RT Journal Article SR Electronic T1 Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study JF BMJ Open Respiratory Research JO BMJ Open Resp Res FD British Thoracic Society SP e000393 DO 10.1136/bmjresp-2018-000393 VO 6 IS 1 A1 McCollum, Eric D A1 Ahmed, Salahuddin A1 Chowdhury, Nabidul H A1 Rizvi, Syed J R A1 Khan, Ahad M A1 Roy, Arun D A1 Hanif, Abu AM A1 Pervaiz, Farhan A1 Ahmed, ASM Nawshad U A1 Farrukee, Ehteshamul H A1 Monowara, Mahmuda A1 Hossain, Mohammad M A1 Doza, Fatema A1 Tanim, Bidoura A1 Alam, Farzana A1 Simmons, Nicole A1 Reller, Megan E A1 Harrison, Meagan A1 Schuh, Holly B A1 Quaiyum, Abdul A1 Saha, Samir K A1 Begum, Nazma A1 Santosham, Mathuram A1 Moulton, Lawrence H A1 Checkley, William A1 Baqui, Abdullah H YR 2019 UL http://bmjopenrespres.bmj.com/content/6/1/e000393.abstract AB Introduction To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3–35 months with suspected pneumonia in Sylhet, Bangladesh.Methods Eight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen’s kappa, and a prevalence and bias-adjusted kappa.Results Among 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85).Conclusion Primary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.