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Bothma NP, L'abbé EN, Liebenberg L. Evaluating postcranial macromorphoscopic traits to estimate population variation among modern South Africans. Forensic Sci Int 2024; 356:111954. [PMID: 38382241 DOI: 10.1016/j.forsciint.2024.111954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
Population overlap and the variation within and among populations have been globally observed but is often difficult to quantify. To achieve this, numerous different methods need to be explored and validated to assist with the creation of an accurate biological profile. The current lack of databases for postcranial macromorphoscopic traits indicates the need to further investigate if the method can be employed repeatably in a forensic context. The current study aimed to assess the prevalence of eleven postcranial macromorphoscopic traits in a South African sample. A total of 271 postcrania of adult black, coloured, and white South Africans were assessed. The intra- and inter-observer agreement ranged from fair to almost perfect except for the accessory transverse foramen of C1, which had poor agreement between observers. Only seven traits differed significantly between at least two of the groups. Univariate and multivariate random forest models were created to test the positive predictive performance of the traits to classify population affinity. The classification accuracies for the univariate models ranged from 33.3% to 53.0% and ranged from 54.6% to 62.1% for the multivariate models. Based on the variable importance, the traits assessing spinous process bifurcation were the most discriminatory variables. The results indicate that the postcranial MMS approach does not outperform current methods employed to estimate population affinity. Further research needs to be done for the method to have practical applicability for medicolegal casework in South Africa.
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Affiliation(s)
- N P Bothma
- University of Pretoria, Department of Anatomy, Pretoria, South Africa, Private Bag x323, Gezina 0031, South Africa.
| | - E N L'abbé
- University of Pretoria, Department of Anatomy, Pretoria, South Africa, Private Bag x323, Gezina 0031, South Africa
| | - L Liebenberg
- University of Pretoria, Department of Anatomy, Pretoria, South Africa, Private Bag x323, Gezina 0031, South Africa
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Borgbjerg J, Larsen NE, Salte IM, Grønli NR, Klæstrup E, Negård A. Dataset on renal tumor diameter assessment by multiple observers in normal-dose and low-dose CT. Data Brief 2023; 51:109672. [PMID: 37965591 PMCID: PMC10641580 DOI: 10.1016/j.dib.2023.109672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/16/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
Computed tomography-based active surveillance is increasingly used to manage small renal tumors, regardless of patient age. However, there is an unmet need for decreasing radiation exposure while maintaining the necessary accuracy and reproducibility in radiographic measurements, allowing for detecting even minor changes in renal mass size. In this article, we present supplementary data from a multiobserver investigation. We explored the accuracy and reproducibility of low-dose CT (75% dose reduction) compared to normal-dose CT in assessing maximum axial renal tumor diameter. Open-access CT datasets from the 2019 Kidney and Kidney Tumor Segmentation Challenge were used. A web-based platform for assessing observer performance was used by six radiologist observers to obtain and provide data on tumor diameters and accompanying viewing settings, in addition to key images of each measurement and an interactive module for exploring diameter measurements. These data can serve as a baseline and inform future studies investigating and validating lower-dose CT protocols for active surveillance of small renal masses.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus University Hospital, Sykehusveien 25, Nordbyhagen 1478, Norway
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ivar Mjåland Salte
- Department of Radiology, Akershus University Hospital, Sykehusveien 25, Nordbyhagen 1478, Norway
| | - Niklas Revold Grønli
- Department of Radiology, Akershus University Hospital, Sykehusveien 25, Nordbyhagen 1478, Norway
| | - Elise Klæstrup
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Negård
- Department of Radiology, Akershus University Hospital, Sykehusveien 25, Nordbyhagen 1478, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mugisha AM, Muyinda Z, Kambugu JB, Apolot D, Atugonza E, Teu A, Mubuuke AG. Observer agreement in single computerized tomography use for diagnosing paediatric head and neck malignancies at Uganda Cancer Institute. J Egypt Natl Canc Inst 2023; 35:20. [PMID: 37423951 DOI: 10.1186/s43046-023-00179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/18/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND In the Ugandan setting, investigation for PHNM with CT uses a protocol with both unenhanced and contrast enhanced procedures hence doubling the ionizing radiation exposure. The purpose of this study was to determine the feasibility of single CT procedures in diagnosing PHNM. METHODS This was a cross-sectional study using CT images from patients, aged fifteen years and below, investigated for head and neck malignancies at the Uganda Cancer Institute. Three radiologists, observers A, B and C, with 12, 5 and 2 years of experience, respectively, participated in the study. They independently reported contrast enhanced images (protocol A), unenhanced images (protocol B), then both unenhanced and contrast enhanced images (protocol C) in 2 months intervals. Inter- and intra- observer agreement was determined using Gwen's Agreement coefficient. RESULTS Seventy-three CT scans of 36 boys and 37 girls, with a median age of 9 (3-13) years, were used. Intra-and inter-observer agreement on primary tumour location ranged from substantial to almost perfect with the highest intra-observer agreement observed when protocols A and C were compared. Inter-observer agreement for tumour calcifications was substantial for protocol A. Observers A and C demonstrated an almost perfect intra-observer agreement when protocols A and C were compared. There was a substantial inter-observer agreement on diagnosis for all protocols. CONCLUSIONS In our setting and examining a limited number of CT images, we demonstrated that contrast-enhanced CT scans provide sufficient information with no evidence of additional value of unenhanced images. Using contrast-enhanced images alone reduced the radiation exposure significantly.
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Affiliation(s)
| | | | | | - Denise Apolot
- Makerere University, College of Health Sciences, Kampala, Uganda
| | | | - Anneth Teu
- Makerere University, College of Health Sciences, Kampala, Uganda
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Borgbjerg J, Steinkohl E, Olesen SS, Akisik F, Bethke A, Bieliuniene E, Christensen HS, Engjom T, Haldorsen IS, Kartalis N, Lisitskaya MV, Naujokaite G, Novovic S, Ozola-Zālīte I, Phillips AE, Swensson JK, Drewes AM, Frøkjær JB. Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study. Abdom Radiol (NY) 2023; 48:306-317. [PMID: 36138242 DOI: 10.1007/s00261-022-03667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intra-observer variability in CT-based measurements of ductal- and gland diameters in CP patients. MATERIALS AND METHODS Prospectively acquired pancreatic CT examinations from 50 CP patients were reviewed by 12 radiologists and four pancreatologists from 10 institutions. Assessment entailed measuring maximum diameter in the axial plane of four structures: (1) pancreatic head (PDhead), (2) pancreatic body (PDbody), (3) main pancreatic duct in the pancreatic head (MPDhead), and (4) body (MPDbody). Agreement was assessed by the 95% limits of agreement with the mean (LOAM), representing how much a single measurement for a specific subject may plausibly deviate from the mean of all measurements on the specific subject. Bland-Altman limits of agreement (LoA) were generated for intra-observer pairs. RESULTS The 16 observers completed 6400 caliper placements comprising a first and second measurement session. The widest inter-observer LOAM was seen with PDhead (± 9.1 mm), followed by PDbody (± 5.1 mm), MPDhead (± 3.2 mm), and MPDbody (± 2.6 mm), whereas the mean intra-observer LoA width was ± 7.3, ± 5.1, ± 3.7, and ± 2.4 mm, respectively. CONCLUSION Substantial intra- and inter-observer variability was observed in pancreatic two-point measurements. This was especially pronounced for parenchymal and duct diameters of the pancreatic head. These findings challenge the implementation of two-point measurements as the foundation for quantitative imaging scoring systems in CP.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Emily Steinkohl
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Søren S Olesen
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Anne Bethke
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Edita Bieliuniene
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Heidi S Christensen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Trond Engjom
- Department of Medicine, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Ulriksdal 8, 5009, Bergen, Norway
| | - Nikolaos Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, O-huset 42, 14186, Stockholm, Sweden.,Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186, Stockholm, Sweden
| | - Maria V Lisitskaya
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Gintare Naujokaite
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Imanta Ozola-Zālīte
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Pilsoņu iela 13, Zemgales priekšpilsēta, Riga, 1002, Latvia
| | - Anna E Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan K Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark.
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Fischer J, Halbig J, Augdal T, Angenete O, Stoustrup PB, Dahl Kristensen K, Slåttelid Skeie M, Tylleskär K, Rosén A, Shi X, Rosendahl K. Observer agreement of imaging measurements used for evaluation of dentofacial deformity in juvenile idiopathic arthritis. Dentomaxillofac Radiol 2022; 51:20210478. [PMID: 35466687 PMCID: PMC10043626 DOI: 10.1259/dmfr.20210478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the precision of imaging measures commonly used to assess mandibular morphology in children and adolescents with juvenile idiopathic arthritis (JIA). Secondly, to compare cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in the measurement of condylar height. METHODS Those included were children diagnosed with JIA during 2015-18 who had had an MRI, a CBCT of the temporomandibular joints (TMJs) and a lateral cephalogram (ceph) of the head within one month of each other. Agreement within and between observers and methods was examined using Bland-Altman mean-difference plots and 95% limits of agreement (LOA). A 95% LOA within 15% of the sample mean was considered acceptable. Minimal detectable change (MDC) within and between observers was estimated. RESULTS 90 patients (33 males) were included, with a mean age of 12.8 years. For MRI, intra- and interobserver 95% LOA were relatively narrow for total mandibular length: 9.6% of the sample mean. For CBCT, condylar height, both intra- and interobserver 95% LOA were wide: 16.0 and 28.4% of the sample mean, respectively. For ceph, both intra- and interobserver 95% LOA were narrow for the SNA-angle and gonion angle: 5.9 and 8% of the sample mean, and 6.2 and 6.8%, respectively. CONCLUSIONS We have identified a set of precise measurements for facial morphology assessments in JIA, including one MRI-based (total mandibular length), one CBCT-based (condylar height), and three ceph-based. Condylar height was higher for MRI than for CBCT; however, the measurement was too imprecise for clinical use. MDC was also determined for a series of measurements.
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Affiliation(s)
- Johannes Fischer
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway
| | | | | | | | | | | | - Karin Tylleskär
- The Children’s Clinic at Haukeland University Hospital, Bergen, Norway
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Cibulka M, Buck J, Busta B, Neil E, Smith D, Triller R. Intra and inter observer agreement in the mobility assessment of the upper thoracic costovertebral joints. Physiother Theory Pract 2022:1-7. [PMID: 35343374 DOI: 10.1080/09593985.2022.2058439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Determining the mobility of the costovertebral joints might be important in patients with neck-upper thoracic pain. Little research has been performed on observer agreement when assessing the mobility of these joints. PURPOSE The purpose of this study was to determine intra- and inter-observer agreements when assessing costovertebral joint mobility of the upper three ribs in those with and without neck pain and to compare the difference between the Kappa and AC statistic. METHODS Forty-four participants, with and without current neck/upper-thoracic pain, were assessed by two raters. Raters applied a posterior to anterior pressure to the anatomical neck of the first three ribs bilaterally. Mobility was graded: normal, increased, or decreased. An AC1, for nominal data, AC2 for ordinal data, and the Kappa statistics were used to analyze the results. The AC statistics determines chance agreement different than Kappa. RESULTS AC1 showed "moderate to very good" (0.74-1.0) intra-rater reliability, while inter-rater reliability showed "fair to good" agreement (0.51-0.79). Using the AC2 Intra-rater reliability was "very good" and "almost perfect" (AC2: 0.93-1.0), while using the AC2 was "good to very good" and "good to almost perfect" (0.76-0.94). Kappa values for intra-rater reliability ranged from "fair to moderate" (0.38-0.54), while inter-rater reliability ranged from "poor to fair" (-0.10-0.26). CONCLUSION Posterior/anterior pressure is a reliable method to assess the mobility of the upper costovertebral joints. Assessing costovertebral mobility is important when establishing a movement diagnosis in patients with neck/upper thoracic pain.
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Affiliation(s)
- Michael Cibulka
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
| | - Justin Buck
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
| | - Bria Busta
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
| | - Erika Neil
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
| | - Drake Smith
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
| | - Reece Triller
- Physical Therapy Program, Maryville University, St. Louis, MO, USA
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Traub B, Wüest RO. Analysing the quality of Swiss National Forest Inventory measurements of woody species richness. For Ecosyst 2020; 7:37. [PMID: 32685239 PMCID: PMC7357775 DOI: 10.1186/s40663-020-00252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Under ongoing climate and land-use change, biodiversity is continuously decreasing and monitoring biodiversity is becoming increasingly important. National Forest Inventory (NFI) programmes provide valuable time-series data on biodiversity and thus contribute to assessments of the state and trends in biodiversity, as well as ecosystem functioning. Data quality in this context is of paramount relevance, particularly for ensuring a meaningful interpretation of changes. The Swiss NFI revisits about 8%-10% of its sample plots regularly in repeat surveys to supervise the quality of fieldwork. METHODS We analysed the relevance of observer bias with equivalence tests, examined data quality objectives defined by the Swiss NFI instructors, and calculated the pseudo-turnover (PT) of species composition, that is, the percentage of species not observed by both teams. Three attributes of woody species richness from the latest Swiss NFI cycles (3 and 4) were analysed: occurrence of small tree and shrub species (1) on the sample plot and (2) at the forest edge, and (3) main shrub and trees species in the upper storey. RESULTS We found equivalent results between regular and repeat surveys for all attributes. Data quality, however, was significantly below expectations in all cases, that is, as much as 20%-30% below the expected data quality limit of 70%-80% (proportion of observations that should not deviate from a predefined threshold). PT values were about 10%-20%, and the PT of two out of three attributes decreased significantly in NFI4. This type of uncertainty - typically caused by a mixture of overlooking and misidentifying species - should be considered carefully when interpreting change figures on species richness estimates from NFI data. CONCLUSIONS Our results provide important information on the data quality achieved in Swiss NFIs in terms of the reproducibility of the collected data. The three applied approaches proved to be effective for evaluating the quality of plot-level species richness and composition data in forest inventories and other biodiversity monitoring programmes. As such, they could also be recommended for assessing the quality of biodiversity indices derived from monitoring data.
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Affiliation(s)
- Berthold Traub
- Scientific Service NFI, Swiss Federal Research Institute WSL, Zürcherstrasse 111, 8903 Birmensdorf, Switzerland
| | - Rafael O. Wüest
- Spatial Evolutionary Ecology, Swiss Federal Research Institute WSL, Zürcherstrasse 111, 8903 Birmensdorf, Switzerland
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Bragança FMS, Brommer H, van den Belt AJM, Maree JTM, van Weeren PR, van Oldruitenborgh-Oosterbaan MMS. Subjective and objective evaluations of horses for fit-to-compete or unfit-to-compete judgement. Vet J 2020; 257:105454. [PMID: 32546354 DOI: 10.1016/j.tvjl.2020.105454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022]
Abstract
At Fédération Equestre Internationale (FEI) competitions, horses undergo veterinary inspection for judgement of 'fit-to-compete'. However, FEI Veterinary Delegates (VDs) often differ in opinion. The aim of the present study was to evaluate intra- and inter-observer agreements of fit-to-compete judgement and compare these with objective gait analysis measurements. Twelve horses were evaluated by three experienced VDs and one veterinary specialist and video-recorded for re-evaluation later. Simultaneously, quantitative gait analysis measurements were acquired. Inter-observer agreement during live evaluations was fair (κ = 0.395, 58% agreement). Intra-observer agreement between live observations and videos at one and 12 months was 71% and 73% respectively. Sensitivity and specificity of motion symmetry measured with quantitative gait analysis system were 83.3% and 66.7% respectively, against the consensus of all observers as a reference. These findings might suggest that more VDs should be used to adequately judge fit-to-compete. Quantitative-gait-analysis may be useful to support decision making during fit-to-compete judgement.
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Affiliation(s)
- F M Serra Bragança
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, NL-3584 CM Utrecht, The Netherlands.
| | - H Brommer
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, NL-3584 CM Utrecht, The Netherlands
| | - A J M van den Belt
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 110,3584 CM Utrecht, The Netherlands
| | - J T M Maree
- Huisdierenziekenhuis en Paardenkliniek Honselersdijk, Harteveldlaan 1a, 2675 LE Honselersdijk, The Netherlands
| | - P R van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, NL-3584 CM Utrecht, The Netherlands
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Huh J, Park J, Kim KW, Kim HJ, Lee JS, Lee JH, Jeong YK, Shinagare AB, Ramaiya NH. Optimal Phase of Dynamic Computed Tomography for Reliable Size Measurement of Metastatic Neuroendocrine Tumors of the Liver: Comparison between Pre- and Post-Contrast Phases. Korean J Radiol 2018; 19:1066-1076. [PMID: 30386138 PMCID: PMC6201971 DOI: 10.3348/kjr.2018.19.6.1066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/22/2018] [Indexed: 11/16/2022] Open
Abstract
Objective The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. Materials and Methods The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Inter- and intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. Results Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (−6.1–5.7 mm), followed by PVP (−7.9–7.1 mm) and AP (−8.5–7.4 mm) images. Intra-observer agreement showed the same trend: −2.8–2.9 mm and −2.9–2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, −2.8–2.9 mm and −3.0–3.2 mm, respectively, on PVP, and −3.2–4.2 mm and −3.4–3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. Conclusion There was better inter- and intra-observer agreement in size measurements of NET liver metastases on precontrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.,Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, Suwon 16499, Korea
| | - Jisuk Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Hwa Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Yoong Ki Jeong
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Bruserud IS, Roelants M, Oehme NHB, Eide GE, Bjerknes R, Rosendahl K, Júlíusson PB. Ultrasound assessment of pubertal breast development in girls: intra- and inter observer agreement. Pediatr Radiol 2018; 48:1576-1583. [PMID: 29982956 DOI: 10.1007/s00247-018-4188-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
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Affiliation(s)
- Ingvild Særvold Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ninnie Helén Bakken Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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11
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Brunings JW, Vanbelle S, Akkermans A, Heemskerk NMM, Kremer B, Stokroos RJ, Baijens LWJ. Observer Agreement for Measurements in Videolaryngostroboscopy. J Voice 2017; 32:756-762. [PMID: 29122415 DOI: 10.1016/j.jvoice.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/25/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study evaluated the levels of intraobserver and interobserver agreement for measurements of visuoperceptual variables in videolaryngostroboscopic examinations and compared the observers' behavior during independent versus consensus panel rating. STUDY DESIGN This is a retrospective study. SETTING This study was conducted in a single-center tertiary care facility. PARTICIPANTS Sixty-four patients with dysphonia of heterogeneous etiology were included. EXPOSURE All subjects underwent a standardized videolaryngostroboscopic examination. MAIN OUTCOME AND MEASURES Two experienced and trained observers scored exactly the same examinations, first independently and then on a consensus panel. Specific visuoperceptual variables and the clinical diagnosis (as recommended by the Committee on Phoniatrics and the Phonosurgery Committee of the European Laryngological Society and advised by the American Speech-Language-Hearing Association) were scored. Descriptive and kappa statistics were used. RESULTS In general, intraobserver agreement was better than agreement between observers for measurements of several variables. The intrapanel observer agreement levels were slightly higher than the intraobserver agreement levels on the independent rating task. When rating on the consensus panel, the observers deviated considerably from the scores they had previously given on the independent rating task. CONCLUSION AND RELEVANCE Observer agreement in videolaryngostroboscopic assessment has important implications not only for the diagnosis and treatment of dysphonic patients but also for the interpretation of the results of scientific studies using videolaryngostroboscopic outcome parameters. The identification of factors that can influence the levels of observer agreement can provide a better understanding of the rating process and its limitations. The results of this study suggest that future research could achieve better agreement levels by rating the visuoperceptual variables in a panel setting.
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Affiliation(s)
- Jan Wouter Brunings
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; MHeNs-School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Sophie Vanbelle
- Department of Methodology and Statistics, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Akkermans
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nienke M M Heemskerk
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; MHeNs-School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Pustelnik FS, Gronbek C, Døssing H, Nguyen N, Bonnema SJ, Hegedüs L, Godballe C, Sorensen JR. The compensatory enlargement of the remaining thyroid lobe following hemithyroidectomy is small and without impact on symptom relief. Eur Arch Otorhinolaryngol 2017; 275:161-167. [PMID: 29043478 DOI: 10.1007/s00405-017-4777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
According to previous studies, hemithyroidectomy results in growth of the remaining thyroid lobe by up to 30% in first 12 months after surgery. However, this estimate is based on imprecise methods, high inter- and intra-observer variability, and lack of blinding of the measurements. Furthermore, it is unknown whether enlargement of the remaining hemi-thyroid interferes with the improvement in symptoms after surgery for goiter. We aimed to assess the impact of postoperative thyroid growth on goiter symptom relief following hemithyroidectomy in patients with benign nodular goiter. Outcomes were measured before and 6 months after hemithyroidectomy in 44 patients. Thyroid volumes were determined by two independent and blinded observers using magnetic resonance imaging (MRI). Inter- and intra-observer variability was visualized by Bland-Altman plots. Goiter symptoms were assessed by the Thyroid-Specific Patient-Reported-Outcome Questionnaire (ThyPRO) on a scale from 0 to 100 points. After hemithyroidectomy, the remaining thyroid lobe was 13.7 ± 6.4 mL, and enlarged by a mean of 1.8 mL over 6 months [95% confidence interval (CI) (1.6; 2.1), p < 0.001], corresponding to an increase of 17% [95% CI (12; 22)]. The Goiter Symptom score improved by 27 points [95% CI (21; 34), p < 0.0001] from median 39 points (range 2-86) at baseline, and was unaffected by the compensatory thyroid growth. Six months after hemithyroidectomy, using blinded MRI evaluations, we demonstrated a small but significant postoperative growth of the remaining hemi-thyroid, which did not significantly affect the considerable improvement in goiter symptoms.
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Affiliation(s)
- Frederik Schultz Pustelnik
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Casper Gronbek
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Helle Døssing
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Roed Sorensen
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, 5000, Odense C, Denmark.
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13
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Kato M, Goda K, Shimizu Y, Dobashi A, Takahashi M, Ikegami M, Shimoda T, Kato M, Sharma P. Image assessment of Barrett's esophagus using the simplified narrow band imaging classification. J Gastroenterol 2017; 52:466-475. [PMID: 27448208 DOI: 10.1007/s00535-016-1239-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND A simplified narrow band imaging (NBI) classification has been proposed with the objective of integrating multiple classifications of NBI surface patterns in Barrett's esophagus (BE). Little is known about the impact of the simplified NBI classification on the diagnosis of BE when using high-definition magnification endoscopy with NBI (HM-NBI). This study aimed to evaluate (a) the reproducibility of NBI surface patterns and predicted histology and (b) the diagnostic accuracy of interpreting HM-NBI images by using the simplified NBI classification. METHODS Two hundred and forty-eight HM-NBI images from macroscopically normal areas in patients with BE were retrieved from endoscopy databases and randomized for review by four endoscopists (two experts, two non-experts). We evaluated inter- and intra-observer agreement of the interpretation of NBI surface patterns and the predicted histology (dysplasia vs. non-dysplasia), as calculated by using κ statistics, and diagnostic values of the prediction. RESULTS The overall inter-observer agreements were substantial for mucosal pattern (κ = 0.73) and vascular pattern (κ = 0.71), and almost perfect for predicting dysplastic histology (κ = 0.80). The overall intra-observer agreements were almost perfect for mucosal (κ = 0.84) and vascular patterns (κ = 0.86), and predicting dysplastic histology (κ = 0.89). The mean accuracy in predicting dysplastic histology for all reviewers was 95 % (experts: 96.8 %, non-experts: 93.1 %). CONCLUSIONS The simplified NBI classification has the potential to provide high diagnostic reproducibility and accuracy when using HM-NBI.
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Affiliation(s)
- Masayuki Kato
- Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yuichi Shimizu
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masakazu Takahashi
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Mototsugu Kato
- National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Prateek Sharma
- Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas, USA
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14
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Pollock M, Fernandes RM, Hartling L. Evaluation of AMSTAR to assess the methodological quality of systematic reviews in overviews of reviews of healthcare interventions. BMC Med Res Methodol 2017; 17:48. [PMID: 28335734 PMCID: PMC5364717 DOI: 10.1186/s12874-017-0325-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background Overviews of reviews (overviews) compile information from multiple systematic reviews (SRs) to provide a single synthesis of relevant evidence for decision-making. It is recommended that authors assess and report the methodological quality of SRs in overviews—for example, using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Currently, there is variation in whether and how overview authors assess and report SR quality, and limited guidance is available. Our objectives were to: examine methodological considerations involved in using AMSTAR to assess the quality of Cochrane and non-Cochrane SRs in overviews of healthcare interventions; identify challenges (and develop potential decision rules) when using AMSTAR in overviews; and examine the potential impact of considering methodological quality when making inclusion decisions in overviews. Methods We selected seven overviews of healthcare interventions and included all SRs meeting each overview’s inclusion criteria. For each SR, two reviewers independently conducted AMSTAR assessments with consensus and discussed challenges encountered. We also examined the correlation between AMSTAR assessments and SR results/conclusions. Results Ninety-five SRs were included (30 Cochrane, 65 non-Cochrane). Mean AMSTAR assessments (9.6/11 vs. 5.5/11; p < 0.001) and inter-rater reliability (AC1 statistic: 0.84 vs. 0.69; “almost perfect” vs. “substantial” using the Landis & Koch criteria) were higher for Cochrane compared to non-Cochrane SRs. Four challenges were identified when applying AMSTAR in overviews: the scope of the SRs and overviews often differed; SRs examining similar topics sometimes made different methodological decisions; reporting of non-Cochrane SRs was sometimes poor; and some non-Cochrane SRs included other SRs as well as primary studies. Decision rules were developed to address each challenge. We found no evidence that AMSTAR assessments were correlated with SR results/conclusions. Conclusions Results indicate that the AMSTAR tool can be used successfully in overviews that include Cochrane and non-Cochrane SRs, though decision rules may be useful to circumvent common challenges. Findings support existing recommendations that quality assessments of SRs in overviews be conducted independently, in duplicate, with a process for consensus. Results also suggest that using methodological quality to guide inclusion decisions (e.g., to exclude poorly conducted and reported SRs) may not introduce bias into the overview process. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0325-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Pollock
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Ricardo M Fernandes
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.,Department of Pediatrics, Santa Maria Hospital, Lisbon, Portugal
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada. .,, 4-472 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G-1C9, Canada.
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15
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de Quadros LG, Galvão Neto MDP, Campos JM, Kaiser Junior RL, Grecco E, Flamini Junior M, de Santana MF, Zotarelli Filho IJ, Almeida Alexandre AATV. Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study. BMC Res Notes 2017; 10:13. [PMID: 28057045 PMCID: PMC5217566 DOI: 10.1186/s13104-016-2350-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/16/2016] [Indexed: 01/14/2023] Open
Abstract
Background and aims Between 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire. Methods We selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA). Results We obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01). Conclusion The new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees.
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Affiliation(s)
- Luiz Gustavo de Quadros
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil. .,Department of Digestive Surgery, School of Medicine of ABC, Santo Andre, SP, 09080-650, Brazil. .,Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.
| | - Manoel Dos Passos Galvão Neto
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Gastro Obeso Center, São Paulo, SP, 01308-000, Brazil
| | - Josemberg Marins Campos
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Recife, PE, 50670-901, Brazil
| | - Roberto Luiz Kaiser Junior
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil
| | - Eduardo Grecco
- Department of Digestive Surgery, School of Medicine of ABC, Santo Andre, SP, 09080-650, Brazil.,Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil
| | - Mario Flamini Junior
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil
| | - Marcelo Falcao de Santana
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Recife, PE, 50670-901, Brazil
| | - Idiberto Jose Zotarelli Filho
- State University of Sao Paulo-Unesp-Ibilce, Rua Cristovão Colombo 2265, Sao Jose do Rio Preto, SP, 15054-000, Brazil
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Phythian CJ, Cripps PJ, Grove-White D, Michalopoulou E, Duncan JS. Inter- observer agreement for clinical examinations of foot lesions of sheep. Vet J 2016; 216:189-95. [PMID: 27687951 DOI: 10.1016/j.tvjl.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 03/28/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022]
Abstract
In sheep, the diagnosis of foot lesions is routinely based on physical examination of the hoof. Correct diagnosis is important for the effective treatment, prevention and control of both infectious and non-infectious causes of lameness. Therefore, the aim of this study was to evaluate the level of inter-observer agreement for clinical examination of ovine foot lesions. Eight observers of varying experience, training and occupation performed foot examinations on a total of 1158 sheep from 38 farms across North England and Wales. On each farm, a group of two to four observers independently examined a sample of 24 to 30 sheep to diagnose the presence or absence of specific foot lesions including white line lesions (WL), contagious ovine digital dermatitis (CODD), footrot (FR), inter-digital dermatitis (ID) and toe granuloma (TG). The inter-observer agreement of foot lesion assessments was examined using Fleiss kappa (κ), and Cohen's κ examined the paired agreement between the test standard observer (TSO) and each observer. Scoring differences with the TSO were examined as the percentage of scoring errors and assessed for evidence of systematic scoring bias. With the exception of WL (maximum error rate 33.3%), few scoring differences with the TSO occurred (maximum error rate 3.3%). This suggests that observers can achieve good levels of reliability when diagnosing most of the commonly observed foot conditions associated with lameness in sheep.
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Affiliation(s)
- C J Phythian
- Department of Epidemiology, Institute of Global Health and Infection, and Population Health, University of Liverpool, Leahurst, Neston CH64 7TE, UK; Section for Small Ruminant Research, Norwegian University of Life Sciences (NMBU), Høyland, 4325 Sandnes, Norway.
| | - P J Cripps
- Department of Epidemiology, Institute of Global Health and Infection, and Population Health, University of Liverpool, Leahurst, Neston CH64 7TE, UK
| | - D Grove-White
- Department of Epidemiology, Institute of Global Health and Infection, and Population Health, University of Liverpool, Leahurst, Neston CH64 7TE, UK
| | - E Michalopoulou
- Department of Epidemiology, Institute of Global Health and Infection, and Population Health, University of Liverpool, Leahurst, Neston CH64 7TE, UK
| | - J S Duncan
- Department of Epidemiology, Institute of Global Health and Infection, and Population Health, University of Liverpool, Leahurst, Neston CH64 7TE, UK
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Arana E, Kovacs FM, Royuela A, Asenjo B, Pérez-Ramírez Ú, Zamora J. Spine Instability Neoplastic Score: agreement across different medical and surgical specialties. Spine J 2016; 16:591-9. [PMID: 26471708 DOI: 10.1016/j.spinee.2015.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/27/2015] [Accepted: 10/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. PURPOSE This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. STUDY DESIGN Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. PATIENT SAMPLE Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. OUTCOME MEASURES Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. METHODS Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. RESULTS Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category. CONCLUSIONS Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.
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Affiliation(s)
- Estanislao Arana
- Department of Radiology, Valencian Oncology Institute Foundation, C/ Beltrán Báguena, 19, 46009 Valencia, Spain; Research Institute in Health Services Foundation, C/ San Vicente,112, 3, 46007 Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
| | - Ana Royuela
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain
| | - Beatriz Asenjo
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Avda Carlos Haya s/n, 29010 Málaga, Spain
| | - Úrsula Pérez-Ramírez
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, CPI Building (8E), F access, 1st floor, Cami de Vera, s/n, 46022 Valencia, Spain
| | - Javier Zamora
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain; Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, UK
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18
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Cui L, Yin JB, Hu CH, Gong SC, Xu JF, Yang JS. Inter- and intra observer agreement of ADC measurements of lung cancer in free breathing, breath-hold and respiratory triggered diffusion-weighted MRI. Clin Imaging 2016; 40:892-6. [PMID: 27183136 DOI: 10.1016/j.clinimag.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To prospectively evaluate the inter- and intraobserver agreement of apparent diffusion coefficient (ADC) measurements in free breathing, breath-hold, and respiratory triggered diffusion-weighted imaging (DWI) of lung cancer. METHODS Twenty-two patients with lung cancer (tumor size >2cm) underwent DWIs (3.0T) in three imaging methods. Lesion ADCs were measured twice by both of the two independent observers and compared. RESULTS No statistical significance was found among methods, though respiratory-triggered DWI tended to have higher ADCs than breath-hold DWI. Great inter- and intraobserver agreement was shown. CONCLUSION ADCs had good inter- and intraobserver agreement in all three DWI methods.
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Affiliation(s)
- Lei Cui
- Department of Radiology, First Affiliated Hospital of Soochow University, 188 Shixi Street, Suzhou, Jiangsu, PR China, 215006; Department of Radiology, Second Affiliated Hospital of Nantong University, 6 Hai'er Road, Chongchuan District, Nantong, Jiangsu, PR China, 226001
| | - Jian-Bing Yin
- Department of Radiology, Second Affiliated Hospital of Nantong University, 6 Hai'er Road, Chongchuan District, Nantong, Jiangsu, PR China, 226001
| | - Chun-Hong Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, 188 Shixi Street, Suzhou, Jiangsu, PR China, 215006.
| | - Shen-Chu Gong
- Department of Radiology, Second Affiliated Hospital of Nantong University, 6 Hai'er Road, Chongchuan District, Nantong, Jiangsu, PR China, 226001.
| | - Jun-Feng Xu
- Department of Radiology, Second Affiliated Hospital of Nantong University, 6 Hai'er Road, Chongchuan District, Nantong, Jiangsu, PR China, 226001
| | - Ju-Shun Yang
- Department of Radiology, Second Affiliated Hospital of Nantong University, 6 Hai'er Road, Chongchuan District, Nantong, Jiangsu, PR China, 226001
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Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Cesarean section scar measurements in non-pregnant women using three-dimensional ultrasound: a repeatability study. Eur J Obstet Gynecol Reprod Biol 2016; 201:65-9. [PMID: 27064944 DOI: 10.1016/j.ejogrb.2016.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate intra- and inter-observer agreement in measurements of the cesarean scar niche and the residual myometrial thickness (RMT) using 3-dimensional (3D) transvaginal ultrasonography. STUDY DESIGN Fifty-eight uterine 3D volumes from women with deep cesarean scar niches were evaluated. 3D volumes were obtained six to fifteen months after a primary cesarean section. Evaluation of the 3D volume was performed in a standardized multiplanar view. Two observers independently obtained RMT, cesarean scar niche depth (D), length (L), width (W), and myometrium adjacent to the scar (M). Differences within and between observers were expressed in mm and were evaluated according to the Bland-Altman method including the calculation of limits of agreement (LOAs). RESULTS The intra-observer LOAs in mm were as follows: RMT: -3.7 to 4.0; D: -2.2 to 2.6; L: -3.6 to 4.2; W: -4.0 to 3.7; and M: -3.4 to 4.5. The inter-observer LOAs in mm were as follows: RMT: -3.2 to 4.1; D: -3.3 to 2.2; L: -3.4 to 4.2; W: -3.2 to 4.1; and M: -4.1 to 3.2. CONCLUSIONS In non-pregnant women, we found rather wide limits of agreement measuring the cesarean section scar niche and myometrium using 3D volumes. Whether 3D transvaginal ultrasonography provides clinical advantages compared to 2D TVU needs clarification.
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Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - L D Madsen
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - M Dueholm
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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Pilz W, Vanbelle S, Kremer B, van Hooren MR, van Becelaere T, Roodenburg N, Baijens LW. Observers' Agreement on Measurements in Fiberoptic Endoscopic Evaluation of Swallowing. Dysphagia 2016; 31:180-7. [PMID: 26803774 DOI: 10.1007/s00455-015-9673-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/15/2015] [Indexed: 11/23/2022]
Abstract
This study analyzed the effect that dysphagia etiology, different observers, and bolus consistency might have on the level of agreement for measurements in FEES images reached by independent versus consensus panel rating. Sixty patients were included and divided into two groups according to dysphagia etiology: neurological or head and neck oncological. All patients underwent standardized FEES examination using thin and thick liquid consistencies. Two observers scored the same exams, first independently and then in a consensus panel. Four ordinal FEES variables were analyzed. Statistical analysis was performed using a linear weighted kappa coefficient and Bayesian multilevel model. Intra- and interobserver agreement on FEES measurements ranged from 0.76 to 0.93 and from 0.61 to 0.88, respectively. Dysphagia etiology did not influence observers’ agreement level. However, bolus consistency resulted in decreased interobserver agreement for all measured FEES variables during thin liquid swallows. When rating on the consensus panel, the observers deviated considerably from the scores they had previously given on the independent rating task. Observer agreement on measurements in FEES exams was influenced by bolus consistency, not by dysphagia etiology. Therefore, observer agreement on FEES measurements should be analyzed by taking bolus consistency into account, as it might affect the interpretation of the outcome. Identifying factors that might influence agreement levels could lead to better understanding of the rating process and assist in developing a more precise measurement scale that would ensure higher levels of observer agreement for measurements in FEES exams.
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Adiotomre E, Summers L, Allison A, Walters SJ, Digby M, Broadley P, Lang I, Offiah AC. Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable? Pediatr Radiol 2016; 46:680-8. [PMID: 26902300 DOI: 10.1007/s00247-015-3537-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/03/2015] [Accepted: 12/30/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. OBJECTIVE To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. MATERIALS AND METHODS Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. RESULTS Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming. CONCLUSION Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures.
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Campos M, Urrutia J, Zamora T, Román J, Canessa V, Borghero Y, Palma A, Molina M. The Spine Instability Neoplastic Score: an independent reliability and reproducibility analysis. Spine J 2014; 14:1466-9. [PMID: 24275615 DOI: 10.1016/j.spinee.2013.08.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 04/26/2013] [Accepted: 08/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metastatic vertebral instability has not yet been clearly defined in the literature; there still exists a paucity of reliable criteria to assess the risk of vertebral collapse. PURPOSE We performed an independent interobserver and intraobserver agreement evaluation of the Spine Instability Neoplastic Score (SINS) and correlated the score with selected clinical cases and the treatment they received. STUDY DESIGN Independent reliability study for the newly created SINS. PATIENT SAMPLE Thirty patients who underwent either radiotherapy alone or surgery followed by radiotherapy were randomly selected from the orthopedic surgery and radiotherapy department's databases. OUTCOME MEASURES Patients were rated and classified for spinal stability using SINS. Intraclass correlation coefficient (ICC) and Fleiss's kappa measures were occupied for reliability analysis. METHODS Patients who underwent either radiotherapy alone or surgery followed by radiotherapy were randomly selected and classified for spinal stability using the SINS by orthopedic surgeons and nonorthopedic oncology specialists. ICC and Fleiss's kappa were calculated for inter- and intraobserver agreement. A comparative analysis of SINS and the actual management was also conducted. RESULTS Interobserver ICC reliability for the SINS was 0.79; κ values for location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement were 0.81, 0.58, 0.21, 0.45, 0.42, and 0.29 respectively. Intraobserver ICC for the SINS scores was 0.96; ICC values for the same components were 0.98, 0.98, 0.87, 0.88, 0.92, and 0.86, respectively. Potentially unstable lesions (SINS score≥7) were operated on in 62.5%. CONCLUSIONS SINS seem to be a reproducible tool that could be used equally by multiple specialists to estimate metastatic vertebral stability; however, prospective clinical validation is still pending.
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Affiliation(s)
- Mauricio Campos
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile.
| | - Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile
| | - Tomás Zamora
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile
| | - Javier Román
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile
| | - Valentina Canessa
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile
| | - Yerko Borghero
- Radiotherapy Service, Hemato-oncology Department, Pontificia Universidad Católica de Chile, Diagonal Paraguay 319, Santiago, Chile
| | - Alejandra Palma
- Palliative Medicine Service, Internal Medicine Department, Pontificia Universidad Católica de Chile, Lira 63, Santiago, Chile
| | - Marcelo Molina
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile
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Bonekamp D, Bonekamp S, Halappa VG, Geschwind JFH, Eng J, Corona-Villalobos CP, Pawlik TM, Kamel IR. Inter observer agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol 2013; 83:487-96. [PMID: 24387824 DOI: 10.1016/j.ejrad.2013.11.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the interobserver agreement in 50 patients with hepatocellular carcinoma (HCC) before and 1 month after intra-arterial therapy (IAT) using two semi-automated methods and a manual approach for the following functional, volumetric and morphologic parameters: (1) apparent diffusion coefficient (ADC), (2) arterial phase enhancement (AE), (3) portal venous phase enhancement (VE), (4) tumor volume, and assessment according to (5) the Response Evaluation Criteria in Solid Tumors (RECIST), and (6) the European Association for the Study of the Liver (EASL). MATERIALS AND METHODS This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Tumor ADC, AE, VE, volume, RECIST, and EASL in 50 index lesions was measured by three observers. Interobserver reproducibility was evaluated using intraclass correlation coefficients (ICC). P<0.05 was considered to indicate a significant difference. RESULTS Semi-automated volumetric measurements of functional parameters (ADC, AE, and VE) before and after IAT as well as change in tumor ADC, AE, or VE had better interobserver agreement (ICC=0.830-0.974) compared with manual ROI-based axial measurements (ICC=0.157-0.799). Semi-automated measurements of tumor volume and size in the axial plane before and after IAT had better interobserver agreement (ICC=0.854-0.996) compared with manual size measurements (ICC=0.543-0.596), and interobserver agreement for change in tumor RECIST size was also higher using semi-automated measurements (ICC=0.655) compared with manual measurements (ICC=0.169). EASL measurements of tumor enhancement in the axial plane before and after IAT ((ICC=0.758-0.809), and changes in EASL after IAT (ICC=0.653) had good interobserver agreement. CONCLUSION Semi-automated measurements of functional changes assessed by ADC and VE based on whole-lesion segmentation demonstrated better reproducibility than ROI-based axial measurements, or RECIST or EASL measurements.
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Affiliation(s)
- David Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Susanne Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Vivek Gowdra Halappa
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - John Eng
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - Timothy M Pawlik
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Johns Hopkins School of Medicine, Department of Surgery, Oncology, Baltimore, MD, United States
| | - Ihab R Kamel
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States.
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