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Undiagnosed and undertreated posterior malleolus fractures lead to early ankle instability and arthritis. A preoperative CT scan could improve the management of those fractures. This study assessed the benefits of a systematic ankle CT scanner to diagnose and manage posterior malleolus fracture. A monocentric retrospective cohort study was conducted. Sixty consecutive patients with bimalleolar fractures were operated and underwent a preoperative CT scan. The mean age was 50.0 years old (18.6 years old) with a mean body mass index of 20.3 (kg/m2) (11.4 kg/m2) and 71.7% (43/60) of women. The primary outcome was the rate of posterior malleolus fragment diagnosed on X-rays and on CT scan. Secondly, interobserver and interobserver’s agreement were compared between conventional X-rays and CT scan. Thirty-five (58.3%) posterior fragment fractures were observed on X-rays and 53 (88.3%) on the preoperative CT scan (p

Objectives To assess the reliability of the current computed tomography (CT) based technique for determining femoral anteversion, and quantify the prevalence and magnitude of side-to-side differences. Design Cross-sectional cohort study. Setting Academic trauma center. Patients We reviewed CT scans from 120 patients with bilateral full-length axial cuts of both femurs. Two hundred forty femurs with no fractures or other identifying features in their femora were included. Ten unique data sets were created to measure anteversion of the left and right sides. Main outcome measurements Intraobserver and interobserver reliability were calculated using intraclass correlation coefficients (ICC) and pooled absolute differences. The mean absolute difference between the sides was determined using a fixed-effects model. Results Interobserver reliability was high (ICC: 0.85, 95% confidence interval [CI]: 0.83-0.88). The pooled mean absolute magnitude of variation between reviewers was small at 1.6 degrees (95% CI: 1.4-1.8 degrees) per scan. The intraobserver reproducibility was high (ICC: 0.91, 95% CI: 0.88-0.93) with a mean error of 2.7 degrees (95% CI: 2.2-3.1 degrees) per repeat viewing of the same scan by the same person. The magnitude of side-to-side variation was 2.0 degrees (95% CI: 1.5-2.6 degrees). Twenty-one subjects (18%, 95% CI: 12-25%) had a mean side-to-side calculated femoral anteversion difference of ≥10 degrees, while 6 (5%, 95% CI: 2-10) subjects had a calculated mean side-to-side difference ≥15 degrees. Conclusions CT based femoral anteversion measurement techniques demonstrate good precision. Only 1 in 20 patients had side-to-side differences of 15 degrees or more. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

INTRODUCTION To extra validate and evaluate the reproducibility of a commercial deep convolutional neural network (DCNN) algorithm for pulmonary nodules on chest radiographs (CRs) and to compare its performance with radiologists. METHODS This retrospective study enrolled 434 CRs (normal to abnormal ratio, 246:188) from 378 patients that visited a tertiary hospital. DCNN performance was compared with two radiology residents and two thoracic radiologists. Abnormality assessment (using the area under the receiver operating ch3cteristics (AUROC)) and nodule detection (using jackknife alternative free-response ROC (JAFROC)) were compared among three groups (DCNN only, radiologist without DCNN and radiologist with DCNN). A subset of 56 paired cases, having two CRs taken within a 7-day period, were assessed for intraobserver reproducibility using the intraclass correlation coefficient. Independent characteristics of pulmonary nodules detected by DCNN were assessed by multiple logistic regression analysis. RESULTS The AUROC for abnormality detection for the three groups were 0.87, 0.93 and 0.96, respectively (P

Background Most patients with spinal tumors suffer no symptoms or have mild symptoms, but about 14% of patients have refractory pain caused by mechanical instability, or symptoms of spinal cord damage caused by epidural spinal cord compression. The Spinal Instability Neoplastic Score (SINS) and Kostuik classification are commonly used to evaluate spinal stability, and help to make a more detailed operation plan. The objectives of this study are to evaluate the reliability and reproducibility of the SINS and Kostuik classification, and to explore their clinical application value. Methods All 80 patients with spinal tumors were enrolled. Six spine surgeons who have certain clinical experience were selected. Patients were scored according to the SINS scoring system and classification was determined according to the Kostuik system. We used Fleiss and Cohen κ values to check the coefficient consistency for multifactors. We used Cohen κ value to check the interobserver reliability and intraobserver reproducibility. After 12 weeks, we repeated the analysis. Results The interobserver reliability and intraobserver reproducibility of the SINS scoring system were near perfect with values of 0.831 and 0.874, respectively. The interobserver reliability and intraobserver reproducibility of the Kostuik classification system were moderate with values of 0.505 and 0.595, respectively. Conclusions Compared with the Kostuik classification system, the SINS scoring system has better interobserver reliability and intraobserver reproducibility, which can be widely used in clinical practice and has great significance in the decision-making of spinal tumor treatment. Although the Kostuik classification system is often used in clinical practice, it shows inferior reliability and reproducibility in our study.

Aims: To analyse the intra- and interobserver variability of two elastographic methods of quantification available on the same machine, the technical factors that may influence variability as well as the intra- and interobserver variability for the same indices between two different ultrasound machines in an in vitro experimental setting.Material and methods: Three different types of silicone experimental devices (ED) were conceived for the purpose of this study. Two observers performed repeated measurements on two ultrasound machines. Strain elastography, with strain ratio determination between the ED was performed on both machines. Shear wave ratio was also assessed. The data obtained were used to calculate intra- and interobservervariability. Reproducibility was assessed in relation to the size of the elastographic region of interest (ROI) and to the difference in stiffness between the ED, through the value of the ICCs (Intraclass Correlation Coefficient).Results: Strain ratio had high inter- and intraobserver reproducibility, regardless of the machine used, on a large number of determinations.The choice of a small ROI diameter (5 mm) over a large ROI diameter (15mm) increased reproducibility (ICC = 0.87 vs 0.78, p=0.000). It is observed that, by Shear Wave Elastography, only when analysing structures with a large difference in hardness, significance is obtained in terms of interobserver reproducibility (ICC = 0.75, p=0.000).Conclusions: On a large number of determinations, both techniques are inter- and intraobserver reproducible. It is preferable to opt for a smaller ROI diameter in order to increase interobserver reproducibility. SWE Ratio provides significant reproducibility only when analysing structureswith large difference in hardness.

Purpose To evaluate the intra and interobserver reproducibility of a new goniometric method for evaluating the isolated passive range of motion of the glenohumeral joint in an outpatient setting. Methods This is a prospective observational study on healthy subjects. The Glenohumeral ROM Assessment with Scapular Pinch (GRASP) method is a new method for assessing the isolated range of motion (ROM) of the glenohumeral joint (GH) by a single examiner with a clinical goniometer. It measures the isolated glenohumeral passive abduction (GH-AB), passive external rotation (GH-ER) and internal rotation (GH-IR) with the arm at 45º of abduction. These three GH ROM parameters were measured in both shoulders of 30 healthy volunteers (15 males/15 females, mean age:41.6[SD = 10.3] years). The full shoulder passive abduction, passive external rotation and internal rotation 45º of abduction were measured by the same examiners with a goniometer for comparison. One examiner made two evaluations and a second examiner made a third one. The primary outcome was the intra- and interobserver reproducibility of the measurements assessed with intraclass correlation coefficients (ICC) and the Bland–Altman plot. Results The intra-observer ICC for isolated glenohumeral ROM were: 0.84 ± 0.07 for GH-ABD, 0.63 ± 0.09 for GH-ER, and 0.61 ± 0.14 for GH-IR. The inter-observer ICC for isolated glenohumeral ROM were: 0.86 ± 0.06 for GH-ABD, 0.68 ± 0.12 for GH-ER, and 0.62 ± 0.14 for GH-IR. These results were similar to those obtained for full shoulder ROM assessment with a goniometer. Conclusion The GRASP method is reproducible for quick assessment of isolated glenohumeral ROM. Level of evidence III

Objective: To evaluate the intra and interobserver variation in the Sanders classification of calcaneal fractures and the clinical-radiological correlation of postoperative X-ray images and computed tomography (CT) scans. Methods: We sent pre- and postoperative images in the form of a questionnaire to 18 foot and ankle surgeons with varying experience and examined evaluations of the postoperative reduction and Sanders classification quality criteria of 12 calcaneal fractures. The kappa (Ƙ) values were calculated and compared to those in the literature, and the quality of the reduction was compared to the patient's American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) score. Results: The mean intraobserver Ƙ of the Sanders classification was 0.49. Disregarding the subclasses, the intraobserver Ƙ was 0.55, and when type III and IV fractures were grouped, the intraobserver Ƙ was 0.57. The interobserver Ƙ values in these same three conditions were 0.22, 0.20, and 0.21, respectively. We also observed that the group of less experienced surgeons showed better intraobserver Ƙ values than the more experienced surgeons. In the analysis of the reduction quality based on X-ray images and the AOFAS-AHS score of the patient, we found a value of p=0.043. Conclusion: The Ƙ values were consistent with previous studies, confirming moderate intraobserver reproducibility and acceptable interobserver reliability. We also confirmed the presence of a significant relationship between the reduction quality based on X-ray images and the AOFAS-AHS score of the patient. Level of Evidence III; Diagnostic Studies; Nonconsecutive patients, no uniformly applied reference gold standard.

OBJECTIVES Doppler Color Scoring (DCS) has been used to predict successful expectant management of incomplete miscarriage. The aim of this study was to assess inter- and intraobserver reproducibility of the DCS system in women with incomplete miscarriage noted on transvaginal sonography. METHODS This was a prospective reproducibility study involving offline analysis of 32 prerecorded video sets on transvaginal sonography in real time of women with incomplete miscarriage. Vascularization of retained products of conception was recorded using the DCS system adopted from the International Ovarian Tumor Analysis group. Five gynecologic sonologists of varying experience assigned a DCS classification to each video in the analysis. The same videos were reanalyzed, in a different order, at least 7 days later, to assess intraobserver agreement. Inter- and intraobserver correlations were performed to determine agreement. Interobserver agreement was also measured between each observer and the reference standard (G.C.). A Cohen's κ coefficient value less than 0 suggests poor agreement, 0.01 to 0.20 slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 and 0.99 almost perfect. RESULTS Interobserver agreement for all observers for DCS allocation ranged from 0.480 to 0.751. Overall interobserver agreement for 5 observers was substantial (κ, 0.626). Overall interobserver agreements for the 2 inexperienced and 3 experienced observers compared to G.C. were 0.521 and 0.618, respectively. Experienced observers achieved overall almost perfect intraobserver agreement, compared to substantial agreement for inexperienced sonologists. CONCLUSIONS DCS interobserver reproducibility between all observers and GC ranged from moderate to substantial. DCS intraobserver reproducibility was substantial to almost perfect. The DCS system appears to be a reproducible tool in evaluating women with incomplete miscarriage.

Introduction Accurate results on the status of programmed cell death-ligand 1 (PD-L1) rely on not only the quality of immunohistochemistry testing but also the accuracy of the pathologic assessments. We explored the intraobserver and interobserver reproducibility of the interpretations for the companion diagnostics, the Dako PD-L1 22C3 pharmDx kit (Dako North America, Inc, Carpinteria, CA) and the VENTANA PD-L1 (SP263, Ventana Medical Systems, Inc, Tucson, AZ) assay, and the consistency between microscopic and digital interpretations of PD-L1. Methods A total of 150 surgical specimens diagnosed as NSCLC from December 2013 to July 2017 were included in this study. Twenty pathologists from different medical centers were enrolled to interpret the results of PD-L1 on the same day. A total of 100 sections were stained with the 22C3 clone and scored for the interobserver reproducibility, 20 cases of which were interpreted twice to assess the intraobserver reproducibility, and 50 cases of which were scanned into digital images to measure the consistency between microscopic and digital interpretations. A total of 44 sections were stained with the SP263 clone and scored for the interobserver reproducibility. Results For the intraobserver reproducibility of 22C3, the overall percent agreements were 92.0% and 89.0% for binary tumor evaluation at the cutoffs of 1% and 50%, respectively. The reliability among the pathologists revealed a substantial agreement for 22C3, whereas it revealed a substantial agreement at the cutoff of 1% and moderate agreement at the cutoffs of 25% and 50% for SP263. Microscopic and digital interpretations of PD-L1 revealed good consistency. Conclusions Intraobserver and interobserver reproducibility of the interpretations for PD-L1 was high using the 22C3 clone but lower for the SP263 clone. Corresponding training on such assessments, especially on the cases around the specific cutoffs, is essential for markedly improving such reproducibility. Digital imaging could improve the reproducibility of interpretation for PD-L1 among pathologists.

Objective: Many recent studies are pointing out the heterogeneity between pathologists in the classification of malignant pleural mesotheliomas. Besides, they reported the prognostic impact of classifying epithelioid mesotheliomas according to the predominant architectural features and the nuclear grade. The authors assessed the interobserver and the intraobserver agreement of subtyping mesotheliomas between 2 pathologists used to thoracic pathology. Material and Method: The observers reviewed all the slides of the malignant pleural mesotheliomas diagnosed during the period ranging from 2004 to 2017. The Cohen Kappa was performed in order to evaluate the agreement between both observers into classifying mesotheliomas, subtyping and grading epithelioid mesotheliomas. Two rounds of examination were planned with a delay period of one month. After the first round, the reviewers discussed the different difficulties and challenges they faced. All the statistic tests were performed using the SPSS software version 12.0. Results: After the first round, a fair agreement between both observers was reported. After the second round, an improvement of the concordance rate with a good agreement in subtyping epithelioid mesotheliomas was noticed. Concerning the grading of mesotheliomas, the interobserver agreement was poor even after the second round examination. The intraobserver reproducibility of epithelioid mesothelioma subtyping was fair or moderate for both reviewers. The intraobserver agreement was poor concerning the grading of epithelioid mesothelioma. Conclusion: Integrating subtyping and grading of epithelioid mesotheliomas into a new classification necessitates an important training of the pathologists. The architectural features' definitions have to be clarified in order to avoid using own subjective opinions and habits by pathologists.

Purpose: The aim of this study was to evaluate the intraobserver reproducibility of demarcation line depth measurement in keratoconic patients after epithelium-off corneal collagen cross linking and assess the interobserver variability/agreement among examiners of various experience levels. Methods: 56 eyes of 56 patients undergoing corneal collagen cross linking for progressive keratoconus were enrolled. After 4 weeks, all patients underwent an anterior segment optical coherence tomography (AS-OCT; CASIA SS-1000; Tomey, Nagoya, Japan) in the cross-linked eye by four masked examiners (two medical students (S1 and S2) and two corneal fellows (F1 and F2)) in order to identify and measure the demarcation line depth in experienced and non-experienced users. The intraclass correlation coefficient and the coefficient of variation were calculated. Agreement between raters was evaluated using Bland–Altman plots, intraclass correlation coefficient and weighted-kappa statistics comparing raters in pairs. Results: The average demarcation line depth of all measurements was 254.34 ± 72.3 μm, varying from 84 to 459 μm. The intraclass correlation coefficient evaluating the reproducibility of measurements for F1 was 0.9379 (95% confidence interval (CI) =0.9035–0.9619), for the second (F2), it was 0.9837 (95% confidence interval = 0.9743–0.9901), while intraclass correlation coefficient between medical students was calculated 0.844. The overall intraclass correlation coefficient among all four observers was 0.8706 (95% confidence interval = 0.8061–0.9185). The coefficient of variation for repeated measurements was 5.981 μm (95% confidence interval = 3.966–7.471) and 3.312 μm (95% confidence interval = 2.468–3.981) for F1 and F2 raters, respectively. The percentage of demarcation line detection was 90.32%. Conclusion: The reproducibility of demarcation line measures although very good (intraclass correlation coefficient > 0.9), yielded a difference between the two experienced raters. Furthermore, the novice raters did not reach an excellent level of agreement with the expert ones showing greater variability in their recordings.

Objectives To estimate intraobserver and interobserver reproducibility for assigning an International Endometrial Tumor Analysis (IETA) group color score for endometrial vascularization on color Doppler imaging. Methods Sixty-eight endometrial 3-dimensional volumes from endometrial color Doppler assessments of women with different endometrial disorders were evaluated by 8 different examiners (4 skilled examiners and 4 obstetric and gynecologic trainees). One skilled examiner who did not participate in the assessments selected the 68 volumes from a database to select a balanced number of each IETA score. Each examiner evaluated the 68 endometrial volumes to assign the IETA color score (1, absence of vascularization; 2, low vascularization; 3, moderate vascularization; or 4, abundant vascularization) using tomographic ultrasound imaging. The analysis was repeated 4 weeks later, and interobserver and intraobserver reproducibility was analyzed by calculating the weighted κ index. The second of the measurements made by each observer was used to estimate interobserver reproducibility. Results The intraobserver reproducibility was very good for all examiners, with a weighted κ index ranging from 0.84 to 0.91. The interobserver reproducibility was good or very good for all estimated comparisons, with a weighted κ index ranging from 0.77 to 0.96, regardless of experience level. Conclusions The reproducibility of assigning the IETA color score for assessing endometrial vascularization using 3-dimensional volumes is good or very good regardless of the experience of the examiner.

BACKGROUND: QRS narrowing after CRT is a predictor of patient outcome. Further narrowing can be obtained by interventricular pacing delay (VVd) optimization, raising interest to inter and intraobserver variation in manual measurements of QRS duration.METHODS: (a) Variation in intrinsic rhythm QRS duration in CRT patients with LBBB: In 40 intrinsic 12-lead ECGs, six observers measured QRS duration defined as widest QRS in any lead. In 20 of these ECGs, two observers repeated the measurements. (b) Variation in paced QRS duration at different VVd settings and agreement in selecting the narrowest QRS: In 20 CRT patients, five paced ECGs were recorded at different VVds. The most frequently selected VVd(s) estimated to cause the narrowest QRS in each patient defined the optimal VVd. Two observers repeated the measurements and VVd selections.RESULTS: Absolute interobserver difference in measured QRS duration in intrinsic rhythm ECGs was mean 2 ms, range (-40; 40 ms), mean limits of agreement (LoA): -21; 25 ms. Absolute interobserver difference in measured QRS duration in paced ECGs was mean 3 ms, range (-50; 60 ms), mean LoA: -20; 27 ms. There was no difference in LoA between intrinsic and paced QRS duration (lower limit p = 0.68; upper limit p = 0.44). The optimal VVd was included in 17/20 (85%) of the VVd selections by six observers. Interobserver variation was comparable with the intraobserver variation.CONCLUSIONS: Interobserver variation and intraobserver variation in manually measured paced and intrinsic rhythm QRS duration are clinically acceptable and comparable in a cohort of CRT patients. Inter and intraobserver reproducibility for selecting the optimal VVd is good and warrants manual VVd optimization for QRS narrowing in CRT.

Background: The purpose of this study is to test the hypothesis of the new classification system of distal end radius fractures (Barzullah working classification) proposed by one of the author in a prospective cohort study, among the orthopaedic residents. Methods: The initial post-injury radiographs of 300 patients with distal radius fractures in a tertiary centre were classified by two junior residents (JR1 and JR2) and two senior residents (SR1 and SR2) in the emergency department over a period of two years. The collected data was analysed statistically by using Cohan's kappa for measuring Intraobserver reproducibility and Fleiss kappa for measuring Interobserver agreement. Results: The mean kappa value for Interobserver agreement was 0.53 (moderate agreement) at the end of one year and the mean kappa value at the end of study period was 0.64 (substantial agreement). The mean kappa value for Intraobserver reproducibility of JR1 was 0.45 (moderate agreement), JR2 was 0.39 (fair agreement), SR1 was 0.62 (substantial agreement) and SR2 was 0.67 (substantial agreement). Conclusions: Barzullah working classification of distal radius fractures presented in this study has good characteristics compared to those of already studied classification systems among orthopaedic residents.

Aim The aim of this systematic review was to assess the in vivo scientific evidence regarding the ability of a recently developed light fluorescence device, SoproLife® (Sopro-Acteon group, La Ciotat, France) in detecting occlusal carious lesions. The PubMed database was searched for in vivo trials that evaluated the validity of the SoproLife® camera for the detection of occlusal carious lesions. Among the 11 articles originally identified with the keyword “Soprolife,” only three articles were included. The three included surveys used the International Caries Detection and Assessment System (ICDAS)-II criteria as gold standard for the assessment of SoproLife® compared or not to other detection devices (DIAGNOdent® and Spectra Caries Detection Aid®). Two of the included studies reported only on permanent teeth or both primary and permanent teeth. The SoproLife® validity values varied markedly among studies with a sensitivity ranging between 0.43 and 0.95 and a specificity between 0.55 and 1. Interobserver reproducibility with the SoproLife® was reported in two of the three studies (0.98 and 0.72) and none of the studies reported about intraobserver reproducibility. No clear-cut conclusion can be made based on the three included clinical studies; further in vivo investigations are needed to confirm the validity of the SoproLife® camera in terms of detection of occlusal carious lesions. How to cite this article Doméjean S, Rongier J, Muller-Bolla M. Detection of Occlusal Carious Lesion using the SoproLife® Camera: A Systematic Review. J Contemp Dent Pract 2016;17(9):774-779.

The aim of this study was to assess inter- and intraobserver agreement of the traditional systems (Ruedi-Allgower, AO [Arbeitsgemeinschaft fur Osteosynthesefragen], and Topliss) and the newly proposed Leonetti classification system of pilon fractures. We studied all patients at our center who underwent pilon fracture surgery over a 2-year period: 68 patients (70 legs) were included. Four observers independently classified each pilon fracture according to the Ruedi-Allgower, AO, Topliss, and Leonetti systems by evaluating radiographs and computed tomography images on 2 occasions. The inter- and intraobserver agreements were calculated using the Fleiss kappa test. Interobserver reliability was good for AO types (A, B, and C) and Ruedi-Allgower (κ = 0.71 and 0.61, respectively), whereas the interobserver reliability was moderate for AO groups (A1, A2, A3, B1, B2, B3, C1, C2, and C3), Topliss families, Topliss subfamilies, Leonetti types, and Leonetti subtypes. Intraobserver reproducibility was excellent for the Ruedi-Allgower classification, AO types, and Topliss families and good for AO groups, Topliss subfamilies, and Leonetti types and subtypes. Ruedi-Allgower and AO classification systems are the most reliable among those currently used for pilon fractures, but with lower agreement at the AO group level. The use of Topliss and Leonetti classification systems is not recommended because of less favorable results.

Category: Trauma Introduction/Purpose: Objective: To perform an independent inter-observer and intra-observer agreement assessment of the new pilon fracture classification system based on CT-scan. Summary of Background Data: Multiple classification systems have been proposed for pilon fractures, with no consensus to date of which is the most useful tool nor the one that provides the best prognostic orientation. Currently, pilon fractures are classified according to AO and Ruedi Allgower systems based on X-rays. A new pilon fracture classification system based on CT-Scan was recently described by Leonetti and Tigani in 2017. It showed substantial inter- and intra-observer agreement in the study describing it; however, an independent evaluation has not yet been performed, which is required for its wide use in clinical practice and research. Methods: CT-scans of 71 patients with acute traumatic pilon fractures were selected and classified using the morphologic grading of the new pilon fracture classification system by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents). After a six-week interval, the 71 cases were presented to the same evaluators in a random sequence for repeat evaluation. The Kappa coefficient (k) was used to determine the inter- and intra-observer agreement. Results: The inter-observer agreement was substantial when considering the fracture main types (I, II, III or IV), with k= 0.635 (0.59 - 0.67), but moderate when considering the sub-types (I, IIF, IIS, IIIF, IIIS or IV): k= 0.588 (0.56 - 0.61). The intra-observer agreement was substantial considering the fracture types, with k= 0.65 (0.62 - 0.71) and considering sub-types, k= 0.62 (0.57 - 0.66). No significant differences were observed between foot and ankle surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific I, II, III or IV type of injuries. Conclusion: The new pilon fracture classification system based on CT-scan allows adequate agreement among different observers and by the same observer on separate occasions. Therefore, studies that use this system should be considered reliable. Future prospective studies should determine whether this classification allows surgeons to decide the best treatment for patients with tibial pilon fractures.

BACKGROUND: Traditionally, distal radius fractures (DRFs) have been described using eponyms, e.g. Colles, Smith, Barton, Chauffeur. During the last half of the 20th century several classification systems for DRF have emerged. We evaluated the inter- and intra-observer agreement of the AO/OTA, Frykman and Older classification systems.METHODS: Four observers, an intern, an orthopaedic registrar, an orthopaedic consultant and a radiology consultant, independently evaluated DRF radiograms and classified the fractures according to the AO/OTA, Frykman and Older classification systems. After an interval of 6 months, radiograms of 30 randomly chosen patients were re-evaluated by the same observers.RESULTS: Radiograms of 573 DRF patients were evaluated in the study. The inter-observer reliability of the AO/OTA fracture types (A, B and C) was 'weak' (kappa = 0.45). The agreement dropped to 'minimal' (kappa = 0.24) regarding the AO/OTA groups (A2, A3, B1, B2, B3, C1, C2 and C3). The reliability of the Frykman classification system was 'weak' (kappa = 0.41), and we observed the lowest inter-observer reliability for the Older classification system (kappa = 0.10). The kappa values for the intra-observer reproducibility of the AO/OTA fracture types (A, B and C) ranged from 0.58 to 0.87. For the AO/OTA groups (A2, A3, B1, B2, B3, C1, C2 and C3) the reproducibility was lower ranging from 'minimal' to 'weak'. The intra-observer reproducibility of the Frykman system was 'weak' to 'moderate' and even worse for the Older classification system.CONCLUSION: Based on these findings the AO/OTA classification system seems to be most reliable for routine use, however, with lower kappa values concerning the agreement for the groups. The Frykman and Older classification systems cannot be recommended because of less convincing results.

Clinical decision support systems (CDSSs) hold potential for the differential diagnosis of neurodegenerative diseases. We developed a novel CDSS, the PredictND tool, designed for differential diagnosis of different types of dementia. It combines information obtained from multiple diagnostic tests such as neuropsychological tests, MRI and cerebrospinal fluid samples. Here we evaluated how the classifier used in it performs in differentiating between controls with subjective cognitive decline, dementia due to Alzheimer's disease, vascular dementia, frontotemporal lobar degeneration and dementia with Lewy bodies. We used the multiclass Disease State Index classifier, which is the classifier used by the PredictND tool, to differentiate between controls and patients with the four different types of dementia. The multiclass Disease State Index classifier is an extension of a previously developed two-class Disease State Index classifier. As the two-class Disease State Index classifier, the multiclass Disease State Index classifier also offers a visualization of its decision making process, which makes it especially suitable for medical decision support where interpretability of the results is highly important. A subset of the Amsterdam Dementia cohort, consisting of 504 patients (age 65 ± 8 years, 44% females) with data from neuropsychological tests, cerebrospinal fluid samples and both automatic and visual MRI quantifications, was used for the evaluation. The Disease State Index classifier was highly accurate in separating the five classes from each other (balanced accuracy 82.3%). Accuracy was highest for vascular dementia and lowest for dementia with Lewy bodies. For the 50% of patients for which the classifier was most confident on the classification the balanced accuracy was 93.6%. Data-driven CDSSs can be of aid in differential diagnosis in clinical practice. The decision support system tested in this study was highly accurate in separating the different dementias and controls from each other. In addition to the predicted class, it also provides a confidence measure for the classification.

Objective the principal objective of this study was to assess the quality of blood loss estimates by midwives and student midwives. The secondary objectives were: to assess the intraobserver agreement of visual blood estimates and the rate of underestimation of blood loss by participants, and to estimate the sensitivity, specificity, and negative likelihood ratio of these estimates for clinically pertinent blood losses (≥ 500mL and ≥ 1000mL). Design multicenter cross-sectional study. Setting thirty-three French maternity units and 35 French midwifery schools participated in this study. Participants volunteer French midwifery students ( n = 463) and practicing midwives ( n = 578). Intervention an online survey showed 16 randomly ordered photographs of 8 different simulated blood quantities (100, 150, 200, 300, 500, 850, 1000, and 1500mL) with a reference 50-mL image in each photo and asked participants to estimate the blood loss. The visual blood loss estimates were compared with Fisher's exact test. Intraobserver agreement for these estimates was assessed with a weighted kappa coefficient, and the negative predictive values (probability of no hemorrhage when visual estimate was negative) were calculated from prevalence rates in the literature. Findings of the 16,656 estimates obtained, 34.1% were accurate, 37.2% underestimated the quantity presented, and 28.7% overestimated it. Analyses of the intraobserver reproducibility between the two estimates of the same photograph showed that agreement was highest (weighted kappa ≥ 0.8) for the highest values (1000mL, 1500mL). For each volume considered, students underestimated blood loss more frequently than midwives. In both groups, the negative predictive values regarding postpartum hemorrhage (PPH) diagnosis (severe or not) were greater than 98%. Key conclusions and implications for practice student midwives tended to underestimate the quantity of blood loss more frequently than the midwives. Postpartum hemorrhage (≥ 500mL) was always identified, but severe postpartum hemorrhage (≥ 1000mL) was identified in fewer than half the cases. These results should be taken into account in training both student midwives and practicing professionals.

To measure the inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements taken by the enhanced depth imaging of spectral-domain optical coherence tomography (EDI-OCT) in randomly selected subjects using two different protocols. Twenty subjects of the Thessaloniki Eye Study database were randomly selected. The participants underwent EDI-OCT, and the choroidal thickness was measured on EDI images using two different protocols. All images were assessed by two examiners independently in two sessions in different days. The interobserver intraclass correlation coefficient (ICC) for average choroidal thickness was 0.944. The average ICC for central, Cmin, and Cmax choroidal thickness was 0.899, 0.863, and 0.955, respectively. The interobserver ICC for average choroidal volume was 0.932. Intraobserver repeatability ICC for grader 1 ranged between 0.925 and 0.9720 and for grader 2 between 0.913 and 0.994. Choroidal thickness measurements by EDI-OCT showed a high inter- and intraobserver reproducibility.

Reliable assessment of islet viability, mass, and purity must be met prior to transplanting an islet preparation into patients with type 1 diabetes. The standard method for quantifying human islet preparations is by direct microscopic analysis of dithizone-stained islet samples, but this technique may be susceptible to inter-/intraobserver variability, which may induce false positive/negative islet counts. Here we describe a simple, reliable, automated digital image analysis (ADIA) technique for accurately quantifying islets into total islet number, islet equivalent number (IEQ), and islet purity before islet transplantation. Islets were isolated and purified from n = 42 human pancreata according to the automated method of Ricordi et al. For each preparation, three islet samples were stained with dithizone and expressed as IEQ number. Islets were analyzed manually by microscopy or automatically quantified using Nikon's inverted Eclipse Ti microscope with built-in NIS-Elements Advanced Research (AR) software. The AIDA method significantly enhanced the number of islet preparations eligible for engraftment compared to the standard manual method ( p < 0.001). Comparisons of individual methods showed good correlations between mean values of IEQ number ( r2 = 0.91) and total islet number ( r2 = 0.88) and thus increased to r2 = 0.93 when islet surface area was estimated comparatively with IEQ number. The ADIA method showed very high intraobserver reproducibility compared to the standard manual method ( p < 0.001). However, islet purity was routinely estimated as significantly higher with the manual method versus the ADIA method ( p < 0.001). The ADIA method also detected small islets between 10 and 50 μm in size. Automated digital image analysis utilizing the Nikon Instruments software is an unbiased, simple, and reliable teaching tool to comprehensively assess the individual size of each islet cell preparation prior to transplantation. Implementation of this technology to improve engraftment may help to advance the therapeutic efficacy and accessibility of islet transplantation across centers.

Purpose To prospectively evaluate the short-term reproducibility of intravoxel incoherent motion (IVIM) parameters and apparent diffusion coefficient (ADC) in lung cancer patients. Materials and methods In all, 50 patients (50 lesions) underwent free-breathing diffusion-weighted imaging (DWI) (b = 0, 300, 800 s/mm2 ) and IVIM (10 b-values, 0-1000 s/mm2 ) scans twice (0.5-1-hour interval) at 3T. Regions of interests (ROIs) were drawn on ADC maps and IVIM images to derive the mean ADC value and IVIM parameters D, D*, and f. Intra- and interobserver, test-retest reproducibility were assessed with intraclass correlation coefficients (ICCs), within coefficient-of-variations (WCVs), and Bland-Altman analysis. The effects of type, size, and location of lung lesions were compared with WCVs. Results D and ADC showed good intraobserver reproducibility and interobserver agreement, while D* and f showed relatively larger variability (WCV 20.89-34.97%). The test-retest reproducibility of D and ADC were good (ICC 0.763-0.837; WCV 11.12-12.55%), while those of D* and f were relatively poor (ICC 0.604-0.842; WCV 36.54-72.62%). D and ADC had decreased reproducibility for lesions 2 cm (WCV 42.64%). D* had even worse reproducibility in peripheral lung cancers (WCV 84.11%) and lesions in the lower lung zones (WCV 80.84%). Conclusion If the change in ADC, D, D*, and f values is less than ∼31%, 34%, 170%, and 130%, respectively, it may be caused by measurement error. The type, size, and location of lung lesions have an effect on measurement errors. Level of evidence 1 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2018;47:1003-1012.

Purpose: To establish normative data of extraocular muscle (EOM) dimensions, both vertically and horizontally, using a reproducible echographic method in various age groups. Methods: Two hundred eyes of 100 healthy subjects (50 males and rest females) were included in this prospective observational study. All subjects were divided into 5 groups with an interval of 10 years from 10 to 60 years. Each group contained 10 male and 10 female healthy subjects. A single operator took measurements at 4 mm distance from the globe plane after drawing a perpendicular line on the globe to the muscle belly. Results: The average age of subjects was 37.28 ± 17.14 years. Intraobserver reproducibility was very high (intersession concordance correlation co-efficient = 0.995). Mean horizontal and vertical diameters of recti were 3.0775 and 8.26 mm, respectively. Mean muscle thickness of superior rectus/levator palpebral superioris (LPS) muscle complex and LPS was 4.56 and 1.45 mm, respectively. Extraocular muscle diameter increases up to the middle age, then it starts decreasing. There was no statistically significant correlation between diameter of each EOM, both eye and gender (p P 0.05). There was a non-significant change in extraocular muscle thickness with age. Conclusion: The study provides normative data for extraocular muscle thickness in both genders of various age groups in Indian population. Muscle dimensions do not change significantly with age, between the eyes and gender.

Background: It has been shown that cam deformities are located at a more anterosuperior location than was previously described. Purpose: To establish, in a large group of asymptomatic participants, the normative range of the alpha angle in the anterosuperior location in both the oblique axial and radial views of magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: In 197 asymptomatic participants (394 asymptomatic hips) with a mean age of 29.4 years (range, 21.4-50.6 years), T1-weighted MRI scans were studied. The anterosuperior alpha angle measurement was performed by 2 observers using a previously described methodology and also using the radial view. The intraclass correlation coefficient (ICC) was determined for interobserver and intraobserver reliability. Descriptive statistics, the Student t test, correlation studies, and the Bland-Altman technique were used for data analysis. Results: The ICC for interobserver and intraobserver reproducibility was 0.74 (good agreement) and 0.84 (very good agreement), respectively. Anterosuperiorly, the mean (±SD) alpha angles in the oblique axial and radial views were 45.11° ± 8.52° and 50.30° ± 7.91°, respectively ( P < .0001). The upper limits of the 95% reference interval for the oblique axial and radial views were 63° and 66°, respectively. In the oblique axial view, the mean (±SD) alpha angle for male participants was 48.3° ± 7.5° compared with 42.6° ± 6.2° for female participants ( P < .0001), and in the radial view, it was 53.0° ± 7.1° compared with 48.1° ± 5.6°, respectively ( P < .0001). Linear regression analysis demonstrated an insignificant relationship between age and alpha angle, regardless of the imaging plane ( r2 = 0.06). Conclusion: We suggest using a higher threshold of 63° (in the oblique axial view) and 66° (in the radial view) at the 1:30 clockface position for the diagnosis of a cam-type deformity. This is significantly higher than 50° to 55° at the 3-o’clock position traditionally used based on the oblique axial view that has been initially described.

OBJECTIVE: To assess the inter- and intraobserver reproducibility of the original version and different descriptions of the Kellgren and Lawrence classification used in epidemiological studies for osteoarthritis of the knee. METHODS: The study included 72 patients with osteoarthritis of the knee. Three medical members of the Brazilian Society of Knee Surgery were invited to evaluate the images. An intra- and interobserver analysis was conducted, with an interval of one month. The intraobserver agreement was analyzed using the weighted Cohen's Kappa coefficient. The interobserver agreement was analyzed using the Krippendorff alpha coefficient (a). RESULTS: The intraobserver assessment indicated conflicting results. In the interobserver analysis, the level of agreement was superficial. CONCLUSIONS: The classification of Kellgren and Lawrence and its variants generated a low reproducibility between observers. The intraobserver analysis showed a lack of uniformity in the use of this classification and its variants, even among experienced observers. RESUMO OBJETIVO: Avaliar a reprodutibilidade inter e intraobservador da versão original e das diferentes descrições da classificação de Kellgren e Lawrence usadas em estudos epidemiológicos para osteoartrite do joelho. MÉTODOS: Foram estudados 72 pacientes com diagnóstico de osteoartrite do joelho. Três médicos membros da Sociedade Brasileira de Cirurgia do Joelho foram convidados para avaliar as imagens. Análises intra e interobservador foram feitas com intervalo de um mês. A concordância intraobservador foi analisada por meio do coeficiente Kappa de Cohen ponderado. Na análise interobservador foi usado o coeficiente alpha de Krippendorff (a). RESULTADOS: A avaliação intraobservador apresentou resultados discordantes. Na análise interobservador, o grau de concordância foi superficial. CONCLUSÕES: A classificação de Kellgren e Lawrence e suas variantes geraram uma baixa reprodutibilidade entre os observadores. A análise intraobservador apresentou resultados discordantes, demonstrou que há falta de uniformidade no uso dessa classificação e de suas variantes mesmo entre observadores experientes.

Purpose To assess inter- and intraobserver reproducibility of DCE-MRI measurements and possible differences between two directly adjacent slices. Materials and Methods DCE-MRI measurements of 30 patients with histologically proven rectal carcinoma were performed on a 1.5 Tesla (T) MR system during intravenous contrast agent application before and after neoadjuvant radiochemotherapy with two directly adjacent slices used for calculation per patient. Images were analyzed semiquantitatively (parameters TTP and MITR) and quantitatively using the Brix compartment model (parameters kep and A) by two different observers and at two different time points. The concordance correlation coefficient was calculated for every parameter in intra-/interobserver comparison and slice comparison. Results Median relative differences below 10% for all parameters and high values of the concordance correlation coefficient (CCC) were found for most pharmacokinetic parameters in inter-/intraobserver comparison and slice comparison, with the exception of the parameter A before therapy in intra-/ interobserver comparison (CCC: 0.315/0.452) and kep before therapy in intraobserver comparison (CCC: 0.362). Conclusion Our results indicate good inter- and intraobserver reproducibility for most pharmacokinetic parameters and for the two adjacent slices measured. However, as there were some parameters that demonstrated poor correlation, testing for reproducibility and a multiobserver approach might be considered whenever using pharmacokinetic parameters as biomarkers. J. Magn. Reson. Imaging 2014;40:715–722. © 2013 Wiley Periodicals, Inc.

Aim With the availability of multidetector computed tomography, 3-D display and measurements of cerebral aneurysms can be performed routinely. Although the 3-D method is more intuitive, 3-D measurements can be more operator dependent. Few data are available on interobserver variability and intraobserver reproducibility. We aimed to assess the interobserver and intraobserver reliability using both planar and 3-D methods. Patients and Methods A total of 48 subarachnoid haemorrhage patients were recruited into the study. Results Aneurysm dimensions showed medium-to-large correlations among observers using the planar method, and large correlations for the 3-D method. The average Kendall's tau b coefficients among observers of aneurysm dimensions were significantly better for 3-D methods compared to the planar method. Excellent correlations in planar and 3-D aneurysm dimensions were found between repeated measurements (Kendall's tau b coefficients: 0.90–0.97; all P

Purpose To establish a new imaging technique using dynamic MRI three-dimensional (3D) volumetric acquisition in real-time, on six normal shoulders for the analysis of the 3D shoulder kinematics during continuous motion. Materials and Methods At first, a standard static acquisition was performed. Then, fast images were obtained with a multi-slice 3D balanced gradient echo sequence to get a real time series during the initial phase of shoulder abduction. Subsequently, the images were reconstructed; registered and the translational patterns of the humeral head relative to the glenoid and the size of the subacromial space were calculated. Additionally, the intraobserver reproducibility was tested. Results The maximal abduction was on average 43° (30° to 60°) and the mean width of the subacromial space was 7.7 mm (SD: ± 1.2 mm). Difference between extreme values and average values was low, respectively 2.5 mm on X-axis, 2 mm on Y-axis, 1.4 mm for the width of the subacromial space and 1.2° for the measure of the glenohumeral abduction. Conclusion This study reported a dynamic MRI protocol for the monitoring of shoulder 3D kinematics during continuous movement. The results suggest that there is no superior shift of the humeral head during the first phase of abduction. J. Magn. Reson. Imaging 2014;39:729–734. © 2013 Wiley Periodicals, Inc.

While neuropathy is common in the elderly, nerve conduction (NC) reproducibility in older adults is not well-established. We sought to evaluate intraobserver reproducibility of peroneal motor NC measures in a diverse sample of older adults.We measured peroneal motor NC amplitude and velocity in a subset of participants (mean age=82.9±2.7, n=62, 50% female, 51.6% black, 35.5% DM) in the Health, Aging, and Body Composition Study. Using coefficients of variation (CVs), intraclass correlation coefficients (ICCs), and Bland Altman Plots, we compared two sets of measurements taken by the same examiner hours apart on the same day.Low CVs (2.15-4.24%) and moderate to high ICCs (0.75-0.99) were observed. No systematic variation was found across measures. Despite small numbers in some subgroups, we found no differences in reproducibility by diabetes, race or study site.NC measures have moderate to high intraobsever reproducibility in older adults and are not affected by diabetes, race, or gender.These data provide evidence to support use of these measures in aging research.

WOS: 000324152600003, PubMed ID: 23748613, Objective: The aim of this study was to evaluate the interobserver reliability and intraobserver reproducibility of the Universal, AO, Fernandez and Frykman classifications for distal radius fractures. Methods: Fifty standard sets of posteroanterior and lateral roentgenograms of displaced distal radius fractures were classified two times by two groups of evaluators at 2-month intervals. The first group consisted of 10 orthopedic surgeons with a minimum of 5 years of experience. The second group consisted of 10 orthopedic residents in their first two years of practice. Interobserver reliability and intraobserver reproducibility were assessed using Cohen's kappa test. Results: None of the classifications achieved good - very good reliability levels. The Fernandez classification had a moderate and the others had a fair interobserver agreement kappa coefficient. All classifications had fair kappa intraobserver agreement although the Frykman and Fernandez classifications had better results. Conclusion: None of the classification systems were superior in terms of reliability and reproducibility. The reliability and reproducibility rates of all four classifications were insufficient.

OBJECTIVE This study aimed to assess which region of interest results in the best intraobserver reproducibility of mebrofenin clearance rate (MCR) processing. METHODS Mebrofenin clearance rate was calculated according to Ekman's formalism. Processing methods included smaller left ventricular (LV) versus larger regions, nearly the whole heart (WH), which were applied to either anterior (ANT) or geometric mean (GEO) data. Each variation was processed twice by an expert operator, and Pearson linear correlation (r) was used to test for reproducibility. RESULTS Studies from 50 patients (16 women) were available for processing. Mean (SD) for age, model for end-stage liver disease, and Child scores were 54 (10) years (range, 23-70 y), 13.1 (4.9) (range, 6-30), and 7.8 (2.1) (range, 5-14), respectively. The linear correlation equations (r, significance) between the 2 processing takes were y=0.34x+4.3 (r=0.5442, P

Summary Purpose: An International League Against Epilepsy (ILAE) consensus classification system for focal cortical dysplasias (FCDs) has been published in 2011 specifying clinicopathologic FCD variants. The aim of the present work was to microscopically assess interobserver agreement and intraobserver reproducibility for FCD categories among an international group of neuropathologists with different levels of experience and access to epilepsy surgery tissue. Methods: Surgical FCD specimens covering a broad histopathology spectrum were retrieved from 22 patients with epilepsy. Three surgical nonepilepsy specimens served as controls. A total of 188 slides with routine or immunohistochemical stainings were digitalized with a slide scanner to allow Internet-based microscopy review. Nine experienced neuropathologists were invited to review these cases twice at a time gap of 3 months and different orders of case presentation. The 2011 ILAE FCD consensus classification served as instruction. Kappa analysis was calculated to estimate interobserver and intraobserver agreement levels. In a third evaluation round, 21 additional neuropathologists with different experience and access to epilepsy surgery reviewed the same case series. Key Findings: Interobserver agreement was good (I° = 0.6360), with 84% consensus of diagnoses during the first evaluation (21 of 25 cases). Kappa values increased to 0.6532 after reevaluation, and consensus was obtained in 24 (96%) of 25 cases. Overall intraobserver reproducibility was also good (I° = 0.7824, ranging from 0.4991 to 1.000). Fewest changes in the classification were made in the FCD type II group (2.2% of 225 original diagnoses), whereas the majority of changes occurred in FCD type III (13.7% of 225 original diagnoses). In the third evaluation round, interobserver agreement was reflected by the level of experience of each neuropathologist, with I° values ranging from moderate (0.5056; high level of experience >40 cases/year) to low (0.3265; low level of experience