Intraexaminer Intraclass Correlation Coefficients Research Articles

Accuracy of intraoral ultrasound to evaluate alveolar bone level: an ex vivo study in human cadavers.

This study aimed to evaluate the reliability and accuracy of an intraoral ultrasound(US) device to evaluate alveolar bone by comparing it between different raters and to microCT (µCT) measurements. 38 teeth distributed across three human cadavers were prepared by placing two notches on the facial enamel surface. The maxillary and mandibular teeth were imaged with a custom-designed intraoral 20MHz ultrasound and µCT with 0.03mm voxel size. µCT was considered the reference standard for this study. For each sample, the distance from the inferior border of the most apical notch to the tip of the alveolar bone crest on the facial aspect of the teeth was measured from the US and µCT images. Intraclass correlation coefficient (ICC) and standard deviation were calculated. The intra-examiner and inter-examiner reliability for both the µCT and US alveolar bone measurements were found to be excellent (intra-examiner ICC was 0.998 for µCT and 0.997 for US, inter-examiner ICC was 0.996 for µCT and between 0.947 and 0.950 for US). The accuracy of the US was found to be good compared to µCT (ICC between 0.885 and 0.894). The study demonstrated that intraoral ultrasound is highly reliable and accurate compared to the µCT reference standard for evaluating facial alveolar bone height.

Maxillary transverse deficiency diagnosed by 3 methods and its relationship with molar angulation in patients with skeletal Class III malocclusion

The objective of this study was to evaluate the relationship between maxillary transverse deficiency (MTD) diagnosed by 3 methods and molar angulation measured in 3-dimensions in patients with skeletal Class III malocclusion, which could give reference to the selection of diagnostic methods in MTD patients. Cone-beam computed tomography data of 65 patients with skeletal Class III malocclusion (mean age 17.35 ± 4.45 years) were selected and imported into MIMICS software. Transverse deficiencies were evaluated by 3 methods, and molar angulations were measured after reconstructing 3-dimensional planes. Two examiners performed repeated measurements to assess the intraexaminer and interexaminer reliability. Pearson correlation coefficient analyses and linear regressions were performed to determine the relationship between a transverse deficiency and molar angulations. One-way analysis of variance was used to compare the diagnostic results of 3 methods. The novel molar angulation measurement method and 3 MTD diagnostic methods have the interexaminer and intraexaminer intraclass correlation coefficient values>0.6. The transverse deficiency diagnosed by 3 methods was significantly and positively correlated with the sum of molar angulation. There was a statistically significant difference for the transverse deficiencies diagnosed by the 3 methods. The transverse deficiency was significantly higher in Boston University's analysis than in Yonsei's analysis. Clinicians ought to choose the diagnostic methods properly, considering the feature of the 3 methods and the individual difference of each patient.

Digital versus conventional full-arch impressions in linear and 3D accuracy: a systematic review and meta-analysis of in vivo studies.

The purpose of this systematic review was to compare the accuracy of digital and conventional full-arch impressions in vivo. This systematic review was conducted according to the PRISMA and registered at the PROSPERO (CRD42021232736). Electronic and hand searches were performed to identify in vivo studies comparing the linear or 3D accuracy of digital and conventional impressions. The risk of bias (ROB) of included studies was assessed by QUADAS-2, and the overall quality of evidence was assessed by GRADE. Twenty-two studies met the inclusion criteria, and 13 studies were included in the meta-analysis. There was no significant difference between digital and conventional impressions in the linear measurements of tooth width, anterior Bolton ratio, overall Bolton ratio, intercanine distance (ICD), and intermolar distance (IMD). The repeated measurement mean errors (RMEs) were less than 0.1 mm, the intra-examiner intraclass correlation coefficient (ICC) values were more than 0.9, and the inter-examiner ICC values were more than 0.87 for both impression techniques. The 3D deviation between digital and alginate impressions was 0.09 mm. The 3D precision of both impression techniques was less than 0.1 mm. The trueness of digital and alginate full-arch impressions was similar, and both impression techniques showed high precision. More research was needed to compare digital impressions and other conventional impression materials. For patients with completely natural dentition, the digital impressions obtained directly from intraoral scanning can be considered a viable alternative to alginate impressions.

COMPARISON OF METHODS FOR EVALUATING UPPER LIMB STRENGTH BY HAND-HELD DYNAMOMETRY

ABSTRACT Introduction The upper limbs are segments of the human body responsible for primary activities of daily life, and the muscles are essential structures for performing these activities. There have been few studies on intra- and inter-examiner reliability of the hand-held dynamometer (HHD) in healthy subjects, and none have been published that compare dynamometric evaluation methods in the main muscles in this segment. Objective Evaluate intra-examiner and inter-examiner assessment reliability of the hand-held dynamometry of upper limb muscles in healthy individuals, as well as comparing the assessment reliability between fixed and non-fixed methods. Methods Healthy subjects aged over 18 years were recruited for the study. The isometric contraction for ten muscle groups of the dominant upper limb was tested. For the fixed method, we used a system of suction cups, connected to the HHD by an inelastic belt. For the non-fixed method, the examiner supported the device by hand. The isometric contraction was sustained for three seconds. Each measurement was repeated three times, considering the highest value obtained. The reliability was calculated using the intraclass correlation coefficient (ICC). The dispersion between measurements was expressed by a Bland-Altman plot. Results The sample consisted of 25 volunteers, all right-handed. The intra-examiner ICC was 0.89-0.99 for the non-fixed method, and 0.43 to 0.85 for the fixed method. Inter-examiner reliability showed equivalent behavior. This study showed that evaluation of upper limb muscle strength using an isometric dynamometer has excellent intra-examiner and inter-examiner reliability. The supine position was chosen due to the need to propose a feasible protocol for clinical practice that could be replicated for the majority of publics and in different environments. The non-fixed method showed better reliability overall, demonstrating the feasibility of this tool without the need for adaptations, additional devices, or increased operating costs for this evaluation. Conclusion Comparison between the fixed and non-fixed HHD methods demonstrated superiority of the non-fixed method in terms of reliability. Level of evidence II; Investigation of a diagnostic exam - Development of diagnostic criteria with consecutive patients.

Reliability and intra-examiner agreement of orthodontic model analysis with a digital caliper on plaster and printed dental models.

To investigate if orthodontic model analysis with a digital caliper can be interchangeably performed between plaster and printed dental models. Forty-eight plaster models were digitized with orthoX®scan (DENTAURUM) and 48 counterparts were printed with Objet30 Dental Prime (Stratasys). One examiner performed five repeated orthodontic model analyses (41 outcomes) with a digital caliper in each plaster and the corresponding printed model and was externally validated by a second examiner. Inter- and intra-examiner reliability and error were evaluated with intraclass correlation coefficients (ICCs) and Dahlberg's formula, intra-examiner agreement with Bland-Altman analyses and Lin's correlation coefficients (CCCs), and changing bias with regression analyses. Inter- and intra-examiner ICCs and Dahlberg's error were ≥ 0.75 and ≤ 0.5mm, respectively, for most outcomes in both plaster and printed models. Intra-examiner agreement (systematic bias) between plaster and printed models ranged from - 0.45 to 0.45mm. Ranges of limits of agreement were wide for cumulative outcomes, such as crowding maxilla and mandible (2.69mm and 3.07mm around zero, respectively). Tooth widths were measured slightly larger in printed models. Lin's CCCs were ≥ 0.87 for all the outcomes between plaster and printed models, while no changing bias was detected. If orthodontic model analyses are consistently performed, plaster casts and their corresponding printed models obtained with orthoX®scan and Objet30 Dental Prime can be interchangeably used for clinical purposes in orthodontics. Orthodontic model analysis is important in treatment planning and printed dental models need to be validated regarding this diagnostic procedure.

Inter- and Intra-Observer Variability of the Volume of Cervical Ossification of the Posterior Longitudinal Ligament Using Medical Image Processing Software.

ObjectiveComputed tomography (CT)-based method of three dimensional (3D) analysis (MIMICS®, Materialise, Leuven, Belgium) is reported as very useful software for evaluation of OPLL, but its reliability and reproducibility are obscure. This study was conducted to evaluate the accuracy of MIMICS® system, and inter- and intra-observer reliability in the measurement of OPLL.MethodsThree neurosurgeons independently analyzed the randomly selected 10 OPLL cases with medical image processing software (MIMICS®) which create 3D model with Digital Imaging and Communication in Medicine (DICOM) data from CT images after brief explanation was given to examiners before the image construction steps. To assess the reliability of inter- and intra-examiner intraclass correlation coefficient (ICC), 3 examiners measured 4 parameters (volume, length, width, and length) in 10 cases 2 times with 1-week interval.ResultsThe inter-examiner ICCs among 3 examiners were 0.996 (95% confidence interval [CI], 0.987–0.999) for volume measurement, 0.973 (95% CI, 0.907–0.978) for thickness, 0.969 (95% CI, 0.895–0.993) for width, and 0.995 (95% CI, 0.983–0.999) for length. The intra-examiner ICCs were 0.994 (range, 0.991–0.996) for volume, 0.996 (range, 0.944–0.998) for length, 0.930 (range, 0.873–0.947) for width, and 0.987 (range, 0.985–0.995) for length.ConclusionThe medical image processing software (MIMICS®) provided detailed quantification OPLL volume with minimal error of inter- and intra-observer reliability in the measurement of OPLL.

Reprodutibilidade da medida da pressão arterial auscultatória durante o exercício de Força.

The auscultatory method has been suggested as a viable option for blood pressure (BP) measurement during resistance exercise. However, indicators of reproducibility of this method during resistance exercise have not been established. This study aimed to analyze intra- and inter-examiner reproducibility of auscultatory BP measurements obtained du­ring resistance exercise. Fourteen subjects (24 ± 5 years; 22.0 ± 2.4 kg/m2; systolic BP, 116 ± 7 mmHg; diastolic BP, 75 ± 4 mmHg) performed three sets of 15 repetitions of the knee extension exercise at 50% of their 1-repetition maximum at two different time points (T1 and T2). Before and during exercise, systolic and diastolic BP were measured simultaneously in both arms by two examiners. The intra-examiner intraclass correlation coefficient (ICC) for systolic BP was 0.75 (0.57-0.86) and 0.76 (0.59-0.87) for examiners 1 and 2, respectively. In addition, systolic BP values were similar at T1 and T2 both for examiner 1 (144 ± 9 vs. 146 ± 18, p = 0.08) and examiner 2 (152 ± 9 vs. 153 ± 12, p = 0.32). Inter-examiner ICC was 0.68 (0.46-0.82) for systolic BP and 0.21 (0.11-0.50) for diastolic BP. It can be conclu­ded that auscultatory systolic BP measurement during resistance exercise shows intra- and inter-examiner reproducibility ranging from 0.68 to 0.76, whereas diastolic BP measurement during resistance exercise shows low reproducibility.

Preliminary Study to Establish a Relationship between Tactile Sensation and Surface Roughness

This study evaluated the ability of tactile sensations to distinguish roughness. Five examiners experienced in visual examination participated. Tactile sensation was assessed by 3 standard references, the average roughnesses 0.49, 0.92 and 1.54 µm. The examiners evaluated the roughness using 2 different ends of sharp explorers (TU 17 SE and 23 SE), each with 2 different handles (Standard Handle and No. 6 Handle-Satin Steel), and 1 WHO probe using a 5-point response score. The examiners performed 3 evaluations to establish repeatability. Using the 23 SE explorer with the steel handle was the best option to distinguish between 3 roughnesses (p < 0.05). The intraexaminer intraclass correlation coefficients (ICC) were between 0.90 and 0.98, but the interexaminer ICC were only between 0 and 0.04, indicating that, although trained examiners could repeat their own scores, they were not consistent with each other in grading roughness.

A New Index of Tooth Wear

A modified wear index, in which the wear of enamel and dentine are recorded separately, is described. The index was applied to estimating the prevalence and extent of tooth wear in a single convenience sample of 18- to 30-year-old students attending a university in London. The subjects were examined under good lighting in a dental chair away from a dental school. A total of 707 females and 303 males were recruited with a mean age of 21.9 years (standard deviation = 0.1, range = 18–30) and examined by 3 trained and calibrated examiners. Intra-examiner intra-class correlation coefficients showed a range of 0.44–0.88. The unweighted κ scores were above 0.88 for enamel and dentine. The presence of enamel wear was common to all subjects, but 6.1% of the participants had more than one third of the tooth surface affected. Dentine was exposed on 5.3% of all surfaces, with the largest proportion accounting for less than 10% of the tooth surface (grade 1). The proportion of subjects with at least 1 surface with dentine exposed was 76.9% of the total population. The males had significantly more wear in dentine than the females (p = 0.001). The inter-examiner intra-class correlation coefficients for enamel and dentine were 0.87 and 0.92, respectively. The reproducibility of the index was comparable to other analyses and provides an opportunity to assess the prevalence of enamel wear in large population-based studies.

Paraspinal Skin Temperature Patterns: An Interexaminer and Intraexaminer Reliability Study

Background Paraspinal thermography is used by chiropractors as an aid in assessing the presence of vertebral subluxation. Few reliability studies have been carried out, with mixed results. Digital infrared scanning equipment is now available with location tracking that may enhance reproducibility. Digitized scans enable a computer-aided interpretation of thermographic patterns. Objective To assess the ability of examiners to reproduce thermal patterns. Study Design Repeated measures with 2 examiners assessing the same patient on 2 occasions. Thirty asymptomatic students served as subjects. Methods A TyTron C-3000 handheld thermographic scanner interfaced to a Microsoft Windows compatible personal computer was used for all recordings. Each examiner recorded 2 scans on each patient. It took an average of 3 minutes to complete all 4 scans. Data were exported to a spreadsheet for initial analysis, then SPSS was used for calculation of intraclass correlation coefficients (ICC). Since the starting and stopping points of scans were not always the same, care was taken to align scans visually, using well-distinguished peaks on the charts as guides. Scans were cropped to remove artifacts that might have occurred at the beginning and end of the scans. Intraexaminer and interexaminer ICCs were calculated. Results Skin temperatures ranged from 35.4°C to 30.0°C over all scans. The average temperatures changed little from the first to the last scans, indicating that subjects' overall skin temperatures were stable during the scanning procedure. Intraexaminer ICCs ranged from 0.953 to 0.984. The left and right channel data show slightly higher congruence than the Delta channel. The interexaminer reliability coefficients ranged from 0.918 to 0.975. Again, the Delta channel shows slightly less reliability, although the ICCs were quite high for all channels. Conclusion Intraexaminer and interexaminer reliability of paraspinal thermal scans using the TyTron C-3000 were found to be very high, with ICC values between 0.91 and 0.98. Changes seen in thermal scans when properly done are most likely due to actual physiological changes rather than equipment error.