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Classification of patients with chronic lung allograft dysfunction (CLAD) into phenotypes requires CT scan interpretation to detect the presence of findings consistent with restrictive allograft syndrome (RAS). Whether this determination is made similarly across centers is unknown. As part of a multi-center prospective trial of surveillance CT scanning after lung transplantation, we performed a pilot study in a cohort of CT scans from patients with biopsy-proven CLAD. Radiologists with lung transplant expertise from three centers evaluated CT scans for the presence of ground glass opacities, consolidation, air trapping, and bronchiectasis (scored as % of lobe area involved, rounded to the nearest 10%), and diagnosed RAS, bronchiolitis obliterans syndrome (BOS), or concurrent pneumonia (scored as absent vs. present). Inter-rater agreement was calculated as Kendall's coefficient of concordance (i.e., Kendall's W, for % involvement of radiographic findings) and Cohen's Kappa (for presence/absence of BOS, RAS & pneumonia). The CT scans available for review were from 9 bilateral lung transplant recipients and 1 right lung transplant recipient, giving a total of 57 allograft lobes in which the presence of ground glass, consolidation, nodules, air trapping, and bronchiectasis were quantified and 10 overall diagnostic assessments. In general, there was good agreement between radiologists across centers for quantifying ground glass (Kendall's W of 0.86), consolidation (0.84), air trapping (0.76), and bronchiectasis (0.82), with moderate agreement for nodules (0.72). Likewise, there was good agreement between radiologists for the diagnosis of RAS (kappa 0.67), but agreement for the presence of BOS (0.35) or pneumonia (0.20) was weak (Table). Radiologists across transplant centers had generally good agreement on the presence of common radiographic findings and the diagnosis of RAS, but agreement on the diagnosis of BOS or concurrent pneumonia was weak. [ABSTRACT FROM AUTHOR]