Evaluation of cervical radiographs in Dutch Warmblood horses, using a novel radiographic grading system for the cervical articular process joints

Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability.

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Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine

European Spine Journal ◽

10.1007/s00586-006-1078-8 ◽

2006 ◽

Vol 15 (6) ◽

pp. 731-731 ◽

Cited By ~ 1

Author(s):

Hans-Joachim Wilke ◽

Friederike Rohlmann ◽

Cornelia Neidlinger-Wilke ◽

Karin Werner ◽

Lutz Claes ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disc ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Interobserver Agreement ◽

Grading System ◽

Radiographic Grading

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Reliability of the International Knee Documentation Committee Radiographic Grading System

The American Journal of Sports Medicine ◽

10.1177/0363546507299742 ◽

2007 ◽

Vol 35 (6) ◽

pp. 933-935 ◽

Cited By ~ 28

Author(s):

Vishal M. Mehta ◽

Liz W. Paxton ◽

Stefan X. Fornalski ◽

Rick P. Csintalan ◽

Donald C. Fithian

Keyword(s):

Correlation Coefficient ◽

Interrater Reliability ◽

Patellofemoral Joint ◽

Case Series ◽

International Knee Documentation Committee ◽

Joint Space ◽

Grading System ◽

Intrarater Reliability ◽

Mixed Effect ◽

Radiographic Grading

Background The International Knee Documentation Committee (IKDC) forms are commonly used to measure outcomes after anterior cruciate ligament (ACL) reconstruction. The knee examination portion of the IKDC forms includes a radiographic grading system to grade degenerative changes. The interrater and intrarater reliability of this radiographic grading system remain unknown. Hypothesis We hypothesize that the IKDC radiographic grading system will have acceptable interrater and intrarater reliability. Study Design Case series (diagnosis); Level of evidence, 4. Methods Radiographs of 205 ACL-reconstructed knees were obtained at 5-year follow-up. Specifically, weightbearing posteroanterior radiographs of the operative knee in 35° to 45° of flexion and a lateral radiograph in 30° of flexion were used. The radiographs were independently graded by 2 sports medicine fellowship—trained orthopaedic surgeons using the IKDC 2000 standard instructions. One surgeon graded the same radiographs 6 months apart, blinded to patient and prior IKDC grades. The percentage agreement was calculated for each of the 5 knee compartments as defined by the IKDC. Interrater reliability was evaluated using the intraclass correlation coefficient (ICC) 2-way mixed effect model with absolute agreement. The Spearman rank-order correlation coefficient (rs) was applied to evaluate intrarater reliability. Results The interrater agreement between the 2 surgeons was 59% for the medial joint space (ICC = 0.46; 95% confidence interval [CI] = 0.35-0.56), 54% for the lateral joint space (ICC = 0.45; 95% CI = 0.27-0.58), 49% for the patellofemoral joint (ICC = 0.40; 95% CI = 0.26-0.52), 63% for the anterior joint space (ICC = 0.20; 95% CI = 0.05-0.34), and 44% for the posterior joint space (ICC = 0.28; 95% CI = 0.15-0.40). The intrarater agreement was 83% for the medial joint space (rs = .77, P < .001), 86% for the lateral joint space (rs = .76, P < .001), 81% for the patellofemoral joint (rs = .79, P < .001), 91% for the anterior joint space (rs = .48, P < .001), and 69% for the posterior joint space (rs = .64, P < .001). Conclusions While intrarater reliability was acceptable, interrater reliability was poor. These findings suggest that multiple raters may score the same radiographs differently using the IKDC radiographic grading system. The use of a single rater to grade all radiographs when using the IKDC radiographic grading system maximizes reliability.

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A Novel Radiographic Grading System to Evaluate Extranodal Extension in Regional Nodal Metastases from Head and Neck Squamous Cell Carcinoma

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.12.136 ◽

2018 ◽

Vol 100 (5) ◽

pp. 1359

Author(s):

M.R. Corby ◽

S. Mukherjee ◽

K. Fedder ◽

M.J. Jameson

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Grading System ◽

Nodal Metastases ◽

Extranodal Extension ◽

Radiographic Grading

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Scapholunate Ligament Repair and Capsulodesis for the Treatment of Static Scapholunate Dissociation

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80095-8 ◽

1998 ◽

Vol 23 (6) ◽

pp. 776-780 ◽

Cited By ~ 80

Author(s):

J. D. WYRICK ◽

B. D. YOUSE ◽

T. R. KIEFHABER

Keyword(s):

Grading System ◽

Scapholunate Ligament ◽

Scapholunate Dissociation ◽

Ligament Repair ◽

Wrist Motion ◽

Normal Side ◽

Scapholunate Instability ◽

Clinical Grading ◽

Radiographic Grading

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78° and was corrected to a normal 47° at surgery. The average final scapholunate angle was 72°, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.

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Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part III. Thoracic spine

European Spine Journal ◽

10.1007/s00586-021-06970-6 ◽

2021 ◽

Author(s):

Christian Liebsch ◽

Youping Tao ◽

Annette Kienle ◽

Hans-Joachim Wilke

Keyword(s):

Intervertebral Disc ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Interobserver Agreement ◽

Weighted Kappa ◽

Intervertebral Discs ◽

Height Loss ◽

Grading System ◽

Perfect Agreement ◽

Radiographic Grading

Abstract Purpose The aim of this study was to assess the validity and objectivity of a new quantitative radiographic grading system for thoracic intervertebral disc degeneration. Methods The new grading system involves the measurement variables “Height loss” and “Osteophyte formation”, which are determined from lateral radiographs, resulting in the “Overall degree of degeneration” on a four-point scale from 0 (no degeneration) to 3 (severe degeneration). Validation was performed by comparing the radiographic degrees of degeneration of 54 human intervertebral discs to the respective macroscopic degrees, which were defined as the “real” degrees of degeneration. Interobserver agreement was examined using radiographs of 135 human thoracic intervertebral discs. Agreement was quantified by means of quadratically weighted Kappa coefficients with 95% confidence limits (CL). Results Validation revealed almost perfect agreement between the radiographic and the macroscopic overall degrees of degeneration (Kappa 0.968, CL 0.944–0.991), while the macroscopic grades tended to be underestimated in low degeneration grades. Radiographic grading of two independent observers also exhibited almost perfect agreement (Kappa 0.883, CL 0.824–0.941) as well as tendencies towards rater-dependent differences in low degeneration grades. Conclusion The new quantitative radiographic grading scheme represents a valid, reliable, and almost objective method for assessing the degree of degeneration of individual thoracic intervertebral discs. Potential effects of interindividual variations and the radiographic superimposition of anatomical structures represent a limitation of this method should be taken into account when using the grading system for clinical and experimental purposes, especially with regard to specific morphological as well as patient- and donor-specific characteristics.

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