Measure Interobserver Agreement Research Articles

Factors influencing the reliability of measurements in eyes with full-thickness macular holes: are we measuring incorrectly?

PurposeThe calliper function is used for manual measurements of full thickness macular holes (FTMHs). We aimed to investigate whether a reproducible difference could be detected beyond interobserver variability between two...

International Multi-Specialty Expert Physician Preoperative Identification of Extranodal Extension n Oropharyngeal Cancer Patients using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation.

Extranodal extension (pENE) is a critical prognostic factor in oropharyngeal cancer (OPC) that drives therapeutic disposition. Determination of pENE from radiological imaging has been associated with high inter-observer variability. However, the impact of clinician specialty on human observer performance of imaging-detected extranodal extension (iENE) remains poorly understood. To characterize the impact of clinician specialty on the accuracy of pre-operative iENE in human papillomavirus-positive (HPV+) OPC using computed tomography (CT) images. This prospective observational human performance study analyzed pre-therapy CT images from 24 HPV+ OPC patients, with duplication of 6 scans (n=30) of which 21 were pathologically confirmed pENE. Thirty-four expert observers, including 11 radiologists, 12 surgeons, and 11 radiation oncologists, independently assessed these scans for iENE and reported human-detected radiologic criteria and observer confidence. The primary outcomes included accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and Brier score for each physician, compared to ground-truth pENE. The significance of radiographic signs for prediction of pENE were determined through logistic regression analysis. Fleiss' kappa measured interobserver agreement, and Hanley-MacNeil AUC discrimination testing. Median accuracy across all specialties was 0.57 (95%CI 0.39 to 0.73), with no specialty showing discriminate performance greater than random estimation (median AUC 0.64, 95%CI 0.44 to 0.83). Significant differences between radiologists and surgeons in Brier scores (0.33 vs. 0.26, p < 0.01), radiation oncologists and surgeons in sensitivity (0.48 vs. 0.69, p > 0.1), and radiation oncologists and radiologists/surgeons in specificity (0.89 vs. 0.56, p > 0.1). Indistinct capsular contour and nodal necrosis were significant predictors of correct pENE status among all specialties. Interobserver agreement was weak for all the radiographic criteria, regardless of specialty (κ<0.6). Multiobserver testing shows physician discrimination of HPV+OPC pENE on pre-operative CT remains non-different than blind guessing, with high interrater variability and low diagnostic accuracy, regardless of clinician specialty. While minor differences in diagnostic performance among specialties are noted, they do not significantly affect the overall poor agreement and discrimination rates observed. The findings underscore the need for further research into automated detection systems or enhanced imaging techniques to improve the accuracy and reliability of iENE assessments in clinical practice.

Timed up and go demonstrates strong interrater agreement and criterion validity as a functional test in geriatric dogs.

To measure interobserver agreement for 4 functional tasks and their summed geriatric functional score (GFS) and correlate tasks and GFS with client-specific outcome measurements (CSOMs): Canine Brief Pain Inventory (CBPI) pain severity, CBPI pain interference, and Liverpool Osteoarthritis in Dogs. 89 geriatric dogs were recruited between April and September 2023 from staff, friends, and clients of the Cornell University College of Veterinary Medicine with a median age of 11.0 years and weight of 26.4 kg. Dogs underwent 4 sequential functional tests: timed up and go (TUG), cavallettis, figure 8s, and down to stands. Two observers independently scored each dog. The GFS was calculated based on the summed scores of the individual tests. Additional information collected included signalment, weight, measurements reflecting the comorbidities of aging (body condition score and muscle condition score), and CSOMs. Strong interrater agreement was found for all functional tests. The TUG in seconds (sTUG) and figure 8s demonstrated significant (P < .05) moderate to strong correlations to all CSOMs. The GFS showed similar significant correlations with all CSOMs except CBPI pain severity; however, when correlating individual tests to CSOMs, only figure 8s and TUG were significantly contributing to GFS results. Receiver operating characteristic curve analysis defined highly functional dogs as those completing the sTUG in under 3.83 seconds. The sTUG represented the best test for geriatric function given it was objective, reliable, correlated well to CSOMs, and could help identify highly functioning dogs. The sTUG appears to be the first practical and reliable functional test of canine geriatric mobility.

MR Diffusion-Weighted Imaging in Evaluating Immediate HIFU Treatment Response of Uterine Fibroids.

Nowadays, High Intensity Focused Ultrasound (HIFU) is a common surgery option for the treatment of uterine fibroids in China, the immediate response of which is clinically evaluated using Contrast Enhanced (CE) imaging. However, the injection of gadolinium with its potential adverse effect is of concern in CE and therefore, it deserves efforts to find a better imaging method without the need for contrast agent injection for this task. To assess the role of diffusion-weighted imaging (DWI) in evaluating the immediate therapeutic response of HIFU treatment for uterine fibroids in comparison with CE. 68 patients with 74 uterine fibroids receiving HIFU treatment were enrolled, and immediate treatment response was assessed using post-surgical DWI images. Semi-quantitative ordinal ablation quality grading and quantitative nonperfusion volume (NPV) measurement based on DWI and CE imaging were determined by two experienced radiologists. Agreement of ablation quality grading between DWI and CE was assessed using the weighted kappa coefficient, while intraobserver, interobserver and interprotocol agreements of NPV measurements within and between DWI and CE were evaluated using the intraclass correlation (ICC) and Bland-Altman analysis. Grading of immediate HIFU treatment response showed a moderate agreement between DWI and CE (weighted kappa = 0.446, p < 0.001). NPV measured in 65 fibroids with DWI of Grade 3~5 showed very high ICCs for the intraobserver and interobserver agreement within DWI and CE (all ICC > 0.980, p < 0.001) and also for the interprotocol agreement between DWI and CE (ICC = 0.976, p < 0.001). DWI could provide satisfactory ablation quality grading, and reliable NPV quantification results to assess immediate therapeutic responses of HIFU treatment for uterine fibroids in most cases, which suggests that non-contrast enhanced DWI might be potentially used as a more costeffective and convenient method in a large proportion of patients for this task replacing CE imaging.

Effect of a second-generation motion correction algorithm on image quality and measurement reproducibility of coronary CT angiography in patients with a myocardial bridge and mural coronary artery

To determine the effect of second-generation motion correction (MC2) on image quality and measurement reproducibility of cardiac CT images in patients with a myocardial bridge and mural coronary artery (MB-MCA) compared to standard (STD) images without motion correction and with first-generation motion correction (MC1). A total of 66 patients with MB-MCA in the left anterior descending branch who underwent 256-detector CT with single-heartbeat acquisition were included. Images were reconstructed at 45% and 75% R-R intervals using STD, MC1, and MC2 algorithms. Image quality for MB-MCA was assessed by two observers on a four-point scale (1=poor and 4=excellent) and compared among STD, MC1, and MC2. Depth and length of MB, lumen area, and minimal diameter of MCA were measured and compared. At 45% R-R interval, image quality scores were 1.59±0.78, 2.21±0.97, and 3.21±0.62 for MCA, and 2.48±0.79, 2.76±0.75, and 3.58±0.58 for MB with STD, MC1 and MC2, respectively. At 75% R-R interval, these values were 2.26±0.60, 3.03±0.89, and 3.59±0.55 for MCA and 3.00±0.93, 3.17±0.83, and 3.80±0.44 for MB. Although MC1 was superior to STD in displaying MCA, there was no statistical difference between the two algorithms for MB (p>0.05). Compared with STD and MC1, MC2 statistically improved image quality and interpretability for both MCA and MB and had narrower limits in interobserver agreement for measurements at both 45% and 75% R-R intervals. MC2 improves CT image quality and measurement reproducibility in patients with MB-MCA compared to STD and MC1.

Correlation of transesophageal echocardiography acquired 3D-multiplane reconstruction-planimetry of aortic valve area (AVA) with AVA determined by standard and modified continuity equation

Abstract Background Currently the most accepted method for measuring aortic valve area is the continuity equation. Planimetry is an alternative method that allows the direct measurement of the Aortic valve area (AVA). There are, however, pitfalls in this method, such as artifacts caused by valve calcification and difficulty with the correct alignment of the cusps. Furthermore, these measurements may not correlate linearly, as effective AVA may vary due to contraction of flow and specific 3-dimensional conformation of the aortic valve. The advent of new technology with three-dimensional multiplane reconstruction echocardiography (3D-MPR) could overcome some of those limitations. Methods Measurements were taken from 119 patients who underwent elective transesophageal echocardiography (TEE), encompassing the whole spectrum of aortic opening. AVA was first calculated with the standard continuity equation (CE) in which left ventricular outflow tract (LVOT) area was calculated from its 2D diameter (AVA-CEstd). Secondly, a modified CE (AVA-CEmod) was used, measuring the LVOT area with 3D-MPR. Thirdly, the AVA was directly measured by 3D-MPR planimetry using the maximal opening at mid-systole (AVA-3D). In a subset of 30 Patients in which right and retrograde left heart catheterization was clinically indicated and performed, cardiac output was estimated by the Fick formula and AVA was calculated by the Gorlin formula (AVAGorling). We determined the correlation and level of agreement of AVA-3D with AVA-CEstd, AVA-CEmod and AVAGorling. Lastly, inter-observer reproducibility was evaluated for AVA-3D. Results The mean AVA-3D, AVA-CEmod and CEstd were as wollows: 1.87cm2, 1.81cm2 and 1.69cm2 respectively. There was a strong correlation between AVA-3D and AVA-CEmod (r = 0.963, p &amp;lt; 0.001) with a mean difference of 0.056 cm2 ± 0.273. There was a strong correlation between AVA-3D and AVA-CEstd (r = 0.877, p &amp;lt; 0.001) with a mean difference of 0.179 cm2 ± 0.477. There was a moderate correlation between AVAGorling , AVA-3D (r = 0.40, p &amp;lt; 0.001), AVA-CEmod (r = 0.54, p &amp;lt; 0.001) and AVA-CEstd (r = 0.49, p &amp;lt; 0.001). Intra-observer (ICCs 0.991) and inter-observer (ICCs 0.983) agreement for AVA-3D measurements were excellent. Conclusion Comparison between AVA-3D, AVA-CEmod and CEstd showed a strong correlation and intra-observer and inter-observer variability for AVA-3D were excellent. The correlation of AVAGorling with the AVAs assessed by echocardiography was weaker. The mean differences and variability can be explained by the known hemodynamic and conceptual differences between the geometric AVA, effective AVA and AVA assessed by the Gorlin formula. We can therefore conclude that AVA-3D assessed by TEE is a useful tool in daily clinical practice as it overcomes some pitfalls of the planimetry method, although some of the limitations remain.

MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index.

Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power ( p < 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II , Diagnostic Study.

Description of a new ultrasound sign to distinguish Crohn's anal fistula from cryptoglandular fistula: The rosary sign.

Endoanal and endorectal ultrasound are essential diagnostic tools for perianal fistula. Recent studies have examined ultrasound signs that help differentiate cryptoglandular anal fistula from perianal fistulizing Crohn's disease. The main aim of this work was to describe a new ultrasound sign for perianal fistula and to evaluate its ability to differentiate Crohn's disease from cryptoglandular anal fistula. This study included 363 patients (113 women; mean age 46.5 ± 14.3 years). Overall, 287 (79.1%) patients had a cryptoglandular perianal fistula and 76 (20.9%) had fistulizing Crohn's disease. All patients underwent three-dimensional anal endosonography for perianal fistula. The reading was carried out by two observers. Observer 1, who was an experienced sonographer and colorectal surgeon, observed the ultrasound sign in 120 patients (33.1%), while observer 2, who was inexperienced, observed it in 129 patients (35.5%). The overall interobserver agreement was 67.22%. The Kappa coefficient measuring interobserver agreement was 0.273 (0.17-0.38). Among those patients with Crohn's disease, 48.68% had the sign and 16% did not (p = 0.001). A logistic regression study showed that the sign was a predictor of Crohn's disease (p = 0.001), with an odds ratio of 2.33 (1.39-3.91). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 38.68%, 71.08%, 30.83%, 83.95% and 66.39%, respectively. This study provides a new ultrasound sign for perianal fistula (the rosary sign) in patients with Crohn's disease. The sign can be used to differentiate Crohn's disease from other types of fistula. This is useful in the management of patients with anal fistula.

Lower uterine segment thickness assessed by transvaginal ultrasound before labor induction: reproducibility analysis and relationship with delivery outcome.

To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes. This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes. Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93-0.98)). On Bland-Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, -1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031-1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039-1.445)). In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Three-dimensional Whole-Heart Cardiac MRI Sequence for Measuring Trabeculation in Left Ventricular Noncompaction.

To compare three-dimensional (3D) whole-heart MRI with isotropic submillimeter resolution with standard two-dimensional (2D) cine MRI in measuring the bilayered myocardium in left ventricular noncompaction (LVNC). Twenty-four patients with LVNC (mean age, 42 years ± 16 [SD]) were retrospectively enrolled between October 2011 and July 2020. Compacted myocardium (CM) and noncompacted myocardium (NCM) were measured in long axis (Petersen approach) and short axis (Jacquier approach) at 3D whole-heart and 2D cine MRI by two independent readers. Image quality (1 = excellent, 2 = adequate, 3 = nondiagnostic), considering discrimination between NCM and CM and CM and adjacent tissue, was evaluated. Pearson, Spearman, and intraclass correlation tests were used as statistical tests. In long-axis measurements, the correlation between both sequences was moderate to strong for CM (Pearson, 0.66-0.79; Spearman, 0.61-0.68) and strong to very strong for NCM (Pearson, 0.90-0.97; Spearman, 0.77-0.91). Intraclass correlation coefficient (ICC) in 3D whole-heart MRI was 0.90 (95% CI: 0.78, 0.95) for CM and 0.94 (95% CI: 0.84, 0.97) for NCM, while ICC in 2D cine MRI was 0.77 (95% CI: 0.55, 0.89) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. Short-axis CM and NCM measurements had a strong to very strong correlation between both sequences (Pearson, 0.86-0.98; Spearman, 0.82-0.98). ICC in 3D whole-heart MRI was 0.96 (95% CI: 0.94, 0.99) for CM and 0.98 (95% CI: 0.97, 0.99) for NCM, while ICC in 2D cine MRI was 0.82 (95% CI: 0.63, 0.92) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. 3D whole-heart MRI demonstrated higher image quality than did 2D cine MRI (P < .001). 3D whole-heart MRI revealed higher image quality, with better structure discrimination and interobserver agreement in LVNC measurements, compared with standard 2D cine images.Keywords: MR Imaging, Cardiac, Cardiovascular Magnetic Resonance, Left Ventricular Noncompaction, Free-breathing Imaging Technique Supplemental material is available for this article. © RSNA, 2022See also the commentary by Jensen and Petersen in this issue.

Immersion ultrasonography improves the repeatability of cephalic vein diameter measurements for inexperienced operators

Objective To reduce the empirical dependence of ultrasound measurement of the cephalic vein diameter, improve the repeatability of measurements for inexperienced operators, and provide a new method for inexperienced operators. Methods Operators without ultrasound experience used contact ultrasound and immersion ultrasound to measure the diameter of the cephalic vein. The intraobserver and interobserver repeatability of measurements obtained via the two methods were analyzed. Results The intraobserver and interobserver repeatability of the cephalic vein diameter measured via contact ultrasound by inexperienced operators were average, with intraclass correlation coefficients (ICCs) of 0.572 (95% CI: 0.239–0.759) and 0.405 (95% CI: −0.057–0.666), respectively. The intraobserver and interobserver reproducibility of the cephalic vein diameter measured by immersion ultrasound were very good, with ICCs of 0.955 (95% CI: 0.922–0.975) and 0.943 (95% CI: 0.900–0.967), respectively. In the Bland–Altman diagram of the intraobserver and interobserver agreement of the immersion ultrasound measurements of the cephalic vein diameter, 96% of the points fell within the 95% limits of agreement. Conclusion Immersion ultrasonography can be used to measure the cephalic vein diameter while reducing the dependence of the results on operator experience; inexperienced operators can achieve very good repeatability.

Subchorionic Hematoma Volume Measured by Virtual Organ Computer-Aided Analysis in the Prediction of First-Trimester Pregnancy Outcome.

This study aimed to assess the association of subchorionic hematoma (SCH) size measured by virtual organ computer-aided analysis (VOCAL) with the first-trimester pregnancy outcome. A total of 139 first-trimester pregnancies from 6 to 12 weeks of gestational age with SCH were included. The circumference, area, and volume of the SCH (Cs, As, and 3DVs) and gestational sac (Cg, Ag, and 3DVg) were automatically calculated by VOCAL. Interobserver agreement was assessed with the intraclass correlation coefficient and Bland-Altman plot. Odds ratios for the clinical and ultrasound characteristics of adverse pregnancy outcomes were estimated by univariate or multivariable logistic regression. There was high interobserver agreement in VOCAL measurements of the SCH and gestational sac (intraclass correlation coefficients, >0.900). By univariate regression analysis, women with adverse pregnancy outcomes were more likely to have vaginal bleeding, a larger As and 3DVs, and higher Cs/Cg, As/Ag, and 3DVs/3DVg ratios (all P < 0.05). In the multivariable regression analysis, a higher 3DVs/3DVg ratio of SCH (odds ratio, 1.034; 95% confidence interval [CI], 1.015-1.053; P = 0.000) and vaginal heavy bleeding had a significant positive relationship with the risk of adverse pregnancy outcomes (odds ratio, 7.846; 95% CI, 1.104-55.737; P = 0.039) remained associated with an increased risk of adverse pregnancy outcomes. With 11.87% as the cutoff, the receiver operating characteristic curve yielded a good predictive performance (area under the curve, 0.713) and high sensitivity (91.18%). The measurements of SCH by VOCAL provide high reliability for estimating the total hematoma burden in first-trimester pregnant patients. A greater volume proportion (3DVs/3DVg) of SCH worsens the pregnancy outcome, and a greater risk of adverse pregnancy outcome also associated with the severity of vaginal bleeding.

Hallux Valgus Angular Measurements using WBCT Semiautomatic and Manual Assessments

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Radiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). WBCT already demonstrates significant advances that include the ability to perform traditional measurements for HV in the 3D setting reliably, as well as a more complete and accurate evaluation of the deformity. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group. Methods: In this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus, to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Pathologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P&lt;= 0.05 was considered significant. Results: Intraobserver and Interobserver agreement and consistency for Manual and Semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability in both cases. However, when comparing Manual and Semi-automatic measurements for HVA, IMA, and IPA, Semi-automatic measurements showed the highest values. Agreement between manual (M) and semi-automatic (SA) methods was tested for HVA, IMA and IPA using the Bland-Altman plots. The results indicated a high correlation between the parameters calculated from the manual and semi-automatic measurements, and a strong agreement between the readers and the software. Comparison between pathological group with HV and control (standard) group without HV using semi-automatic measurements was capable of differentiating pathological (HV) from non-pathological conditions for the HVA and IMA angles (p &lt; 0,05). Conclusion: Semi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.

The Use of Advanced Semi-Automated Bone Segmentation in Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Weight-Bearing Computed Tomography (WBCT) measurements represent a reliable tool for radiographic analysis of the first ray, including multiplanar assessment in the axial, sagittal, and coronal planes. WBCT can allow for more reliable studies of pathologies, such as Hallux Rigidus (HR), which permits several anatomical points to be evaluated for a correct clinical-radiographic diagnosis. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The study`s objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HR, (2) to compare semi-automatic to manual measurements in the setting of HR, and (3) to compare semi-automatic measurements between a pathologic (HR) group and a control standard group. Methods: This was a retrospective, IRB approved study of patients with Hallux Rigidus deformity. The sample size calculation was based on the Metatarsus Primus Elevatus (MPE). A control group consisting of 20 feet without HR and a pathologic group consisting of 20 feet with HR was necessary for this study. All WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first Metatarsal-Proximal Phalanx Angle (1stMPP) (sagittal plane), (2) Hallux Valgus Angle (HVA), (3) first to second Intermetatarsal Angle (IMA), (4) Hallux Interphalangeal Angle (IPA), (5) first Metatarsal Lengths (1stML), (6) second Metatarsal Length (2ndML), (7) first Metatarsal Declination Angle (1stMD), (8) second Metatarsal Declination Angles (2ndMD), and (9) MPE. The semiautomatic 3D measurements were performed using the Bonelogic Software. The differences between pathologic and control cases were assessed with a Wilcoxon test and P&lt;= 0.05 was considered significant. Results: Interobserver and intraobserver agreement and consistency for manual versus semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability. Manual and semi-automatic measurements were performed in individuals with HR. According to the Pearson's coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA, (ρ = 0.96); IMA, (ρ = 0.86); IPA, (ρ = 0.89); 1stML, (ρ = 0.96); 2ndML, (ρ = 0.91); 1stMD, (ρ = 0.86); 2ndMD, (ρ = 0.95) and, MPE, (ρ = 0.87). Agreement between the manual and semi-automatic methods was tested using a Bland- Altman plot and expressed excellent agreement between the methods. Comparison between the pathological group with HR and the control (standard) group allowed for the differentiating of the pathological (HR) from the non-pathological conditions for MPE (p &lt; 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement and consistency. The software used differentiated pathological from non- pathological conditions only when submitted to semi-automatic MPE measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is an essential step toward the establishment of big data and can be integrated into clinical practice, facilitating decision making.

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus.

Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study's objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level III, retrospective comparative study.

Artificial Intelligence Tool for Assessment of Indeterminate Pulmonary Nodules Detected with CT.

Background Limited data are available regarding whether computer-aided diagnosis (CAD) improves assessment of malignancy risk in indeterminate pulmonary nodules (IPNs). Purpose To evaluate the effect of an artificial intelligence-based CAD tool on clinician IPN diagnostic performance and agreement for both malignancy risk categories and management recommendations. Materials and Methods This was a retrospective multireader multicase study performed in June and July 2020 on chest CT studies of IPNs. Readers used only CT imaging data and provided an estimate of malignancy risk and a management recommendation for each case without and with CAD. The effect of CAD on average reader diagnostic performance was assessed using the Obuchowski-Rockette and Dorfman-Berbaum-Metz method to calculate estimates of area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Multirater Fleiss κ statistics were used to measure interobserver agreement for malignancy risk and management recommendations. Results A total of 300 chest CT scans of IPNs with maximal diameters of 5-30 mm (50.0% malignant) were reviewed by 12 readers (six radiologists, six pulmonologists) (patient median age, 65 years; IQR, 59-71 years; 164 [55%] men). Readers' average AUC improved from 0.82 to 0.89 with CAD (P < .001). At malignancy risk thresholds of 5% and 65%, use of CAD improved average sensitivity from 94.1% to 97.9% (P = .01) and from 52.6% to 63.1% (P < .001), respectively. Average reader specificity improved from 37.4% to 42.3% (P = .03) and from 87.3% to 89.9% (P = .05), respectively. Reader interobserver agreement improved with CAD for both the less than 5% (Fleiss κ, 0.50 vs 0.71; P < .001) and more than 65% (Fleiss κ, 0.54 vs 0.71; P < .001) malignancy risk categories. Overall reader interobserver agreement for management recommendation categories (no action, CT surveillance, diagnostic procedure) also improved with CAD (Fleiss κ, 0.44 vs 0.52; P = .001). Conclusion Use of computer-aided diagnosis improved estimation of indeterminate pulmonary nodule malignancy risk on chest CT scans and improved interobserver agreement for both risk stratification and management recommendations. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Yanagawa in this issue.

Reliability of radiographic measurements for hip dysplasia using a reduced radiation technique.

The purpose of this study was to examine whether measurement accuracy is impacted with a low radiation radiograph technique. Treatment decisions for hip dysplasia require serial radiographs to monitor acetabular anatomy. However, radiation use creates concern for future malignancy. Standard radiograph technique utilizes a grid to enhance clarity, but requires a larger X-ray dose. We hypothesized grid removal would lower radiation exposure without decreasing measurement accuracy. This is a retrospective cohort study of patients with idiopathic DDH and neuromuscular hip displacement at a single institution from 2019 to 2020 receiving surveillance radiographs. A cohort receiving modified technique radiographs (grid removed) was compared to an age-matched cohort receiving standard technique radiographs. Four examiners measured radiographs on two separate occasions, a minimum of 2 weeks apart. Migration percentage (MP) was measured for neuromuscular patients and acetabular index (AI) for idiopathic DDH. Intraclass correlation coefficient (ICC) with a 95% confidence interval (CI) was used to evaluate inter-observer and intra-observer agreement for measurements. Average radiation dose for both techniques. A total of 134 age-matched patients were included for measurement of MP. Thirty age-matched patients were included for AI measurements. Inter and intra-rater reliability of MP and AI were not different with or without use of the grid. There was a 50-75% decrease in radiation dose per radiograph following grid removal, dependent on patient size. The adjusted radiograph technique showed no significant difference in MP or AI reliability. A slight decrease in picture contrast did not jeopardize measurement reliability and decreased radiation exposure for the patient significantly. This simple technique can be useful for patients requiring multiple radiographs over time.

A Log-Linear Analysis of Efficiency in Wheelchair Basketball According to Player Classification

Within the framework of observational methodology, we conducted a log-linear analysis to study efficiency in relation to players’ functional ability in wheelchair basketball by analyzing associations between the position of the last pass before a shot, a shot position, and a shot result (favorable or unfavorable). The observation sample contained all offensive sequences ending in a shot by the US men’s wheelchair basketball team, who won the gold medal at the 2016 Paralympic Games in Rio de Janeiro. Data were annotated and coded in the Lince software program and their reliability confirmed by measuring interobserver agreement using Cohen’s kappa statistics. Log-linear modeling showed that the models generated to explain offensive sequences ending in a shot by players with greater functional ability were closest to models observed for professional basketball players and were the only models to show significant effects in terms of efficiency.

Exploring the Interobserver Agreement in Computer-Aided Radiologic Tumor Measurement and Evaluation of Tumor Response.

The accurate, objective, and reproducible evaluation of tumor response to therapy is indispensable in clinical trials. This study aimed at investigating the reliability and reproducibility of a computer-aided contouring (CAC) tool in tumor measurements and its impact on evaluation of tumor response in terms of RECIST 1.1 criteria. A total of 200 cancer patients were retrospectively collected in this study, which were randomly divided into two sets of 100 patients for experiential learning and testing. A total of 744 target lesions were identified by a senior radiologist in distinctive body parts, of which 278 lesions were in data set 1 (learning set) and 466 lesions were in data set 2 (testing set). Five image analysts were respectively instructed to measure lesion diameter using manual and CAC tools in data set 1 and subsequently tested in data set 2. The interobserver variability of tumor measurements was validated by using the coefficient of variance (CV), the Pearson correlation coefficient (PCC), and the interobserver correlation coefficient (ICC). We verified that the mean CV of manual measurement remained constant between the learning and testing data sets (0.33 vs. 0.32, p = 0.490), whereas it decreased for the CAC measurements after learning (0.24 vs. 0.19, p < 0.001). The interobserver measurements with good agreement (CV < 0.20) were 29.9% (manual) vs. 49.0% (CAC) in the learning set (p < 0.001) and 30.9% (manual) vs. 64.4% (CAC) in the testing set (p < 0.001). The mean PCCs were 0.56 ± 0.11 mm (manual) vs. 0.69 ± 0.10 mm (CAC) in the learning set (p = 0.013) and 0.73 ± 0.07 mm (manual) vs. 0.84 ± 0.03 mm (CAC) in the testing set (p < 0.001). ICCs were 0.633 (manual) vs. 0.698 (CAC) in the learning set (p < 0.001) and 0.716 (manual) vs. 0.824 (CAC) in the testing set (p < 0.001). The Fleiss’ kappa analysis revealed that the overall agreement was 58.7% (manual) vs. 58.9% (CAC) in the learning set and 62.9% (manual) vs. 74.5% (CAC) in the testing set. The 80% agreement of tumor response evaluation was 55.0% (manual) vs. 66.0% in the learning set and 60.6% (manual) vs. 79.7% (CAC) in the testing set. In conclusion, CAC can reduce the interobserver variability of radiological tumor measurements and thus improve the agreement of imaging evaluation of tumor response.

Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche.