@article {1433733,
	title = {A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation},
	journal = {COPD},
	volume = {9},
	number = {2},
	year = {2012},
	month = {2012 Apr},
	pages = {151-9},
	abstract = {UNLABELLED: The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring.

METHODS: Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements.

RESULTS: Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75\%, 87\% and 65\%, respectively.

CONCLUSIONS: Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.},
	keywords = {Aged, Case-Control Studies, Education, Emphysema, Female, Humans, Lung, Male, Middle Aged, Observer Variation, Prevalence, Pulmonary Disease, Chronic Obstructive, Research Design, Smoking, Tomography, X-Ray Computed},
	issn = {1541-2563},
	doi = {10.3109/15412555.2012.654923},
	author = {Barr, R Graham and Berkowitz, Eugene A and Bigazzi, Francesca and Bode, Frederick and Bon, Jessica and Bowler, Russell P and Chiles, Caroline and Crapo, James D and Criner, Gerard J and Curtis, Jeffrey L and Dass, Chandra and Dirksen, Asger and Dransfield, Mark T and Edula, Goutham and Erikkson, Leif and Friedlander, Adam and Galperin-Aizenberg, Maya and Gefter, Warren B and Gierada, David S and Grenier, Philippe A and Goldin, Jonathan and Han, MeiLan K and Hanania, Nicola A and Hansel, Nadia N and Jacobson, Francine L and Kauczor, Hans-Ulrich and Kinnula, Vuokko L and Lipson, David A and Lynch, David A and MacNee, William and Make, Barry J and Mamary, A James and Mann, Howard and Marchetti, Nathaniel and Mascalchi, Mario and McLennan, Geoffrey and Murphy, James R and Naidich, David and Nath, Hrudaya and Newell, John D and Pistolesi, Massimo and Regan, Elizabeth A and Reilly, John J and Sandhaus, Robert and Schroeder, Joyce D and Sciurba, Frank and Shaker, Saher and Sharafkhaneh, Amir and Silverman, Edwin K and Steiner, Robert M and Strange, Charlton and Sverzellati, Nicola and Tashjian, Joseph H and van Beek, Edwin J R and Washington, Lacey and Washko, George R and Westney, Gloria and Wood, Susan A and Woodruff, Prescott G}
}