Ulnar Variance Determination

Surgical procedures concerning the distal articular surfaces of the radius and ulna, demand an accurate method of measurement of ulnar variance. A new method, which is a modification of the method described by Palmer (1982), is introduced. 100 randomly selected healthy persons were submitted to X-ray of the wrist and the ulnar variance was determined independently by three observers using both methods. By “weighted kappa” statistics the results, expressed in intra- and interobserver agreement, showed a significantly higher reliability in favour of the Modified method.

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A Reliability Study of Multiplanar Radiographs for the Evaluation of SNAC Wrist Arthritis

Hand ◽

10.1177/1558944720937359 ◽

2020 ◽

pp. 155894472093735

Author(s):

Eliana B. Saltzman ◽

Elizabeth P. Wahl ◽

Amanda N. Fletcher ◽

Nicholas Said ◽

Suhail K. Mithani ◽

...

Keyword(s):

Interrater Reliability ◽

Interobserver Agreement ◽

Weighted Kappa ◽

Proximal Row Carpectomy ◽

Substantial Agreement ◽

Reliability Study ◽

Single View ◽

Articular Surfaces ◽

Snac Wrist ◽

Single Versus

Background: Scaphoid nonunion advanced collapse (SNAC) is a common form of wrist arthritis, the treatment of which depends on the arthritic stage. The Vender classification serves to describe SNAC arthritis based on a single posteroanterior (PA) radiograph. The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Vender classification, comparing multi versus single radiographic views. Methods: A retrospective review of patients with SNAC arthritis who underwent a proximal row carpectomy or a 4-corner fusion was performed. The included patients had 3 radiographic views of the pathologic wrist. Fifteen patients were analyzed by 5 blinded reviewers. Wrists were graded using the Vender classification first on the PA view and then using multiview radiographs. The intraobserver and interobserver agreement was determined using weighted kappa analysis. χ2 tests were calculated comparing the evaluation between single- versus multiview radiographs and determining a higher Vender stage. Results: Multiview radiographs demonstrated a higher intraobserver κw compared with single-view radiographs (0.72 vs 0.66), both representing substantial agreement. The average interobserver agreement was moderate (κw of 0.48) for single view and slight (κw of 0.30) for multiview evaluation. Evaluating multiview radiographs was 6.37 times more likely to demonstrate Vender stage 3 arthritis compared with single view (odds ratio = 6.37 [confidence interval, 3.81-10.64], P < .0001). Conclusion: Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification. The decreased interrater reliability in the multiview analysis is likely related to the increased number of articular surfaces evaluated. Using a single PA view may underestimate the severity of arthritis present.

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Radiographic Analysis on the Distortion of the Anatomy of First Metatarsal Head in Dorsoplantar Projection

Diagnostics ◽

10.3390/diagnostics10080552 ◽

2020 ◽

Vol 10 (8) ◽

pp. 552

Author(s):

Jessica Grande-del-Arco ◽

Ricardo Becerro-de-Bengoa-Vallejo ◽

Patricia Palomo-López ◽

Daniel López-López ◽

César Calvo-Lobo ◽

...

Keyword(s):

Hallux Valgus ◽

Interobserver Agreement ◽

Metatarsal Head ◽

Hallux Rigidus ◽

Kappa Statistics ◽

Head Shape ◽

X Ray ◽

Anatomical Dissection ◽

First Metatarsal ◽

Anatomic Dissection

Background: The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. Purpose: The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. Materials and Methods: In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0° until 30° every 5° on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. Results: We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20° of inclination (p < 0.001). The interobserver agreement showed good agreement at 0°, 5°, 10°, 20°, and 25° and was excellent at 30° (p < 0.001). Conclusion: All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made.

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Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000301 ◽

2016 ◽

Vol 42 (6) ◽

pp. 429-434 ◽

Cited By ~ 17

Author(s):

Yurika Maria Fogaça Kawaguchi ◽

◽

Ricardo Kenji Nawa ◽

Thais Borgheti Figueiredo ◽

Lourdes Martins ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Interobserver Agreement ◽

Interobserver Reliability ◽

Weighted Kappa ◽

Cross Cultural ◽

Kappa Statistics ◽

Strong Positive Correlation ◽

Back Translation ◽

Mobility Score

ABSTRACT Objective: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement ( > 0.90) and reliability ( > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.

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P0093IMPROVED INTEROBSERVER AGREEMENT IN BANFF SCORING OF RENAL ALLOGRAFT BIOPSIES WHEN ROUTINELY USING CD3/PAS STAIN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0093 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Neil Abrahams ◽

Lauren Abrahams ◽

Katherine Freeman-Costin ◽

Cecilia Obregon ◽

Mandolin Ziadie

Keyword(s):

Allograft Rejection ◽

Renal Allograft ◽

Interobserver Agreement ◽

Weighted Kappa ◽

Basement Membranes ◽

Kappa Statistics ◽

Renal Allograft Rejection ◽

Antibody Mediated Rejection ◽

Banff Classification ◽

Identical Manner

Abstract Background and Aims The BANFF Classification of renal allograft rejection consists of scores for cellular and antibody mediated rejection. The scores for tubulitis (t), interstitial inflammation (i), glomerulitis (g), total inflammation (ti), and endotheliatis (v) have direct prognostic and therapeutic significance as they contribute to a diagnosis of renal allograft rejection. The original BANFF scoring was developed using hematoxylin and eosin (H&E) stain only. This study examines the level of interobserver agreement using H&E and a combination CD3/PAS stain that highlights T lymphocytes and basement membranes. Method 50 consecutive renal allograft biopsies were retrieved and on each case H&E and CD3/PAS stains (Ventana/Roche Tissue Diagnostics clone 2GV6 for CD3) were performed. CD3/PAS and H&E slides were matched and blinded for two reviewers [reviewer (R1) and reviewer 2 (R2)]. Each case was graded in an identical manner following criteria designated for (t),(i),(g) and (ti) as previously described in the Banff Classification for Renal Allograft Biopsies. Cases were not graded for (v) as there were too few cases with endothelialitis to allow for statistical evaluation. The matched scores were analyzed using weighted Kappa statistics for interobserver agreement within each group. Agreement levels were characterized using Landis and Koch descriptions for level of agreement. All p values were two-tailed, values of <0.05 were considered statistically significant. Statistical analyses was performed using SAS Version 9.4, Cary NC. Results Mean age was 44 years with a range of 9 -75 years. Standard deviation (SD) for age was 18 years. Gender distribution was 20% female and 80% male. Agreement between R1 and R2 for (t) scores was moderate (Weighted Kappa 0.5276) as opposed to fair for H&E group (Weighted Kappa 0.4189). Similarly, interobserver agreement was moderate for scores of (i) and (ti) in the CD3/PAS group and fair in the H&E group. For both CD3/PAS and H&E interrater evaluations, agreement was fair to poor for (g) with weighted Kappa of 0.3928 and 0.3559 respectively. Conclusion This study showed increased levels of interobserver agreement when using a CD3/PAS combination stain to score allograft biopsies for (t), (i) and (ti). Since (t), (i) and (ti) scores directly affect a diagnosis of rejection, we propose routine use of CD3/PAS in addition to H&E when reviewing renal allograft biopsies. Glomerulitis (g) shows poor interobserver agreement regardless of the stain used and further studies to refine the criteria for (g) in Banff revisions of the classification may be of value.

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Fuzzy enhancement and deep hash layer based neural network to detect Covid-19

Journal of Intelligent & Fuzzy Systems ◽

10.3233/jifs-210222 ◽

2021 ◽

pp. 1-11

Author(s):

Amita Nandal ◽

Marija Blagojevic ◽

Danijela Milosevic ◽

Arvind Dhaka ◽

Lakshmi Narayan Mishra

Keyword(s):

Neural Network ◽

Feature Extraction ◽

Performance Metrics ◽

Regularization Parameter ◽

Fuzzy Membership Function ◽

Kappa Statistics ◽

Pixel Intensity ◽

Testing Sample ◽

X Ray ◽

Conventional Methods

This paper proposes a deep learning framework for Covid-19 detection by using chest X-ray images. The proposed method first enhances the image by using fuzzy logic which improvises the pixel intensity and suppresses background noise. This improvement enhances the X-ray image quality which is generally not performed in conventional methods. The pre-processing image enhancement is achieved by modeling the fuzzy membership function in terms of intensity and noise threshold. After this enhancement we use a block based method which divides the image into smooth and detailed regions which forms a feature set for feature extraction. After feature extraction we insert a hashing layer after fully connected layer in the neural network. This hash layer is advantageous in terms of improving the overall accuracy by computing the feature distances effectively. We have used a regularization parameter which minimizes the feature distance between similar samples and maximizes the feature distance between dissimilar samples. Finally, classification is done for detection of Covid-19 infection. The simulation results present a comparison of proposed model with existing methods in terms of some well-known performance indices. Various performance metrics have been analysed such as Overall Accuracy, F-measure, specificity, sensitivity and kappa statistics with values 93.53%, 93.23%, 92.74%, 92.02% and 88.70% respectively for 20:80 training to testing sample ratios; 93.84%, 93.53%, 93.04%, 92.33%, and 91.01% respectively for 50:50 training to testing sample ratios; 95.68%, 95.37%, 94.87%, 94.14%, and 90.74% respectively for 80:20 training to testing sample ratios have been obtained using proposed method and it is observed that the results using proposed method are promising as compared to the conventional methods.

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Linear Mandibular Measurements: Comparison between Orthopantomograms and Lateral Cephalograms

The Cleft Palate-Craniofacial Journal ◽

10.1597/07-123.1 ◽

2009 ◽

Vol 46 (2) ◽

pp. 147-153 ◽

Cited By ~ 24

Author(s):

E. M. Ongkosuwito ◽

M. M. J. Dieleman ◽

A. M. Kuijpers-Jagtman ◽

P. G. H. Mulder ◽

J. W. van Neck

Keyword(s):

Interobserver Variability ◽

Intraclass Correlation ◽

Kappa Statistics ◽

Magnification Factor ◽

Linear Measurements ◽

Lateral Cephalogram ◽

X Ray ◽

Lateral Cephalograms ◽

Left And Right ◽

Cephalometric Measurements

Objective: To investigate the reliability of length measurements of the mandible by comparing orthopantomograms (OPTs) with lateral cephalograms. Design: Observational study. Setting: OPTs and lateral cephalograms were taken of 20 human dry skulls. Four orthodontists and four maxillofacial surgeons located landmarks on all radiographs using a computer program for cephalometric measurements. Intraobserver and interobserver variability in locating landmarks was assessed, as well as positioning of the skulls prior to radiography between the x-ray assistants. Magnification differences between the left and right side of the mandible on the OPT were determined for five skulls. Kappa statistics were used to calculate the intraclass correlation coefficient for intraobserver and interobserver differences. An F test was used to assess differences between methods and between type of observer. Results: No significant differences were found in the magnification factor of the left and right side of the mandible. Compared with a lateral cephalogram, the OPT had comparable reliability in measuring mandibular distances condylion-gonion, gonion-menton, and condylion-menton. No significant differences were observed between the x-ray assistants in taking the OPTs and lateral cephalograms or in repositioning the skulls. Significant differences were found between orthodontists and maxillofacial surgeons for landmark measurements. Conclusion: An OPT is as reliable as a lateral cephalogram for linear measurements of the mandible (condylion-gonion, gonion-menton, and condylion-menton).

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Agreement and association between different indicators of body image and body mass index in adolescents

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201400030014 ◽

2014 ◽

Vol 17 (3) ◽

pp. 747-760 ◽

Cited By ~ 1

Author(s):

Carla Fernandez dos Santos ◽

Inês Rugani Ribeiro de Castro ◽

Letícia de Oliveira Cardoso ◽

Letícia Ferreira Tavares

Keyword(s):

Body Mass Index ◽

Body Image ◽

Nutritional Status ◽

Body Mass ◽

Private Schools ◽

Weighted Kappa ◽

Continuous Variable ◽

The Body ◽

Kappa Statistics ◽

Image Variables

The aim of the study was to examine the correlation among different indicators of body image; between each one of these and nutritional status; and the association of these indicators with the Body Mass Index (BMI) of adolescents. A random sample of 152 students from public and private schools in the city of Rio de Janeiro, Brazil, was studied. On four occasions, two silhouette scales and two questions regarding the opinion of the student about his/her body and weight were applied and weight and height were measured. The BMI was examined both as a continuous and as a categorical variable. The agreement between the variables was analyzed using the quadratic weighted Kappa statistics. The association between body image variables and BMI was examined by the comparison among median, mean, standard deviation and 95% confidence interval of BMI for each category of the body image variables. In general, the correlation among the body image variables ranged from reasonable to good; between these and the variable nutritional status, correlation ranged from regular to reasonable. Best results were observed among boys and students from private schools. All body image variables showed good discriminatory power for BMI, when it was analyzed as a continuous variable, even when controlling for potential confounders. The question about body seems to be better than that about weight to compose the questionnaire of a surveillance system for risk and protective factors for adolescent health.

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Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two

Foot & Ankle International ◽

10.1177/107110079801900809 ◽

1998 ◽

Vol 19 (8) ◽

pp. 555-562 ◽

Cited By ~ 26

Author(s):

Michael E. Brage ◽

Matthew Rockett ◽

Robert Vraney ◽

Robert Anderson ◽

Alicia Toledano

Keyword(s):

Ankle Fracture ◽

Ankle Injury ◽

Ankle Fractures ◽

Kappa Statistics ◽

Fracture Classification ◽

X Ray ◽

Good Accord ◽

Interexaminer Reliability ◽

Intraexaminer Reliability ◽

Good Agreement

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.

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