Tüberküloz tarama amaçli mikrofilm incelemesi yapan hekimlerin degerlendirme farkliliklari/The discrepancies between assessments of physicians in microfilm examination for tuberculosis screening

ÖZET. Amaç: Türkiye'de tüberküloz (TB) için risk gruplari taramalarinda standart olarak mikrofilm (MF) kullanilmaktadir. Çalismada TB taramasinda kullanilan MF degerlendirmesinde okuyucuya bagli degiskenligin tespiti amaçlandi. Gereç ve Yöntem: Mardin Kapali Cezaevinde Ocak 2006 tarihinde yapilan periyodik TB taramasindan elde edilen 253 MF birer gögüs hastaliklari uzmani, radyoloji uzmani ve pratisyen hekim tarafindan birbirinden bagimsiz olarak degerlendirildi. Degerlendirme sonuçlari normal, aktif TB düsündürebilecek bulgular, sekel TB düsündürebilecek bulgular olarak siniflanarak kaydedildi. Bulgular: Teknik yetersizlik nedeniyle 253 MF'den 13'ü degerlendirmeye alinmadi. Degerlendirmeye alinan 240 MF'nin 159'unda (%66.2) üç hekiminde ayni karari verdigi, 81'inde (33.8) en az bir hekimin farkli karar verdigi saptandi. Aktif hastalik düsündürebilecek MF orani pratisyen hekimlerde %8, Radyoloji uzmanlarinda %9, Gögüs hastaliklari uzmanlarinda %11 oldugu saptandi. Aktif hastalik düsünme orani açisindan üç hekim grubu arasinda fark saptanmadi (p>0.05). Sekel hastalik düsünme orani gögüs hastaliklari uzmanlarinda yüksekti (p< 0.05). Sonuç: Mikrofilm tarama amaçli olarak hizli ve ucuz bir yöntem olmasina ragmen degerlendirmede okuyucular arasinda ciddi farklar olusabilecegi düsünüldü. Tüberküloz gibi çok farkli radyolojik bulgulara sahip bir hastalikta tanisal amaçla sübjektif bir yöntem olan radyolojik yöntemlere ek olarak kesin tani yöntemi olan mikrobiyolojik incelemeler gereklidir. Anahtar kelimeler: Tüberküloz, mikrofilm, tarama, hekimler, degerlendirme farki. ABSTRACT. Objectives: Microfilm (MF) are used in community based screening for tuberculosis (TB) in Turkey. This study aimed differences in evaluation between various physicians. Materials and Methods: In the Mardin Prison, 253 microfilms (MFs) were obtained during periodic TB screening in January 2006. A chest disease specialist doctor, a radiology specialist doctor and a general practitioner doctor assessed the MFs separately. The results were classified as i) Normal, ii) Active TB disease findings, iii) and Sequel TB disease findings. Results: A total of 13 MFs were not taken into consideration because of technically unsatisfactory radiographs. The end results were as follows; three physicians had agreed about diagnosis in 159 MFs (66.2%). In 81 MFs (33.8%) at least one physician had a different opinion about microfilm. The general practitioner reported 19 MFs (8%) as active TB disease findings and the radiology specialist doctor reported 22 MFs (9%) as active TB disease. However, the chest diseases specialist doctor reported 26 MFs (11%) as having active TB disease findings. No significant difference was found in active TB diagnosis between three physicians (p>0.05). The frequency of sequel TB diagnosis was higher in Chest disease specialist compared with other physicians (p<0.05). Conclusion: Although MF is a fast screening method, considerable disagreement was found in evaluating abnormal findings among reporting physicians. As TB is a disease with various radiologic appearances, usage of microbiological diagnostic modalities should be added to subjective radiographic methods. Key words: Tuberculosis, microfilm, screening, physicians, assessment differences.

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