Intraobserver Study Research Articles

Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification

PurposeNumerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures.Patients and methodsEighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10–12 weeks later by the same 18 reviewers to test intra-observer reliability.ResultsThe Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment.ConclusionThe AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.

Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms

BackgroundFetal cardiology has shown a rapid development in the last decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly at second and third trimester. The study of fetal cardiac function at the end of first timester has not been properly investigated and there is a lack of reference values at early gestational weeks. ObjectiveTo assess whether the measurement of time related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13.6 gestational weeks. Study designWe conducted a prospective observational study from March to September 2022. The study was carried out in two hospitals (Hospital Universitari Dexeus, Barcelona and Hospital VITAHS 9 Octubre, Valencia). The scans were performed by 3 specialists in fetal medicine. Exclusion criteria were: fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight< 10 centile, diabetes and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were: isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction and filling time fraction. We study the feasibility and intra- and inter-observer reproducibility of this parameters using the interclass correlation coefficient (ICC). Nomograms were made and the percentiles of the values of the different parameters were calculated. Results409 cases were recruited but only 296 could be included in the statistical analysis once exclusion criteria were applied. The intra-observer reproducibility study was excellent (ICC>0.900) and the inter-observer reproducibility study was good (ICC>0.700). Data regression analysis showed that cycle time, filling time, isovolumetric contraction time and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean 0.43±0.08), isovolumetric relaxation time (mean 0.04±0.01) and ejection time (mean 0.16±0.01) remained constant from 11 to 13 weeks. ConclusionsThe study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.

Torsobarography: Intra-Observer Reliability Study of a Novel Posture Analysis Based on Pressure Distribution.

Postural deformities often manifest themselves in a sagittal imbalance and an asymmetric morphology of the torso. As a novel topographic method, torsobarography assesses the morphology of the back by analysing pressure distribution along the torso in a lying position. At torsobarography's core is a capacitive pressure sensor array. To evaluate its feasibility as a diagnostic tool, the reproducibility of the system and extracted anatomical associated parameters were evaluated on 40 subjects. Landmarks and reference distances were identified within the pressure images. The examined parameters describe the shape of the spine, various structures of the trunk symmetry, such as the scapulae, and the pelvic posture. The results showed that the localisation of the different structures performs with a good (ICC > 0.75) to excellent (ICC > 0.90) reliability. In particular, parameters for approximating the sagittal spine shape were reliably reproduced (ICC > 0.83). Lower reliability was observed for asymmetry parameters, which can be related to the low variability within the subject group. Nonetheless, the reliability levels of selected parameters are comparable to commercial systems. This study demonstrates the substantial potential of torsobarography at its current stage for reliable posture analysis and may pave the way as an early detection system for postural deformities.

The AO classification system for tibial plateau fractures: An independent inter and intraobserver agreement study

PurposeClassifying tibial plateau fractures is paramount in determining treatment regimens and systemizing decision making. The original AO classification described by Müller in 1996 and the Schatzker classification of 1970 are the most cited classifications for tibial plateau fractures, demonstrating substantial to almost perfect agreement. The main problem with these classifications schemes is that they lack the detail required to convey the variety of fracture patterns encountered. In 2018, the AO foundation published a new classification system for proximal tibia fractures, highlighting a more complete and detailed number of categories and subcategories. We sought to independently determine inter and intraobserver agreement of the AO classification system, compared to the previous systems described by Müller and Schatzker. MethodsOne hundred seven consecutive tibial plateau fractures were screened, and a representative data set of 69 was created. Six independent evaluators (three knee surgeons, three senior orthopedic residents) classified the fractures using the original AO, the Schatzker and the new AO classifications. After six weeks, the 69 cases were randomized and reclassified by all evaluators. The Kappa coefficient (k) was calculated for inter- and intraobserver correlation and is expressed with 95% confidence intervals. Resultsinterobserver agreement was moderate for all three classifications. k = 0.464 (0.383–0.560) for the original AO; k = 0.404 (0.337–0.489) for Schatzker; and k = 0.457 (0.371–0.545) for the base categories of the new AO classification. The inclusion of subcategories and letter modifiers to the new classification worsened agreement to k = 0.358 (0.302–0.423) and k = 0.174 (0.134–0.222), respectively. There were no significant differences between knee surgeons and residents for the new classification. Intra-observer correlation was also moderate for each of the scores: k = 0.630 (0.578–0.682) for the original AO; k = 0.623 (0.569–0.674) for Schatzker; and k = 0.621 (0.566–0.678) for the new AO base categories; without differences between knee surgeons or residents. ConclusionsThis study demonstrated an adequate inter and intra-observer agreement for the new AO tibial plateau fractures classification system for its base categories, but not at the subcategory or letter modifier levels.

Reproducibility and repeatability of biventricular function/volume and strain parameters by 2D and 4D stress echocardiography in adult patients with repaired TOF

Abstract Funding Acknowledgements Type of funding sources: None. Background The use of 2D and 4D during stress echocardiography to undertake complex measures in complex patients like patients with repaired TOF is challenging and the validity of these measures is not known yet. Methods For test-retest variability, 20 patients with repaired TOF with no or mild pulmonary regurgitation were selected randomly and underwent a cardiopulmonary exercise test (CPET) with echocardiography. Intra-observer variability study was performed for all 20 patients by the same observer. Interobserver variability study was performed for 5 patients by different experienced observer. Intraclass correlation coefficient (ICC), and coefficients of variation (COV) were used to quantify reproducibility and variability. Results For 2D measures, better reproducibility was observed for semiautomated 2D strain measures than 2D functional measures for biventricular systolic function at baseline and during the stress (ICC&amp;gt;.90 vs &amp;gt;.70, p&amp;lt;0.001), with least COV was observed (COV&amp;lt;10%). 4D semiautomated volumetric measures demonstrated less reproducibility during stress with highest COV was observed for 4D RV volume parameters (COV, 35%), followed by 4D LV volume parameters (COV, 27%). CPET had an excellent agreement of all measures (ICC &amp;gt;.90). with very low COV (&amp;lt;10%). Conclusions Semiautomated echo measures outperformed manual measures during stress echocardiography and can be performed with acceptable reproducibility. Variability is at highest for 4D semiautomated measures despite good reproducibility, while lowest variability was observed for 2D semiautomated measures of myocardial deformation.

Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle.

Evaluate the validity of a recent approach to calculate the knee flexion or extension contracture contributing to the overall sagittal deformity using the sagittal mechanical axis angle (SMAA) for the overall alignment assessment and sagittal joint line angle (SJLA) for soft tissue contribution. The methods of evaluating these angles and their clinical applications are discussed. In total, 107 normal limbs met the criteria and were divided into two groups: skeletally mature and immature. Sagittal alignment was evaluated using the Bone Ninja iPad application, and the posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), SMAA and SJLA were recorded. In skeletally immature patients, mean SJLA was 13.46° [standard deviation (SD), 4.55°], and in mature patients, it was 16.91° (SD, 2.948°). The PDFA and PPTA were consistent with previously published measurements. The SJLA method is a practical way to quantify the soft tissue contribution and degree of contracture. It can also be used for monitoring deterioration or improvement of knee range of motion during lengthening or physical therapy. All patients in this study presented to our clinic with symptoms on the contralateral side. This, in addition to the retrospective nature, was a limitation in our study.We recommend a validity study to compare our SJLA method to the classic anterior cortical line angle (ACL) method in addition to an inter-observer and intra-observer reliability study for the SJLA. We also recommend a study on completely normal asymptomatic subjects to better standardise the angle measurements in skeletally immature patients at different ages. Abalkhail TB, McClure PK. Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle. Strategies Trauma Limb Reconstr 2022;17(3):159-164.

Usefulness of digital tomosynthesis in diagnosing cervical ossification of the posterior longitudinal ligament: a comparative study with other imaging modalities.

The diagnosis and classification of ossification of the posterior longitudinal ligament (OPLL) can be difficult with radiography alone; therefore, computed tomography (CT) is also usually performed. There are many reports on the usefulness of digital tomosynthesis (DTS) for image analysis in orthopedics. This study aimed to compare the accuracy of DTS with radiography and CT for the diagnosis and classification of cervical OPLL (C-OPLL). We included 31 patients with OPLL and 30 with cervical spondylotic myelopathy. The patients' cervical spine radiography, DTS, and CT images were each evaluated twice by three specialists and three residents. In the intra-observer reliability study, there was one observer with a fair level of kappa values for radiography and DTS among three residents. The kappa values for CT were the best for all observers. In the inter-observer reliability study, the interclass correlation coefficient (ICC) values were high for both diagnosis and classification by specialists at the almost perfect level for all three imaging modalities. On the other hand, the ICC values for both diagnosis and classification for radiography by the residents were lower than those for DTS and CT. This study revealed that DTS may be an alternative to CT for the diagnosis and classification of C-OPLL by specialists. Caution should be exercised in diagnosing and classifying C-OPLL using radiography and DTS by residents, and the use of CT is recommended.

Core muscle strength can be reliably measured using a novel isokinetic device: An intra-observer study.

BACKGROUND: Core strength is an important aspect of physical fitness. A dynamometer was developed to measure isokinetic core muscle strength in multiple planes of motion. Establishing the reliability is needed before it can be used in practice.OBJECTIVE: Examine the intra-observer reliability of a trunk isokinetic dynamometer.METHODS: 31 participants were recruited. Tests were performed twice with an interval of 5–9 days by the same observer. Testing included rotation, flexion/extension and lateral flexion at speeds of 90/s and 60/s. The main outcome measure was peak torque (PT). The secondary outcomes included peak torque angle (PTA), time to peak torque (TTPT) and compensatory torques (CompTQ). The intra-observer reliability was investigated using intraclass correlation coefficients (ICC).RESULTS:Peak torque reliability was good to excellent (ICC 0.70–0.91), whereas the reliability of the PTA (ICC 0.04–0.56) and TTPT (ICC 0.01–0.68) were poor to moderate. CompTQ reliability was moderate to good (ICC 0.20–0.88).CONCLUSIONS: The intra-observer reliability of the isokinetic measurement of core strength peak torque was good. The secondary outcomes peak torque angle and time to peak torque were less reliable and the compensatory torques showed moderate to good reliability. This isokinetic dynamometer could have useful applications in the field of sports medicine and rehabilitation.

Reproducibility of Systolic Strain in Mice Using Cardiac Magnetic Resonance Feature Tracking of Black-Blood Cine Images.

Mouse models are widely utilized to enhance our understanding of cardiac disease. The goal of this study is to investigate the reproducibility of strain parameters that were measured in mice using cardiac magnetic resonance (CMR) feature-tracking (CMR42, Canada). We retrospectively analyzed black-blood CMR datasets from thirteen C57BL/6 B6.SJL-CD45.1 mice (N=10 female, N=3 male) that were imaged previously. The circumferential, longitudinal, and radial (Ecc, Ell, and Err, respectively) parameters of strain were measured in the mid-ventricular region of the left ventricle. Intraobserver and interobserver reproducibility were assessed for both the end-systolic (ES) and peak strain. The ES strain had larger intraclass correlation coefficient (ICC) values when compared to peak strain, for both the intraobserver and interobserver reproducibility studies. Specifically, the intraobserver study showed excellent reproducibility for all three ES strain parameters, namely, Ecc (ICC 0.95, 95% CI 0.83-0.98), Ell (ICC 0.90, 95% CI 0.59-0.97), and Err (ICC 0.92, 95% CI 0.73-0.97). This was also the case for the interobserver study, namely, Ecc (ICC 0.92, 95% CI 0.60-0.98), Ell (ICC 0.76, 95% CI 0.33-0.93), and Err (ICC 0.93, 95% CI 0.68-0.98). Additionally, the coefficient of variation values were all <10%. The results of this preliminary study showed excellent reproducibility for all ES strain parameters, with good to excellent reproducibility for the peak strain parameters. Moreover, all ES strain parameters had larger ICC values than the peak strain. In general, these results imply that feature-tracking with CMR42 software and black-blood cine images can be reliably used to assess strain patterns in mice.

Standardised classification system for bespoke thermoplastic ankle foot orthoses

PurposeTo validate a new classification system for bespoke thermoplastic ankle foot orthoses (AFOs). MethodsInter- and intra-observer reliability study. A classification system based on the design and function of AFOs was created. Sixty-three independent observers classified thirty-six photographs of different AFOs, according to the proposed classification system via an online questionnaire. Approximately two weeks later, the same AFOs were classified again by fifty-three of the same participants. All participants were health care professionals, researchers, or technicians with experience in referring for, prescribing, fitting, reviewing, researching or manufacturing AFOs. ResultsThe mean inter- and intra-observer agreement Fleiss’ kappa was 0.932 and 0.944, respectively. 98.3% of participants reported that the classification system was very easy or moderately easy to use, with 85.7% reporting they would use the classification system. 90.5% of participants reported that the proposed AFO classification system was clear, with 84% stating it was useful. ConclusionThe proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care.

Expert Cytopathologists Were Not Biased by HPV Data in Interobserver and Intraobserver Study in Low Grade Squamous Lesions in Thin Prep Liquid-based Cytology

Expert Cytopathologists Were Not Biased by HPV Data in Interobserver and Intraobserver Study in Low Grade Squamous Lesions in Thin Prep Liquid-based Cytology

Locating hyperfunctioning parathyroid glands using 11C-Choline PET/CT: an inter- and intra-observer variation study

BackgroundUse of 11C-Choline PET/CT is gaining ground in detecting hyperfunctioning parathyroid glands in primary hyperparathyroidism. The purpose of this study was to evaluate the robustness of 11C-Choline PET/CT by assessing intra- and inter-observer agreement to determine whether the method was reader sensitive and therefore should only be performed at highly specialised sites with a high number of cases.PET/CT images of 40 patients diagnosed with primary hyperparathyroidism were anonymised and evaluated three times by three readers: an expert reader and two non-experts (non-experts were experienced in PET/CT imaging, but not in 11C-Choline PET/CT in the setting of primary hyperparathyroidism). Number of hyperfunctioning parathyroid glands, location relative to the thyroid gland and confidence of each assessment (low, moderate or high) were noted, and intra- and inter-observer agreement calculated using Fleiss’ kappa method. Sensitivities and specificities of the non-experts were calculated using the expert reader as gold standard.ResultsIntra-observer agreement was ‘good’ to ‘near perfect’ for all readers. Inter-observer agreement was good between non-experts and the expert, with kappa values ≥ 0.74. Sensitivities between non-experts and the expert were high, > 81%, when assessing which side and 75% when assessing thyroid quadrant. All specificities were > 94%. Reader certainties were ‘high’ in > 80% of cases for the expert and > 70% and > 65%, respectively for the two non-experts.Conclusion11C-Choline PET/CT is not reader sensitive for the localisation of hyperfunctioning parathyroid glands and may therefore be safely implemented at sites that have a moderate number of cases. Access to a cyclotron laboratory is, however, a necessity for the production of 11C-Choline.The study was conducted in accordance with the Helsinki 2 declaration and The International Council for Harmonisation Guideline for Good Clinical Practice (ICH_GCP) clinical trial, approved by the Research Ethics Committee of the Capital Region of Denmark (Journal-nr.:H-18012490, date of approval: 18 June 2018) and the Danish Medicines Agency (EudraCT no. 2018-000726-63, date of approval: 6 June 2018). The GCP unit in Eastern Denmark has carried out regular monitoring of the trial according to GCP (ID: 2018-1050).

Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: an independent inter- and intra-observer agreement study

BackgroundLumbar degenerative spondylolisthesis (DS) has been a common disease that makes increasing patients to suffer from different degrees of low back pain and radicular symptoms. The Spinal Deformity Study Group (SDSG) and the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to compare the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value.Methods/designAll 117 patients with L5/S1 lumbar DS were enrolled. Five experienced spine surgeons were selected to assess DS with SDSG and CARDS systems. Kappa (K) value was used to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, the analysis was repeated.ResultsThe inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878.ConclusionSDSG system had better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.

An independent inter- and intra-observer agreement assessment of Yeom classification for bone cement leakage following vertebroplasty/kyphoplasty

Study Design An inter- and intra-observer agreement study Background In recent years, vertebroplasty and kyphoplasty have been widely used in treating osteoporotic vertebral compression fractures (OVCF) though the clinical efficacy of them is still controversial. However, there are also inevitable complications, first and foremost is bone cement leakage (BCL). Yeom classification is commonly used to evaluate BCL. The objective of this study is to assess its reliability and reproducibility, and to explore its clinical application value. Methods All 58 patients with BCL following vertebroplasty/kyphoplasty were involved. Six spine surgeons were selected to be evaluators as they were unaware of the identity of the patients and the treatment they received. They classified BCL according to Yeom system, we used kappa (K) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. Results The inter-observer reliability of Yeom classification was substantial with K value of 0.71 (1st assessment) and 0.73 (2nd assessment). The intra-observer reproducibility of Yeom classification was near perfect with K value of 0.88. Conclusion Yeom classification system has substantial inter-observer reliability and near perfect intra-observer reproducibility in BCL following vertebroplasty/kyphoplasty, which can be widely used in clinical care as an appropriate instrument for early observation, mechanism and severity cognition, and prognosis predicting of BCL. Besides, the adding of type M (the mixed type) may improve the classification.

Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study.

Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.

OC15.03: Diagnosing septate uterus using 3D ultrasound using three different classifications: an inter‐ and intraobserver agreement study

To assess inter-observer agreement of non-expert sonographers for classifying septate uterus using the ESHRE/ESGE, ASRM and CUME classifications. Fifty 3D volumes of a non-consecutive series of women with suspected uterine malformation were used. Two non-expert examiners evaluated a single 3D volume of the uterus of each woman blinded each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation and indentation-wall thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM and CUME). Inter-observer agreement regarding the ESHRE/ESGE, ASRM and CUME classifications was assessed using Cohen's weighted kappa index (k). Agreement regarding the three classifications (ASRM vs ESHRE-ESGE, ASRM vs CUME, ESHRE-ESGE vs CUME) was also assessed. Inter-observer agreement between the two non-expert examiners was good for the ESHRE/ESGE (k = 0.74, 95% CI 0.55–0.92) and very good for ASRM and CUME classification systems (k = 0.96, 95% CI 0.88–1.00; and k = 0.91, 95% CI 0.79–1.00), respectively. Agreement between the ESHRE/ESGE and ASRM was moderate for both examiners. Agreement between ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between ASRM and CUME was good for both examiners. The three classifications have good (ESHRE/ESGE) or very good (ASRM, CUME) inter-observer agreement. Agreement between ASRM and CUME was higher than that for ESHRE-ESGE and ASRM and ESHRE-ESGE and CUME.

Digital pathology for primary diagnosis of screen-detected breast lesions-experimental data, validation and experience from four centres.

The rate of deployment of digital pathology (DP) systems for primary diagnosis in the UK is accelerating. The flexibility and resilience of digital versus standard glass slides could be of great benefit in the NHS breast screening programme (NHSBSP). This study aims to document the safety and benefits of DP for preoperative tissue diagnosis of screen-detected breast lesions. Concordance data for glass and digital slides of the same cases from four sites were subjected to detailed concordance-discordance analysis. A literature review of DP in the primary diagnosis of breast lesions is presented, making this the most comprehensive synthesis of digital breast cancer histopathological diagnostic data to date. Detailed concordance analysis of experimental data from two histopathology departments reveals clinical concordance rates for breast biopsies of 96% (216 of 225) and 99.6% (249 of 250). Data from direct comparison validation studies in two histopathology departments, utilising the protocol recommended by the Royal College of Pathologists, found concordance rates for breast histology cases of 99.4% (180 of 181) and 99.0% (887 of 896). An intraobserver variation study for glass versus digital slides for difficult cases from the NHSBSP yielded a kappa statistic of 0.80, indicating excellent agreement. Discordances encountered in the studies most frequently concerned discrepancies in grading attributable to mitotic count-scoring and identification of weddelite. The experience of four histopathology laboratories and our review of pre-existing literature suggests that DP is safe for the primary diagnosis of NHSBSP breast histology specimens, and does not increase the risk of misclassification.

Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study.

Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm. In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study. In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (κ ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (κ > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (κ ≤ 0.6). The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.

The Effect of Clinical Knowledge and Surgical Experience on Treatment Choice in Legg-Calve-Perthes Disease: Intra-observer and Inter-observer Reliability Study.

The aim of this study was to evaluate standardized hip radiographs, arthographs, demographic characteristics, physical examination findings, and their effects on treatment choices in leg-calve-perthes disease (LCPD). Intraobserver and interobserver realibility between orthopaedic residents, orthopaedic surgeons, and paediatric orthopaedic surgeons were also investigated. 47 LCPD patients were included this cross-sectional study. Six separate presentations including different variabilities (clinical findings, standard radiographs, and arthrographs) were evaluated by three different groups (residents, surgeons, paediatric orthopaedic surgeons) and were sent to the observers every other month by hiding patients' personal information. Seven different treatment modalities were introduced for the best treatment modality. Intraobserver and interobserver reliability in these three groups were examined. Percentage aggreement (PA) and intraclass correlation coefficients (ICC) tests were used for this purpose. Treatment PA rates between presentations were 29.5-53.6% in residents, 38.3-60.4% in surgeons, and 39.1-59.8% in pediatric orthopaedic surgeons. Conservative methods were mostly preferred as treatment modality in all groups; followed by proximal femoral osteotomies. Pediatric orthopaedic surgeons preferred safe dislocation and femur head and/or neck reconstruction surgery 5-18 times more than residents and orthopaedic surgeons. Intraobserver reliability of treatment modalities was higher among the paediatric orthopaedic surgeons; the results were fair-good (0.483-0.763). Among residents and orthopaedic surgeons, ICC values were poor to good, respectively (- 0.080 to 0.636 and 0.263-0.643). Interobserver reliability among three groups was meanly good. As surgical experience increases, both the compliance rates of the treatment modalities and the intra- and inter-group reliability are increased. Knowledge of the demographic data and clinical findings of patients besides hip radiographs or arthrographs increase treatment compliance in paediatric orthopaedic surgeons, however, cause changes in treatment modalities in residents. As surgical experience increases, more difficult surgeries such as safe dislocation and femoral head/neck reconstruction are preferred.

Konservatif Tedavi Uygulanan Önkol Kırıklı Pediyatrik Hastalarda Kritik Önkol Radyografisinde Açı Ölçümü: Gözlemciler Arası ve Gözlemciler İçi Korelasyon Çalışması

Konservatif Tedavi Uygulanan Önkol Kırıklı Pediyatrik Hastalarda Kritik Önkol Radyografisinde Açı Ölçümü: Gözlemciler Arası ve Gözlemciler İçi Korelasyon Çalışması