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Introduction The aim of this study was to evaluate observer variations and observer reproducibility in the interpretation of periapical health using the Strindberg system, the periapical index (PAI), and the probability index for radiologic assessment of periapical health. Methods Four observers read digital periapical images to evaluate the periapical health of 200 root-filled teeth. Each observer evaluated a tooth twice by using the Strindberg system, twice by using the PAI, and twice by using the probability index. Each observation session was held at 1-month intervals. Three scores were used for the evaluations conducted by using the Strindberg system. Both the PAI and the probability index were considered on 5-point scales and were also dichotomized. SPSS for Windows 15.0 software (SPSS Inc, Chicago, IL) was used for data analysis, and intra- and interobserver agreements were described by using kappa statistics. Results The average kappa values of intra- and interobserver agreement calculated for the Strindberg system were 0.53 and 0.36, respectively. The corresponding average kappa values were calculated as 0.48 and 0.39 for the PAI and 0.45 and 0.30 for the probability index. The highest mean proportion values of intra- and interobserver agreement were observed for the dichotomization of the PAI (88.9% and 87.0%, respectively) followed by the dichotomization of the probability index (86.8% and 82.9%, respectively). Conclusions The Strindberg system has lower intraobserver variation compared with the PAI and the probability index, whereas PAI has lower interobserver variation compared with the Strindberg system and the probability index. The dichotomization of the PAI and the probability index provided higher intra- and interobserver agreement values in the radiologic assessment of periapical health.

Purpose To assess whether an education program on CT and MRI prostate anatomy would reduce inter- and intraobserver prostate contouring variation among experienced radiation oncologists. Methods and Materials Three patient CT and MRI datasets were selected. Five radiation oncologists contoured the prostate for each patient on CT first, then MRI, and again between 2 and 4 weeks later. Three education sessions were then conducted. The same contouring process was then repeated with the same datasets and oncologists. The observer variation was assessed according to changes in the ratio of the encompassing volume to intersecting volume (volume ratio [VR]), across sets of target volumes. Results For interobserver variation, there was a 15% reduction in mean VR with CT, from 2.74 to 2.33, and a 40% reduction in mean VR with MRI, from 2.38 to 1.41 after education. A similar trend was found for intraobserver variation, with a mean VR reduction for CT and MRI of 9% (from 1.51 to 1.38) and 16% (from 1.37 to 1.15), respectively. Conclusion A well-structured education program has reduced both inter- and intraobserver prostate contouring variations. The impact was greater on MRI than on CT. With the ongoing incorporation of new technologies into routine practice, education programs for target contouring should be incorporated as part of the continuing medical education of radiation oncologists.

PURPOSE: The Icare dynamic tonometer (impact or Rebound tonometry) is a new tonometer based on making a moving object collide with an eye and on monitoring the motion parameters of this object following contact. The purpose of this study was to assess intra- and interobserver variability of IOP measurements with the Icare and their correlations with Goldmann applanation tonometry (GAT) and central corneal thickness (CCT). MATERIAL AND METHODS: A prospective study including three groups of patients: group 1 (50 normal subjects), group 2 (50 patients with OHT or POAG and GAT IOP>22 mmHg), and group 3 (38 glaucomatous patients with GAT IOP< or =22 mmHg). In group 1, three consecutive IOP measurements were taken by three distinct observers with Icare followed by three GAT measurements by the same clinician. In group 2, the same procedure was followed from patients 1 to 25 and the reverse sequence from patients 25 to 50 after a 10-min break. In group 3, only one clinician took three GAT measurements followed by three Icare measurements after a 10-min break to exclude a tonographic effect in eyes with statistically normal-range IOPs. RESULTS:: In group 1, intraobserver variability was about 6% for each observer (NS). There was no learning curve effect. The interobserver variation coefficient was 6.4%. Icare overestimated IOP compared to GAT (mean difference, 1.5-2.2 mmHg) (p

Objectives: Our aim was to validate 3-dimensional echocardiography (3DE) for assessment of left ventricular (LV) end-diastolic volume, end-systolic volume (ESV), stroke volume, and ejection fraction (EF) using the freehand-acquisition method. Furthermore, LV volumes by breath hold—versus free breathing—3DE acquisition were assessed and compared with magnetic resonance imaging (MRI). Methods: From the apical position, a fan-like 3DE image was acquired during free breathing and another, thereafter, during breath hold. In 27 patients, 28 breath hold— and 24 free breathing—3DE images were acquired. A total of 17 patients underwent both MRI and 3DE. MRI contours were traced along the outer endocardial contour, including trabeculae, and along the inner endocardial contour, excluding trabeculae, from the LV volume. Results: All 28 (100%) breath hold— and 86% of free breathing—3DE acquisitions could be analyzed. Intraobserver variation (percentual bias ± 2 SD) of end-diastolic volume, ESV, stroke volume, and EF for breath-hold 3DE was, respectively, 0.3 ± 10.2%, 0.3 ± 14.6%, 0.1 ± 18.4%, and −0.1 ± 5.8%. For free-breathing 3DE, findings were similar. A significantly better interobserver variability, however, was observed for breath-hold 3DE for ESV and EF. Comparison of breath-hold 3DE with MRI inner contour showed for end-diastolic volume, ESV, stroke volume, and EF, a percentual bias (± 2 SD) of, respectively, −13.5 ± 26.9%, −17.7 ± 47.8%, −10.6 ± 43.6%, and −1.8 ± 11.6%. Compared with the MRI outer contour, a significantly greater difference was observed, except for EF. Conclusions: 3DE using the freehand method is fast and highly reproducible for (serial) LV volume and EF measurement, and, hence, ideally suited for clinical decision making and trials. Breath-hold 3DE is superior to free-breathing 3DE regarding image quality and reproducibility. Compared with MRI, 3DE underestimates LV volumes, but not EF, which is mainly explained by differences in endocardial contour tracing by MRI (outer contour) and 3DE (inner contour) of the trabecularized endocardium. Underestimation is reduced when breath-hold 3DE is compared with inner contour analysis of the MRI dataset. (J Am Soc Echocardiogr 2003;16:101-9.)

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent κ values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, κ values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

This study was undertaken with the aim of evaluating inter- and intraobserver variation on the pathophysiological interpretation of individual electromyographic (EMG) tests on muscles and nerve segments. Seven physicians from 6 European EMG laboratories independently interpreted 81 EMG studies comprising 735 muscle tests and 726 tests on nerve segments. Pathophysiological conclusions were inferred from findings of these tests without considering clinical information. For most combinations of findings, both the inter- and intraobserver variations on the interpretation were low, suggesting that common criteria for pathophysiological interpretations were used and that these were used consistently. For some combinations of findings, however, there was disagreement on whether these indicated specific or unspecific pathophysiological changes. In particular disagreement on whether findings indicated demyelination may be of clinical significance. A large part of the intraobserver variation may be explained by a change towards more cautious interpretations during the study for most of the physicians. It is concluded that there is a need to seek for consensus on the pathophysiological interpretation of individual findings and for incentives to ensure consistency in interpretations. The fact that experienced physicians changed their ways to interpret findings during the study suggests that agreement may be improved globally.

Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy Jaksin Sottisuporn*, Nisa Netinatsunton, Naichaya Chamroonkul, Teepawit Witeerungrot, Theeratus Jongboonyanuparp, Siriboon Attasaranya, Bancha Ovartlarnporn NKC institute of Gastroenterology and Hepatology, Hatyai, Thailand Background: Minimal changes esophagitis lesions (MCL) has been regarded as one of the spectrum of erosive esophagitis in some studies. The MCLs are subtle changes and are difficult to identify by conventional endoscopy. I-Scan endoscopy (SE) is a new imaging technology that enhances the mucosal details. Limited studies showed the SE to be better than white light endoscopy in detecting MCL. The intraobserver and interobserver variations of SE in detecting MCL have never been reported before. Aim: To assess the intraand interobserver variations in detecting MCL by high-definition endoscopy (HD) and SE in tone enhancement mode for esophagus (TE-e) in dyspeptic patients. Method: The endoscopic images in HD and TE-e modes of distal esophagus of all patients with upper abdominal symptoms scheduled for upper gastrointestinal endoscopy at the NKC institute from February 2010 till August 2011 were used to assess the consistency of images interpretation by 6 endoscopists. A set of images representing MCL that included punctate erythema (PE), blurred vessels (BV), minute erosion (ME) and triangular lesion with elongated pit (TLE) were used to educate all the endoscopists. 6 endoscopists randomly evaluated the endoscopic images of 89 patients in HD and TE-e mode twice with at least 24 hours interval in between. The intra and inter-observer consistency of images interpretation was analyzed. Result: Intraobserver kappa values (95% CI) for HD group were 0.44(0.24-0.65), 0.44(0.24-0.65), 0.410.2-0.62), 0.59(0.39-0.8), 0.45(0.24-0.65), 0.13(0.00-0.34) and for TE-e SE were 0.35(0.15-0.56), 0.56(0.360.77), 0.97(076-1.00), 0.51(0.31-0.71), 0.44 (0.61-0.27), 0.32(0.11-0.53) respectively. These represent fair to excellent agreement for intraobserver image interpretation in both HD and TE-e. One of the endoscopist had significant improvement in detecting MCL on the second image interpretation (kappa 0.13 versus 0.32 p 0.05). In the interobserver consistency of image interpretation, the pairwise kappa values for HD and TE-e of all 6 endoscopists were rather low (range 0.16-0.3 and 0.05-0.37 respectively). When the evaluations in both groups were analyzed by pairing individual endoscopist into 15 pairs, the kappa values improved with agreement in 7 of 15 pairs without statistical significance. (p 1) Conclusions: The intraobsever agreement for MCL by HD and i-Scan is fair to excellent. The poor interobserver agreement by HD and TE-e for MCL limits the value of the MCL in clinical practice. The SE imaging technology did not improve the interobserver image interpretation consistency.

OBJECTIVES: Fetal movement has been shown to change the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. The effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is unknown. Therefore we tested the hypothesis that the amniotic fluid index was unaffected by fetal movement. STUDY DESIGN: A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of fetal movement during 96 biophysical profiles. A reliable blinded examiner provided a second postmovement measurement as a control. Data were analyzed by the paired t test. RESULTS: The mean change in the amniotic fluid index after fetal movement was 1.5 ± 0.1 cm and 2.5 ± 0.2 cm for postmovement determinations by the same examiner and blinded observer, respectively ( p CONCLUSION: Interobserver and intraobserver variation can account for the change in the amniotic fluid index after fetal movement.

Esophageal pressure tracings of 10 normal subjects were used to determine the observer variation in assessing base line pressures and sphincter landmarks. These parameters were identified by two observers on two occasions. Comparison was made between one observer’s two assessments (intraobserver variation), and between the assessments made by the two observers (interobserver variation). Intra and interobserver variations were least in areas of relatively stable base line pressures (stomach and body of the esophagus), and highest in the two sphincters where pressure shifts made the selection of representative base line pressures difficult. Observer variation, however, did not obliterate inherent differences between individual tracings.