3 Samara City Tuberculosis Service, Samara, Russia
  4. 4 College for Public Health, St Petersburg Academy for Postgraduate Sciences, Russia
  5. 5 Department of Internal Medicine, Samara State Medical University, Russia
  6. 6 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
  7. 7 Centre for Health Management, Tanaka Business School, Imperial College, London
  1. Correspondence to: F Drobniewski, Health Protection Agency National Mycobacterium Reference Unit, Institute of Cell and Molecular Sciences, Queen Mary's School of Medicine, London E1 2AT
  • Accepted 22 June 2005


Objective To determine variability in interpretation of chest radiographs among tuberculosis specialists, radiologists, and respiratory specialists.

Design Observational study.

Setting Tuberculosis and respiratory disease services, Samara region, Russian Federation.

Participants 101 clinicians involved in the diagnosis and management of pulmonary tuberculosis and respiratory diseases.

Main outcome measures Interobserver and intraobserver agreement on the interpretation of 50 digital chest radiographs, using a scale of poor to very good agreement (κ coefficient: ≤ 0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81-1.00 very good).

Results Agreement on the presence or absence of an abnormality was fair only (κ = 0.380, 95% confidence interval 0.376 to 0.384), moderate for localisation of the abnormality (0.448, 0.444 to 0.452), and fair for a diagnosis of tuberculosis (0.387, 0.382 to 0.391). The highest levels of agreement were among radiologists. Level of experience (years of work in the specialty) influenced agreement on presence of abnormalities and cavities. Levels of intraobserver agreement were fair.

Conclusions Population screening for tuberculosis in Russia may be less than optimal owing to limited agreement on interpretation of chest radiographs, and may have implications for radiological screening programmes in other countries.


  • Embedded Image Table showing levels of experience is on

  • Contributors FD and RC developed the original concept. FD, RC, and YB designed the study. YB, IF, SZ, NK, and FD implemented the study. YB collected the data. YB, RC, SP, and FD analysed the data. YB, RC, and FD drafted the paper and all authors contributed to the interpretation, editing, and final draft of the paper. FD is guarantor.

  • Funding UK Department for International Development and a European Respiratory Society fellowship to YB.

  • Competing interests None declared.

  • Ethical approval Not required.

  • Accepted 22 June 2005
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