Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study

Abstract Background To evaluate the correlation and agreement between superb micro-vascular imaging (SMI) mode and the contrast-enhanced ultrasound (CEUS) mode for the ablative completeness and the volumes of ablation lesions to determine the clinical application value of SMI in follow-up after radiofrequency ablation. Methods From April 2020 to June 2020, two radiologists used SMI and CEUS mode to measure the volume of the ablation lesion. We use intra-class correlation coefficient (ICC), scatter plots and Bland–Altman plots to evaluate the correlation and agreement of the two techniques. In addition, intra- and inter-observer reliability in volume measurement of ablation lesions with SMI mode was assessed. Results SMI mode and CEUS mode have good agreement in the evaluation of ablative completeness. The ICC was 0.876 and 0.928 of reader A and reader B between SMI mode and CEUS mode in terms of ablation lesions volume measurement. There was a strong correlation between the two modes in both reader A and reader B (rA = 0.808; rB = 0.882). The ICC was 0.836 for the inter-observer reliability of SMI technique. The scatter plot showed a good linear relation (r = 0.715). In the Bland–Altman plot, 4.35% (1/23) of the points was outside the 95% limits of agreement. The ICC was 0.965 for the intra-observer reliability of SMI technique, the scatter plot also showed a strong linear correlation (r = 0.965). In the Bland–Altman plot, 8.70% (2/23) of the points was outside the 95% limits of agreement. Conclusions SMI and CEUS have good agreement and correlation in the ablation volume measurement. SMI technology is expected to be applied as an alternative to CEUS in the clinical follow-up of ablation lesions.

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Artificial intelligence system can achieve comparable results to experts for bone age assessment of Chinese children with abnormal growth and development

PeerJ ◽

10.7717/peerj.8854 ◽

2020 ◽

Vol 8 ◽

pp. e8854

Author(s):

Fengdan Wang ◽

Xiao Gu ◽

Shi Chen ◽

Yongliang Liu ◽

Qing Shen ◽

...

Keyword(s):

Artificial Intelligence ◽

Growth And Development ◽

Bone Age ◽

Chinese Children ◽

Absolute Difference ◽

Reference Standard ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Abnormal Growth

Objective Bone age (BA) is a crucial indicator for revealing the growth and development of children. This study tested the performance of a fully automated artificial intelligence (AI) system for BA assessment of Chinese children with abnormal growth and development. Materials and Methods A fully automated AI system based on the Greulich and Pyle (GP) method was developed for Chinese children by using 8,000 BA radiographs from five medical centers nationwide in China. Then, a total of 745 cases (360 boys and 385 girls) with abnormal growth and development from another tertiary medical center of north China were consecutively collected between January and October 2018 to test the system. The reference standard was defined as the result interpreted by two experienced reviewers (a radiologist with 10 years and an endocrinologist with 15 years of experience in BA reading) through consensus using the GP atlas. BA accuracy within 1 year, root mean square error (RMSE), mean absolute difference (MAD), and 95% limits of agreement according to the Bland-Altman plot were statistically calculated. Results For Chinese pediatric patients with abnormal growth and development, the accuracy of this new automated AI system within 1 year was 84.60% as compared to the reference standard, with the highest percentage of 89.45% in the 12- to 18-year group. The RMSE, MAD, and 95% limits of agreement of the AI system were 0.76 years, 0.58 years, and −1.547 to 1.428, respectively, according to the Bland-Altman plot. The largest difference between the AI and experts’ BA result was noted for patients of short stature with bone deformities, severe osteomalacia, or different rates of maturation of the carpals and phalanges. Conclusions The developed automated AI system could achieve comparable BA results to experienced reviewers for Chinese children with abnormal growth and development.

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Correlation of Corneal Thickness Measurements Between Tono-pachymeter and Scheimpflug- Placido Topography

Medicine & Health ◽

10.17576/mh.2021.1602.12 ◽

2021 ◽

Vol 16 (2) ◽

pp. 161-167

Author(s):

Zeynep Eylül Ercan ◽

Keyword(s):

Corneal Thickness ◽

Age Groups ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Significant Relationships ◽

Plot Analysis ◽

Group 2 ◽

Thickness Measurements ◽

Group 1

Central corneal thickness (CCT) measurements are important for diagnosis, treatment, and surgery planning in ophthalmology. The purpose of this study was to see whether CCT measurements taken with Tono-pachymeter and Scheimpflug- Placido Topography had any significant differences. Tono-pachymeter and topography CCT measurements were taken (n=400). Inter-measurement agreement between them was determined using Bland-Altman Plot analysis. Age groups were also formed as group 1 (aged 18-50 years, 94 males, 106 females) and group 2 (age >51 years, 100 males, 100 females). Mean CCTs measured by Tonopachymeter and topography were 563.77 +±26.43 and 560.88 + 26.341 microns. Bland-Altman Plot analysis showed in total, 13 were above the upper limit and 5 were under the minimum limit of agreement with regression analysis showing no significant relationships (p=0.213). Group 1 had 7 above and 2 below from the limits of agreement. Group two had 9 above and 2 below from the limits of agreement. Both groups showed insignificant differences between devices (p=0.07 and p=0.86). Tono-pachymeter and Scheimpflug-Placido Topography give reliable CCT results within each other. However, since the limit of agreement ranges can still affect one-to-one patient evaluations, we recommend clinics that use these devices to not interchange measurements in practice.

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Does time to surgery affect patient-reported outcome in proximal humeral fractures? A subanalysis of the PROFHER randomized clinical trial

The Bone & Joint Journal ◽

10.1302/0301-620x.102b1.bjj-2020-0546.r1 ◽

2020 ◽

Vol 102-B (1) ◽

pp. 33-41 ◽

Cited By ~ 1

Author(s):

John G. Norman ◽

Stephen Brealey ◽

Ada Keding ◽

David Torgerson ◽

Amar Rangan

Keyword(s):

United Kingdom ◽

Functional Outcome ◽

The United States ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Altman Plot ◽

Bland Altman Plot ◽

Time To Surgery ◽

The United Kingdom

Aims The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures Methods A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot. Results The mean time from initial trauma to surgery was 10.5 days (1 to 33). Earlier surgical intervention did not improve OSS throughout follow-up, nor when stratified by participant age (< 65 years vs ≥ 65 years) and fracture severity (one- and two-part vs three- and four-part fractures). Participants managed later than reported international averages (three days in the United States and Germany, eight days in the United Kingdom) did not have worse outcomes. At five-year follow-up, 50 participants (76%) had the same or improved OSS compared with six months (six-month mean OSS 35.8 (SD 10.0); five-year mean OSS 40.1 (SD 9.1); r = 0.613). A Bland-Altman plot demonstrated a positive mean difference (3.3 OSS points (SD 7.92)) with wide 95% limits of agreement (-12.2 and 18.8 points). Conclusion Timing of surgery did not affect OSS at any stage of follow-up, irrespective of age or fracture type. Most participants had maximum functional outcome at six months that was maintained at five years. These findings may help guide providers of trauma services on surgical prioritization. Cite this article: Bone Joint J 2020;102-B(1):33–41

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Evaluating the agreement between the empirical volumes of tumor lesions and the estimated volumes of tumor lesions based on the longest diameter.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.635 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 635-635 ◽

Cited By ~ 1

Author(s):

Ruediger P. Laubender ◽

Michael Schlichting ◽

Ute Sartorius ◽

Dominik Paul Modest ◽

Ulrich Robert Mansmann ◽

...

Keyword(s):

Tumor Volume ◽

Three Dimensional ◽

Disease Process ◽

Volume Data ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Volume Measurements ◽

Colorectal Cancer Patients ◽

The Impact

635 Background: Tumor lesions are commonly evaluated by RECIST or WHO criteria, which involves reducing the development of a three-dimensional tumor to a two-dimensional process. However, volume measurements might reflect the clinical impact of the disease process more precisely. Therefore, we investigated if the volume of a tumor lesion can be reconstructed from RECIST- or WHO-based measurements. Methods: 20 colorectal cancer patients underwent routine staging MDCT examinations as part of the multicenter phase II CIOX trial comparing cetuximab + XELOX versus cetuximab + XELIRI. Two hepatic target lesions per patient were defined at baseline and measured using 1) semi-automated volumetry (Siemens Syngo Via Oncology, Siemens Healthcare) with manual correction and 2) semi-automated measurement of the longest diameter (LD) according to RECIST 1.1 and the corresponding longest orthogonal diameter (LOD). Patient lesions were followed over time using the same measurement strategies. An algorithm was developed for reconstructing the volume of a lesion based on the LD and the corresponding LOD. Agreement of the volume data generated by both methods was analyzed by a Bland-Altman plot. The limits of agreements were calculated using a variance components model considering repeated tumor assessments based on the log-transformed sum over the volume of a patient’s lesions. Results: 151 lesions from the 20 patients were measured at 73 tumor assessments. Volume was slightly overestimated by the algorithm compared to the volumetric measurements (p = 0.07). The Bland-Altman plot showed good agreement (mean difference −0.05, limits of agreement [−0.40, 0.30]). As expected, three out of the 73 measurements fell outside the limits of agreement. Conclusions: The proposed algorithm for the WHO-based reconstruction of the tumor volume provides a good approximation to the true sum of the volumes of the lesions. In future studies, volumetric tumor information can be included even if not all centers have full volumetric software available. This enables further research on the impact of changes in tumor volume on disease prognosis and/or prediction of treatment efficacy.

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Validation of a pre-coded food diary with energy expenditure, comparison of under-reporters v. acceptable reporters

British Journal Of Nutrition ◽

10.1079/bjn20051587 ◽

2005 ◽

Vol 94 (6) ◽

pp. 998-1003 ◽

Cited By ~ 38

Author(s):

I. T. L. Lillegaard ◽

L. F. Andersen

Keyword(s):

Food Intake ◽

Energy Expenditure ◽

Pearson Correlation ◽

Pearson Correlation Coefficient ◽

Confidence Limits ◽

Food Diary ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Males And Females

The objective of the present study was to compare energy intake (EI) assessed from a pre-coded food diary (PFD) with energy expenditure (EE) measured by a validated position-and-movement monitor (ActiReg®; PreMed AS, Oslo, Norway) in a group of Norwegian 9-year-olds. Moreover, we examined whether and how under-reporters (UR), identified with ActiReg®, differed from acceptable reporters (AR) according to food intake and BMI. A total of fifty-one 9-year-olds completed PFD and ActiReg®. The present study showed that on average EI was underestimated by 18 % compared with EE measured by ActiReg®. The 95 % confidence limits of agreement in a Bland–Altman plot for EI and EE varied from 1·97 MJ to −4·23 MJ (sd 2) among the girls and from 0·74 MJ to −5·26 MJ (sd 2) among the boys. The Pearson correlation coefficient between EI and EE was 0·28 (P=0·05) for males and females combined. Fifty-seven per cent of the participants were classified as AR, 39 % as UR and 4 % as over-reporters with the PFD. Under-reporting of energy remains a problem with the PFD method used in a group of 9-year-olds, especially among boys. However, UR and AR did not show a systematic misreporting related to macronutrients, unhealthy foods or BMI.

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Design and Reliability of a Novel Heel Rise Test Measuring Device for Plantarflexion Endurance

BioMed Research International ◽

10.1155/2014/391646 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Amy D. Sman ◽

Claire E. Hiller ◽

Adam Imer ◽

Aldrin Ocsing ◽

Joshua Burns ◽

...

Keyword(s):

Interrater Reliability ◽

Test Device ◽

Limits Of Agreement ◽

Altman Plot ◽

Measuring Device ◽

Bland Altman Plot ◽

Measurement Protocol ◽

Combined Action ◽

And Performance ◽

Gastrocnemius Muscles

Background. Plantarflexion results from the combined action of the soleus and gastrocnemius muscles in the calf. The heel rise test is commonly used to test calf muscle endurance, function, and performance by a wide variety of professionals; however, no uniform description of the test is available. This paper aims to document the construction and reliability of a novel heel rise test device and measurement protocol that is suitable for the needs of most individuals.Methods. This device was constructed from compact and lightweight materials and is fully adjustable, enabling the testing of a wide variety of individuals. It is easy to assemble and disassemble, ensuring that it is portable for use in different settings.Findings. We tested reliability on 40 participants, finding excellent interrater reliability (ICC2,10.97, 95% CI: 0.94 to 0.98). Limits of agreement were less than two repetitions in 90% of cases and the Bland-Altman plot showed no bias.Interpretation. We have designed a novel, standardized, simple, and reliable device and measurement protocol for the heel rise test which can be used by researchers and clinicians in a variety of settings.

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Tidal Volume Estimation during Helmet Noninvasive Ventilation: an Experimental Feasibility Study

Scientific Reports ◽

10.1038/s41598-019-54020-5 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Andrea Cortegiani ◽

Paolo Navalesi ◽

Giuseppe Accurso ◽

Ignazio Sabella ◽

Giovanni Misseri ◽

...

Keyword(s):

Tidal Volume ◽

Noninvasive Ventilation ◽

Normal Condition ◽

Pressure Support ◽

Respiratory Mechanics ◽

Volume Estimation ◽

Positive End Expiratory Pressure ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot

AbstractWe performed a bench (BS) and human (HS) study to test the hypothesis that estimation of tidal volume (VT) during noninvasive helmet pressure support ventilation (nHPSV) would be possible using a turbine driven ventilator (TDV) coupled with an intentional leak single-limb vented circuit. During the BS a mannequin was connected to a lung simulator (LS) and at different conditions of respiratory mechanics, positive end expiratory pressure (PEEP) levels and leaks (30, 50 and 80 L/min). All differences were within the 95% limits of agreement (LoA) in all conditions in the Bland-Altman plot. The overall bias (difference between VT measured by TDV and LS) was 35 ml (95% LoA 10 to 57 ml), 15 ml (95% LoA −40 to 70 ml), 141 ml (95% LoA 109 to 173 ml) in the normal, restrictive and obstructive conditions. The bias at different leaks flow in normal condition was 29 ml (95% LoA 19 to 38 ml). In the HS four healthy volunteers using nHPSV had a pneumotachograph (P) inserted through a mouthpiece to measure subject’s VT.The bias showed a scarce clinical relevance. In conclusions, VT estimation seems to be feasible and accurate in all conditions but the obstructive one. Additional leaks seem not to affect VT reliability.

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Investigating the Dutch Movement-Specific Reinvestment Scale in people with stroke

Clinical Rehabilitation ◽

10.1177/0269215512448381 ◽

2012 ◽

Vol 27 (2) ◽

pp. 160-165 ◽

Cited By ~ 19

Author(s):

Melanie Kleynen ◽

Susy M Braun ◽

Anna JHM Beurskens ◽

Jeanine A Verbunt ◽

Rob A de Bie ◽

...

Keyword(s):

Confidence Interval ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Limits Of Agreement ◽

Rehabilitation Centre ◽

Altman Plot ◽

Rehabilitation Process ◽

Bland Altman Plot ◽

Intraclass Correlation Coefficients ◽

Conscious Control

Objective: Reinvestment is a phenomenon in which conscious control of movements that are best controlled automatically disrupts performance. The propensity for reinvestment may therefore play an important role in the movement rehabilitation process. The Movement-Specific Reinvestment Scale measures an individual’s propensity for reinvestment. The aim of this study was to translate the scale for use with Dutch participants with stroke and to assess its reliability. Design: A test–retest design. Setting: In community after discharge from rehabilitation centre. Subjects: Forty-five people with stroke. Measures: Reliability of the translated scale was assessed using intraclass correlation coefficients (ICC) and Bland–Altman plot. Results: The ICC was 0.85 (95% confidence interval (CI) 0.74–0.91). Limits of agreement ranged from −2.38 to 3.10. Conclusion: The Dutch Movement-Specific Reinvestment Scale appears to be a reliable tool with which to assess the propensity for movement-specific reinvestment by people with stroke.

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An Extension of the Bland–Altman Plot for Analyzing the Agreement of More than Two Raters

Diagnostics ◽

10.3390/diagnostics11010054 ◽

2021 ◽

Vol 11 (1) ◽

pp. 54

Author(s):

Sören Möller ◽

Birgit Debrabant ◽

Ulrich Halekoh ◽

Andreas Kristian Petersen ◽

Oke Gerke

Keyword(s):

Confidence Intervals ◽

Simulation Study ◽

Health Research ◽

Common Method ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Present Bias

The Bland–Altman plot is the most common method to analyze and visualize agreement between raters or methods of quantitative outcomes in health research. While very useful for studies with two raters, a limitation of the classical Bland–Altman plot is that it is specifically used for studies with two raters. We propose an extension of the Bland–Altman plot suitable for more than two raters and derive the approximate limits of agreement with 95% confidence intervals. We validated the suggested limit of agreement by a simulation study. Moreover, we offer suggestions on how to present bias, heterogeneity among raters, as well as the uncertainty of the limits of agreement. The resulting plot could be utilized to investigate and present agreement in studies with more than two raters.

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Agreement and Repeatability of Central and Peripheral Refraction by One Novel Multispectral-Based Refractor

Frontiers in Medicine ◽

10.3389/fmed.2021.777685 ◽

2021 ◽

Vol 8 ◽

Author(s):

Weicong Lu ◽

Rongyuan Ji ◽

Wenzhi Ding ◽

Yuyin Tian ◽

Keli Long ◽

...

Keyword(s):

Standard Deviation ◽

Correlation Coefficient ◽

Refractive Error ◽

Intraclass Correlation ◽

The Novel ◽

Limits Of Agreement ◽

Altman Plot ◽

Bland Altman Plot ◽

Before And After ◽

Good Repeatability

Purpose: To evaluate the repeatability of a multispectral-based refractor in central and peripheral refraction measurement, and to assess the agreement of such measurements with objective refraction (OR) and subjective refraction (SR) in patients with myopia.Methods: A total of 60 subjects were recruited in this prospective research. Patients were divided into three groups according to the refractive error. Next, the central and peripheral refraction parameters were measured using multispectral refractive tomography (MRT) before and after cycloplegia. In addition, OR and SR measurements were also performed. The intraobserver repeatability was analyzed using within-subject standard deviation (Sw), test–retest repeatability (TRT), and intraclass correlation coefficient (ICC). Agreement was evaluated using Bland-Altman plot and 95% limits of agreement (LoA).Results: The ICC value of central and peripheral refraction were all higher than 0.97 with or without cycloplegia. The peripheral refraction in the nasal, temporal, superior, and inferior quadrants was slightly worse than other parameters, with the largest error interval being 1.43 D. The 95% LoA of the central refraction and OR or SR ranged from −0.89 to 0.88 D and −1.24 to 1.16 D without cycloplegia, respectively, and from −0.80 to 0.42 D and −1.39 to −0.84 D under cycloplegia, respectively.Conclusions: The novel multispectral refraction topography demonstrated good repeatability in central and peripheral refraction. However, the refraction in the nasal, temporal, superior, and inferior quadrants were not as good as that of central and circle peripheral refraction.

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