scholarly journals Standardized method for the measurement of Grabb’s line and clival-canal angle

2017 ◽  
Vol 20 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Jonathan E. Martin ◽  
Markus Bookland ◽  
Douglas Moote ◽  
Catherine Cebulla
Keyword(s):  
Measurement Technique ◽  
Clinical Decision Making ◽  
Measurement Techniques ◽  
Intraclass Correlation ◽  
Clinical Decision ◽  
Radiographic Measurement ◽  
Pediatric Radiologist ◽  
Intrarater Reliability ◽  
Measurement Protocol ◽  
Standardized Measurement

OBJECTIVEGrabb’s line—the perpendicular distance from the basion-C2 line (pB-C2)—is a widely used radiographic measurement with significant clinical implications in patients with a complex Chiari malformation. Rigorous demonstration of the reproducibility of this measurement has not previously been reported. The authors report a standardized measurement technique with excellent inter- and intrarater reliability on T1-weighted sagittal MRI.METHODSThe authors developed a standardized measurement technique that included specifications of midline slice selection, landmark and reference line definitions, and measurement technique on T1-weighted sagittal images. Twenty MR images were reviewed by 2 pediatric neurosurgeons, 1 pediatric radiologist, and 1 undergraduate student. Measurements were performed using the technique specified on 2 separate occasions. Intrarater and interrater reliabilities were calculated using the intraclass correlation coefficient.RESULTSA combined interrater reliability of 0.879 was achieved for the pB-C2, and 0.916 for the clival-canal angle, another measure of interest in patients with complex Chiari malformations. Intrarater reliability for these measurements exceeded 0.858 for all 4 reviewers.CONCLUSIONSGrabb’s line—the pB-C2—can be measured with excellent reliability using a standardized measurement protocol. Individual clinicians and collaborative databases should consider using validated measurement techniques to guide clinical decision making in patients with craniocervical junction pathology.

scholarly journals Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2135
Author(s):  
Vincenza Granata ◽  
Damiano Caruso ◽  
Roberto Grassi ◽  
Salvatore Cappabianca ◽  
Alfonso Reginelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Correlation Coefficient ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Clinical Decision ◽  
Cancer Staging ◽  
Structured Reporting ◽  
Quality Analysis ◽  
Promising Tool ◽  
Structured Reports

Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

Reliability and Accuracy of Biomechanical Measurements of the Lower Extremities

2002 ◽  
Vol 92 (6) ◽  
pp. 317-326 ◽  
Author(s):  
Bart Van Gheluwe ◽  
Kevin A. Kirby ◽  
Philip Roosen ◽  
Robert D. Phillips
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Lower Extremities ◽  
Intrarater Reliability ◽  
Intraclass Correlation Coefficients ◽  
Measurement Protocol ◽  
Left And Right ◽  
Asymptomatic Subjects ◽  
Forefoot Varus ◽  
Biomechanical Measurements

The reliability of biomechanical measurements of the lower extremities, as they are commonly used in podiatric practice, was quantified by means of intraclass correlation coefficients (ICCs). This was done not only to evaluate interrater and intrarater reliability but also to provide an estimate for the accuracy of the measurements. The measurement protocol involved 30 asymptomatic subjects and five raters of varying experience. Each subject was measured twice by the same rater, with the retest immediately following the test. The study demonstrated that the interrater ICCs were quite low (≤0.51), except for the measurements of relaxed calcaneal stance position and forefoot varus (both 0.61 and 0.62 for left and right, respectively). However, the intrarater ICCs were relatively high (&gt;0.8) for most raters and measurement variables. Measurement accuracy was moderate between raters. (J Am Podiatr Med Assoc 92(6): 317-326, 2002)

scholarly journals Automated detection and segmentation of intracranial hemorrhage suspect hyperdensities in non-contrast-enhanced CT scans of acute stroke patients

2021 ◽  
Author(s):  
N. Schmitt ◽  
Y. Mokli ◽  
C. S. Weyland ◽  
S. Gerry ◽  
C. Herweh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Sensitivity And Specificity ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Area Under The Curve ◽  
Ground Truth ◽  
Clinical Decision ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Abstract Objectives Artif icial intelligence (AI)–based image analysis is increasingly applied in the acute stroke field. Its implementation for the detection and quantification of hemorrhage suspect hyperdensities in non-contrast-enhanced head CT (NCCT) scans may facilitate clinical decision-making and accelerate stroke management. Methods NCCTs of 160 patients with suspected acute stroke were analyzed regarding the presence or absence of acute intracranial hemorrhages (ICH) using a novel AI-based algorithm. Read was performed by two blinded neuroradiology residents (R1 and R2). Ground truth was established by an expert neuroradiologist. Specificity, sensitivity, and area under the curve were calculated for ICH and intraparenchymal hemorrhage (IPH) detection. IPH-volumes were segmented and quantified automatically by the algorithm and semi-automatically. Intraclass correlation coefficient (ICC) and Dice coefficient (DC) were calculated. Results In total, 79 of 160 patients showed acute ICH, while 47 had IPH. Sensitivity and specificity for ICH detection were 0.91 and 0.89 for the algorithm; 0.99 and 0.98 for R1; and 1.00 and 0.98 for R2. Sensitivity and specificity for IPH detection were 0.98 and 0.89 for the algorithm; 0.83 and 0.99 for R1; and 0.91 and 0.99 for R2. Interreader reliability for ICH and IPH detection showed strong agreements for the algorithm (0.80 and 0.84), R1 (0.96 and 0.84), and R2 (0.98 and 0.92), respectively. ICC indicated an excellent (0.98) agreement between the algorithm and the reference standard of the IPH-volumes. The mean DC was 0.82. Conclusion The AI-based algorithm reliably assessed the presence or absence of acute ICHs in this dataset and quantified IPH volumes precisely. Key Points • Artificial intelligence (AI) is able to detect hyperdense volumes on brain CTs reliably. • Sensitivity and specificity are highest for the detection of intraparenchymal hemorrhages. • Interreader reliability for hemorrhage detection shows strong agreement for AI and human readers.

scholarly journals Digital Pain Drawings Can Improve Doctors’ Understanding of Acute Pain Patients: Survey and Pain Drawing Analysis (Preprint)

2018 ◽  
Author(s):  
Nour Shaballout ◽  
Anas Aloumar ◽  
Till-Ansgar Neubert ◽  
Martin Dusch ◽  
Florian Beissner
Keyword(s):  
Acute Pain ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Clinical Decision ◽  
Doctor Patient Communication ◽  
Additional Information ◽  
Pain Specialist ◽  
Assessment And Treatment ◽  
Pain Drawings ◽  
Specific Factors

BACKGROUND Pain drawings (PDs) are an important tool to evaluate, communicate, and objectify pain. In the past few years, there has been a shift toward tablet-based acquisition of PDs, and several studies have been conducted to test the usefulness, reliability, and repeatability of electronic PDs. However, to our knowledge, no study has investigated the potential role of electronic PDs in the clinical assessment and treatment of inpatients in acute pain situations. OBJECTIVE The aim of this study was to evaluate whether knowledge of the patients’ electronic PD has the potential to improve the doctors’ understanding of their patients and to influence their clinical decision making. Furthermore, we sought to identify differences between electronic PDs of patients and their treating pain specialists in an acute pain situation and to find those specific characteristics derived from the PDs that had the largest impact on doctors’ understanding. METHODS We obtained electronic PDs from 47 inpatients in acute pain situations before their consultation with a pain specialist on a tablet personal computer with a stylus. Before looking at their patients’ drawings, these specialists drew their own conception of the patients’ pain after anamnesis and physical examination. Patients’ drawings were then revealed to the doctors, and they were asked to evaluate how much the additional information improved their understanding of the case and how much it influenced their clinical decision on an 11-point Likert scale (0=“not at all” and 10=“very much”). Similarities and differences of patients’ and doctors’ PDs were assessed by visual inspection and by calculating Jaccard index and intraclass correlation coefficient (ICC) of the pain area and the number of pain clusters. Exploratory analyses were conducted by means of correlation tables to identify specific factors that influenced doctors’ understanding. RESULTS Patients’ PDs significantly improved the doctors’ understanding (mean score 4.81, SD 2.60, P<.001) and to a lesser extent their clinical decision (mean 2.68, SD 1.18, P<.001). Electronic PDs of patients and doctors showed fair to good similarity for pain extent (r=.454, P=.001) and widespreadness (P=.447, r=.002) were important factors helping doctors to understand their patients. CONCLUSIONS In a clinical setting, electronic PDs can improve doctors’ understanding of patients in acute pain situations. The ability of electronic PDs to visualize differences between doctors’ and patients’ conception of pain has the potential to improve doctor-patient communication.

scholarly journals Standardized technique of water permeability measurement for biomedical applications

2018 ◽  
Vol 4 (1) ◽  
pp. 633-636
Author(s):  
Swen Grossmann ◽  
Stefan Siewert ◽  
Robert Ott ◽  
Klaus-Peter Schmitz ◽  
Stefanie Kohse ◽  
...  
Keyword(s):  
Measurement Technique ◽  
Medical Devices ◽  
Water Permeability ◽  
Measurement Techniques ◽  
Test Sample ◽  
Hydraulic Pressure ◽  
Key Factor ◽  
Flow Through ◽  
Standardized Measurement ◽  
Nanofiber Membranes

AbstractStandardized methods and measures are ubiquitous in biomedical engineering and a key factor for the successful development and certification of novel biomaterials, implants or other medical devices. Hence, the development of standardized measurement techniques, which can be applied to nearly every material and device is of crucial importance. Within the current work, we introduce a method to evaluate the water permeability according to ISO/FDIS 7198. The setup was designed to determine the volumetric flow through a test sample for a given hydraulic pressure. One key feature is the effortless replacement of the chamber containing the test sample. The measurement technique can thus be applied to a variety of materials and medical devices. To demonstrate the functionality of the setup we fabricated nanofiber membranes using the process of electrospinning. Nonwovens with comparable thickness and varying morphology were analyzed with regard to water permeability. In particular the different fiber diameters as well as the modified inter-fiber distances result in large deviations of the water permeability. Furthermore, there are hints for a rearrangement of the nanofibers due to the applied hydraulic pressure. The developed measurement technique provides a powerful tool for the standardized quantification of the water permeability and can be applied to a variety of biomaterials and medical devices.

scholarly journals Reliability of new radiographic measurement techniques for elbow bony impingement

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Uros Meglic ◽  
Oskar Zupanc
Keyword(s):  
Clinical Evaluation ◽  
Treatment Plan ◽  
Pearson Correlation ◽  
Measurement Techniques ◽  
Intraclass Correlation ◽  
Radiographic Measurement ◽  
Impingement Angle ◽  
Rater Reliability ◽  
Bony Impingement ◽  
Radiographic Parameters

Abstract Background Identifying the location and scale of radiographic changes in elbow bony impingement (EBI) is critical in formulating an appropriate diagnosis and treatment plan for such patients. The purpose of present study was to evaluate the intra-rater and inter-rater reliability of the new radiographic parameters, Anterior Impingement angle (AIa) and Posterior Impingement angle (PIa), for EBI. In addition, to determine if there was a relationship between radiographic parameters and clinical evaluation. Patients and methods Three raters of different levels of training evaluated the radiographs of 60 patients (30 in EBI group and 30 in normal group) twice, at least 2 weeks apart. Intra-rater and inter-rater reliabilities were calculated by Intraclass Correlation Coefficients (ICC) with 95% confidence intervals. Correlation between radiographic parameters and clinical evaluation was calculated by Pearson correlation coefficient. Results In both groups, intra-rater and inter-rater reliabilities were substantial. There were no significant differences in reliability between upper-hand expert surgeons and resident for either measurement. Good correlation was observed between impingement arcs and range of motion values. Conclusions Both AIa and PIa measurements demonstrated substantial intra-rater and inter-rater reliability for normal radiographs and in EBI patients. Good reliability, for either expert surgeons or residents in training, and good correlation between radiographic measurements and manual testing, appoints this method may be easily and reliably used in every day practice.

scholarly journals Radiomics feature robustness as measured using an MRI phantom

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joonsang Lee ◽  
Angela Steinmann ◽  
Yao Ding ◽  
Hannah Lee ◽  
Constance Owens ◽  
...  
Keyword(s):  
Coefficient Of Variation ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Small Variation ◽  
Clinical Decision ◽  
Resonance Imaging ◽  
Scanning Protocol ◽  
Large Numbers ◽  
T1 And T2 ◽  
Magnetic Resonance Imaging Mri

AbstractRadiomics involves high-throughput extraction of large numbers of quantitative features from medical images and analysis of these features to predict patients’ outcome and support clinical decision-making. However, radiomics features are sensitive to several factors, including scanning protocols. The purpose of this study was to investigate the robustness of magnetic resonance imaging (MRI) radiomics features with various MRI scanning protocol parameters and scanners using an MRI radiomics phantom. The variability of the radiomics features with different scanning parameters and repeatability measured using a test–retest scheme were evaluated using the coefficient of variation and intraclass correlation coefficient (ICC) for both T1- and T2-weighted images. For variability measures, the features were categorized into three groups: large, intermediate, and small variation. For repeatability measures, the average T1- and T2-weighted image ICCs for the phantom (0.963 and 0.959, respectively) were higher than those for a healthy volunteer (0.856 and 0.849, respectively). Our results demonstrated that various radiomics features are dependent on different scanning parameters and scanners. The radiomics features with a low coefficient of variation and high ICC for both the phantom and volunteer can be considered good candidates for MRI radiomics studies. The results of this study will assist current and future MRI radiomics studies.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

Sign in / Sign up

Export Citation Format

Share Document