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March 29, 1947


JAMA. 1947;133(13):963. doi:10.1001/jama.1947.02880130063023

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To the Editor:—  Although self analysis is a most laudable form of criticism, it can sometimes take such an extreme form that it only defeats its own purpose. The investigation to determine the relative diagnostic efficiency of the various roentgen modalities employed in mass x-ray surveys for tuberculosis case finding by Birkelo, Chamberlain, Phelps, Schools, Zacks and Yershulamy (The Journal, February 8) resulted in the comment that no one technic was superior to the others. In itself this conclusion might lead one to accept any one method of roentgen survey as efficient as another. An examination of the results, however, does not entirely bear this out, for it revealed an astonishingly wide variation in interpretation by various examiners and by the same examiners at various times. One interpreter found 47 cases positive for tuberculosis, while four of the interpreters agreed on only 17 cases. Twenty per cent of the films

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