Observer variation in skeletal radiology

Cockshott, W. Peter; Park, W M

doi:10.1007/bf00360790

Cited by 29 publications

(11 citation statements)

References 31 publications

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“…Consistency is mandatory if a scoring system is to be used for monitoring the progression of a disease and the effects of therapy. Since interobserver variation is generally greater than intraobserver variation, assessment of the former can be used as a test for diagnostic value (4,13).…”

Section: Grading Systems and Observer Variationmentioning

confidence: 99%

“…Perception is influenced by the examination technique, psychologic factors and experience (10). In order to keep variation in the judgement of a feature low, it is essential to exclude vague or indefinite findings; features must be strictly defined to avoid semantic confusion (4,13). Grading of a feature can be facilitated if the different radiologic changes can be measured quantitatively.…”

Section: Grading Systems and Observer Variationmentioning

confidence: 99%

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Reproducibility of the Pettersson Scoring System

et al. 1989

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By means of the Pettersson scoring system, the degree of severity of haemophilic arthropathy in 128 knee, elbow and ankle joints was estimated by 5 radiologists. Their scores varied on average by approximately 3 points. Minimal and maximal joint involvement were scored consistently; exclusion of haemophilic arthropathy was possible with the highest degree of certainty. With regard to changes of a moderate degree agreement was seldom reached. With precisely defined characteristics, a high degree of consistency between observers was evident. Interobserver variation in the scoring was more marked in the ankle joint than in the other joints. Scoring was more consistent with the more experienced observers.

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Section: Grading Systems and Observer Variationmentioning

confidence: 99%

Section: Grading Systems and Observer Variationmentioning

confidence: 99%

Reproducibility of the Pettersson Scoring System

et al. 1989

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“…Studies have also demonstrated that training can improve the performance of examiners. 38,39 We are convinced that our examiners demonstrated improvement in performance as evidenced by comparing the inter-rater reliability between the third (experienced) examiner and the 2 primary examiners for the first (κ w =0.37, 0.39) and the second sessions (κ w =0.57, 0.68). This may be explained by the additional training before the second session.…”

Section: Discussionmentioning

confidence: 71%

Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study

Little

Grieve

Cramer

et al. 2015

Journal of Manipulative and Physiological Therapeutics

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Objective-This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. CORRESPONDING AUTHOR CONTACT INFORMATION: Gregory D. Cramer, DC, PhD, gcramer@nuhs.edu or gregorycramer@sbcglobal.net, NUHS, 200 E. Roosevelt Rd., Lombard, IL 60148,. CONFLICTS OF INTERESTNo conflict of interest were reported. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMethods-Modifications were made to Kellgren's grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1 to 4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intra-rater and inter-rater agreement was determined by weighted kappa (κ w ) from the examination of 79 Z joints (25 packets).Results-Using the modified scale and following training, examiners demonstrated a moderate to substantial level of inter-rater agreement (κ w = 0.57, 0.60, and 0.68). Intra-rater agreement was moderate (κ w = 0.42 and 0.54).Conclusions-The modified Kellgren 5-point grading system provides acceptable intra-and inter-rater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints. v

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“…On the other hand, this can be the source of systematic errors [7]. Special training and greater professional experience can lead to greater diagnostic reliability [3]. The influence of the latter could not be excluded in our study.…”

Section: Discussionmentioning

confidence: 95%

Interobserver variation in the detection of osteopenia by radiography and comparison with dual X-ray absorptiometry of the lumbar spine

et al. 1994

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In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of osteopenia in the form of a binary decision. A posteranterior dual x-ray absorptiometry (PA DXA) measurement of the lumbar spine was performed in all patients using the Hologic QDR 1000 bone densitometer. A bone mineral density (BMD) of 0.83 g/cm2 (T-score about 2 SD and 2.5 SD lower than BMD in normal young female and male subjects respectively) was used as a threshold for the diagnosis of osteopenia. Complete agreement amongst the 9 readers was achieved in 43 patients. In 26 more patients at least 8 readers agreed. kappa-coefficients for interobserver variation ranged from 0.458 to 0.691 for reader pairs. For agreement between the observer ratings and the DXA results, kappa-coefficients ranging between 0.347 and 0.555 were found. The vast majority of readers agreed in the diagnosis of osteopenia in cases where the BMD was less than 0.73 g/cm2. Where the BMD was between 0.73 and 1.03 g/cm2 a substantial disagreement was found between reader evaluation and DXA measurement, and also amongst the readers. We conclude from our results that osteopenia can reliably be detected from lumbar spine radiographs by all readers only after a substantial amount of BMD is lost. On the other hand, a diagnosis based solely on PA DXA measurement of the spine may also lack accuracy, due to a substantial influence of degenerative changes of the lumbar spine and aortic calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

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Observer variation in skeletal radiology

Cited by 29 publications

References 31 publications

Reproducibility of the Pettersson Scoring System

Reproducibility of the Pettersson Scoring System

Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study

Interobserver variation in the detection of osteopenia by radiography and comparison with dual X-ray absorptiometry of the lumbar spine

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