Radiographic Sagittal Tibio-Talar Offset in Ankle Arthrodesis—Accuracy and Reliability of Measurements

Radiographic outcome assessment of ankle arthrodesis (AA) requires accurate measurement techniques. This study aimed to identify the most reliable methods for sagittal tibio-talar alignment measurements with regard to the tibio-talar offset after AA. Lateral weight-bearing radiographs of 38 fused ankles were selected for retrospective review. The sagittal tibio-talar angle (STTA), the modified tibio-talar ratio (mT-T ratio) and the sagittal tibio-talar offset (tibCOR, procLAT) were measured by three independent observers. Intra- and interobserver correlation coefficients (ICC) and mean measurement differences were calculated to assess measurement reliability and accuracy. By defining the talar longitudinal axis as a line from the inferior aspect of the posterior tubercle of the talus to the most inferior aspect of the talar neck, STTA showed excellent (ICC 0.924; CI 95% 0.862–0.959) and mTT-ratio provided high (ICC 0.836; CI 95% 0.721–0.909) interobserver reliability, respectively. For tibio-talar offset measurement the tibCOR method showed superior reliability and better interobserver agreement compared to the procLAT technique. The STTA and a modified T-T ratio are recommended for future scientific radiographic measurements in AA.

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The Novel Technique of using Superb Microvascular Imaging to Determine Carotid Intima-media Thickness

American Journal of Sonography ◽

10.25259/ajs-40-2018 ◽

2018 ◽

Vol 1 ◽

pp. 16

Author(s):

Fatima Musarrat Hasan ◽

Musarrat Hasan

Keyword(s):

Interobserver Agreement ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Media Thickness ◽

Superb Microvascular Imaging ◽

Microvascular Imaging ◽

Near Wall

Objective The objective of this study was to investigate the interobserver reliability when measuring the carotid intima media thickness (IMT) using superb microvascular imaging (SMI) and B-mode ultrasonography. Methods Two sonologists were selected to scan the left common carotid artery and measure IMT first with B-mode and then with SMI on 20 patients. They were blinded to each other results. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability using both the modes of scanning. Results Interobserver agreement when using SMI, for both near wall and far wall, was almost perfect (ICC, 0.870; 95% confidence interval [CI], 0.700–0.946). Interobserver agreement when using B-mode was poor for near wall (ICC, 0.396; 95% CI, −0.048–0.708) and moderate for far wall (ICC, 0.474, 95% CI, 0.070–0.749). Conclusions SMI proved to be a greatly reliable tool in the measurement of carotid IMT.

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3D biometrics for hindfoot alignment using Weight Bearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00323 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Francois Lintz ◽

Shu Zhang ◽

Alessio Bernasconi ◽

Jianzhong Zhang

Keyword(s):

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Continuous Series ◽

Hindfoot Alignment ◽

Group 3 ◽

Group 2 ◽

Weightbearing Ct ◽

Group 1

Category: Hindfoot Introduction/Purpose: Hindfoot alignment is an important reference for foot and ankle surgery, and the Foot Ankle Offset (FAO) using semi-automatic software has been reported as a valuable hindfoot alignment measurement in weightbearing CT(WBCT). The objective was to assess the clinical relevance and reproducibility of the FAO value for hindfoot alignment and compare it with previous findings. Methods: A prospective study was conducted, with ethics committee approval. Patients were included, clinically examined and divided into 3 groups: normal alignment (Group 1), valgus (Group 2), varus (Group 3). A continuous series of 140 feet (71 patients) were referred from September to December 2017 (65 normal, 41 valgus, and 34 varus). All patients had a bilateral weight bearing CT, and the FAO values were recorded. The long axial view angle(HAct)was measured on Digitally Reconstructed Radiographs (DRR) as comparison. All values were measured and compared by two different investigators. The reproducibility of FAO and HAct were calculated using intraclass correlation coefficients(ICCs) and regression analysis was conducted to study the correlation between the two methods. Results: In Group 1, the mean value for FAO/HAct was 1.69%±2.58%/4.13±2.67, in Group 2, the FAO/HAct was 7.46%±3.18%/9.00±3.43; in Group 3 the values were -6.11%±4.55%/-7.49±6.06. The intra- and interobserver reliability were 0.991/0.992 and 0.976/0.976. There was a good linear correlation between HAct and FAO (R2=0.778, and the regression slope was 1.083. Conclusion: The use of weightbearing CT can help characterize hindfoot alignment objectively using WBCT. The present study is the first prospective comparative assessment of this technology and shows that FAO has good repeatability, and it correlates well with clinical examination,, X ray findings and previous literature. The FAO is a clinically relevant and reproducible method for measuring hindfoot alignment.

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The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT

The Bone & Joint Journal ◽

10.1302/0301-620x.102b4.bjj-2019-0632.r3 ◽

2020 ◽

Vol 102-B (4) ◽

pp. 478-484 ◽

Cited By ~ 2

Author(s):

Anne M. Daniels ◽

Caroline E. Wyers ◽

Heinrich M. J. Janzing ◽

Sander Sassen ◽

Daan Loeffen ◽

...

Keyword(s):

High Resolution ◽

Interobserver Agreement ◽

Interobserver Reliability ◽

Scaphoid Fracture ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Kappa Statistics ◽

Quantitative Ct ◽

Scaphoid Fractures

Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.

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Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray

Foot & Ankle Specialist ◽

10.1177/19386400211029162 ◽

2021 ◽

pp. 193864002110291

Author(s):

Pablo Wagner ◽

Nicole Lescure ◽

Noman Siddiqui ◽

Jessica Fink ◽

Emilio Wagner

Keyword(s):

Internal Rotation ◽

Hallux Valgus ◽

Interobserver Agreement ◽

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Validity And Reliability ◽

Substantial Agreement ◽

X Ray ◽

Rotation Measurement

Background Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs’ (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT. Methods Three observers evaluated WBCT and WBXR of 33 HV feet twice. Medial column internal rotation was measured with WBCT and classified into 3 levels according to WBXR findings. Intra- and interobserver reliability were obtained for WBXR and WBCT, in addition to WBXR-WBCT correlation. Results WBXR and WBCT intraobserver agreement was substantial and near perfect, respectively (κ 0.79 and 0.84). Their interobserver agreement was excellent (intraclass correlation 0.85 and 0.9, respectively). The WBXR-WBCT correlation was substantial (κ 0.68). WBXR diagnostic accuracy to predict the WBCT results was 85%. Conclusions The proposed method for medial column internal rotation measurement using WBXR is reliable and has a substantial agreement with WBCT measurements. Levels of Evidence Level III

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Quantification of fluoroscopic fundoplication anatomy: inter- and intraobserver reliability

Diseases of the Esophagus ◽

10.1093/dote/doab045 ◽

2021 ◽

Author(s):

Siang Wei Gan ◽

Natalie Lee ◽

Siao En Tan ◽

Suzanne M Edwards ◽

George K Kiroff ◽

...

Keyword(s):

Interobserver Agreement ◽

Interobserver Reliability ◽

Gastroesophageal Junction ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Barium Swallow ◽

Anatomical Features ◽

Intraclass Correlation Coefficients ◽

Objectively Measured ◽

Video Fluoroscopy

SUMMARY The etiology of postfundoplication dysphagia remains incompletely understood. Subtle changes of gastroesophageal junction (GEJ) anatomy may be contributory. Barium swallows have potential for standardization to evaluate postsurgical anatomical features. Using structured barium swallows, we aim to identify reproducible, objectively measured postfundoplication anatomical features that will permit future comparison between patients with/without dysphagia. At 6–12 months of postfundoplication, 31 patients underwent structured barium swallow with video–fluoroscopy recording: standing anteroposterior; standing oblique (×2); prone oblique (×2); and prone oblique with continuous free drinking. A primary observer recorded 11 variables of GEJ anatomy for each view, repeated 3 months later, forming two datasets to assess intraobserver consistency. Interobserver reliability was determined using a dataset each from the primary observer and two medical students (after training). Intraclass correlation coefficients (ICC) were based on two-way mixed-effects model (ICC agreement: 0.40–0.59 ‘fair’; 0.60–0.74 ‘good’; 0.75–1.00 ‘excellent’). Interobserver reliability was good–excellent for 47 of 66 measurements. Measures of maximal esophageal diameter cf. wrap opening diameter and posterior esophageal angle showed high interobserver reproducibility on all views (ICC range 0.84–0.91; 0.68–0.80, respectively). Interobserver agreement was good–excellent for 5/6 views when measuring anterior GEJ displacement and axis deviation (ICC range 0.56–0.79; 0.41–0.77, respectively). Measures of wrap length showed lower reproducibility. Prone oblique measurements showed highest reproducibility (good–excellent agreement in 19/22 measurements). Intraobserver consistency was excellent for 98% of measurements (ICC range 0.74–0.99). Objective measurements of postfundoplication GEJ anatomy using structured barium swallow are reproducible and may allow further interrogation of anatomical features contributing to postfundoplication dysphagia.

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Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion

Einstein (São Paulo) ◽

10.1590/s1679-45082014ao2964 ◽

2014 ◽

Vol 12 (2) ◽

pp. 198-203 ◽

Cited By ~ 1

Author(s):

Alberto Ofenhejm Gotfryd ◽

Felipe de Moraes Pomar ◽

Nicola Jorge Carneiro Neto ◽

Fernando José Franzin ◽

Luciano Miller Reis Rodrigues ◽

...

Keyword(s):

Reliability Analysis ◽

Interobserver Agreement ◽

Interobserver Reliability ◽

Plain Film ◽

Kappa Coefficient ◽

Lumbosacral Fusion ◽

Orthopedic Surgeons ◽

Radiographic Measurements ◽

Flexion And Extension

Objective To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis.Methods Twenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria.Results Intra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used.Conclusion There was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods.

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The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.180087 ◽

2019 ◽

Vol 13 (1) ◽

pp. 67-72

Author(s):

G. A. Schmale ◽

A. F. Bayomy ◽

A. O. O’Brien ◽

V. Bompadre

Keyword(s):

Lower Extremity ◽

Acl Reconstruction ◽

Interobserver Reliability ◽

Cruciate Ligament ◽

Measurement Techniques ◽

Tibial Slope ◽

Intraobserver Reliability ◽

Radiographic Measurement ◽

Orthopaedic Resident ◽

Radiographic Measurements

Purpose Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction Methods A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope. Results Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator’s measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator’s measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs. Conclusions Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction. Level of Evidence III

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Normal Variation and Instability Values of the Tibiofibular Joint on Weightbearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00196 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0019

Author(s):

Noortje Hagemeijer ◽

Song Ho Chang ◽

Mohamed Abdelaziz Elghazy ◽

Gregory Waryasz ◽

Daniel Guss ◽

...

Keyword(s):

Internal Control ◽

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Ankle Injury ◽

P Value ◽

Uninjured Side ◽

Tibiofibular Joint ◽

Value Range

Category: Ankle Introduction/Purpose: Prompt management of syndesmotic instability is critical for optimizing clinical outcome, but subtle injuries may be difficult to diagnose. Application of modern imaging modalities such as weight bearing CT (WBCT) may better identify such injuries by virtue of assessing the distal tibiofibular articulation under physiologic load. The aim of this study was to evaluate the distal tibiofibular articulation using WBCT among patients with known syndesmotic instability and compare these findings with their uninjured contralateral sides, and thereafter corroborate such measurement differences with patients devoid of any syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring surgical fixation (n=12) underwent bilateral ankle WBCT that incorporated the entire foot. A separate cohort of patients without ankle injury also underwent bilateral ankle WBCT for assessment of either a Lisfranc injury or forefoot condition (n=24). All WBCT imaging was performed preoperatively. A set of five axial plane tibiofibular joint measurements including one angular measurement were standardly assessed one cm above the tibial plafond. Values were recorded by two independent observers to assess for interobserver reliability scores. Interpretation of the intraclass correlation coefficients was carried out according to the guidelines proposed by Shrout: 0.00-0.10 virtually none, 0.11-0.40 slight, 0.41-0.60 fair, 0.61-0.80 moderate, 0.81 -1.00 substantial. Results: Among the control population without ankle injury, no differences were found between bilateral measurements (p-value range 0.172 - 0.961). Among those with known unilateral syndesmotic instability, values differed between the injured and uninjured side in five of six measurements— including syndesmotic area, direct anterior-, middle-, and posterior- difference, and sagittal translation (p <0.001, <0.001, <0.001, <0.001, 0.039, respectively). Those same measurements also differed when comparing the left-right delta values between uninjured and injured patients (p <0.001, 0.002, <0.001, <0.001, and 0.042, respectively). Fibular rotation differed neither in direct nor delta comparisons (p=0.460 and 0.271 respectively). Substantial agreement was found for all measurements except for sagittal translation, which had only slight agreement. Conclusion: This study highlights the ability of WBCT to effectively differentiate syndesmotic diastasis and fibular translation among patients with surgically-confirmed syndesmotic instability as compared to those without syndesmotic instability. It also underscores the importance of using the contralateral, uninjured side as a valid internal control. Additional studies are necessary to better understand the role of WBCT in prospectively diagnosing more subtle cases of syndesmotic instability among patients for whom the diagnosis remains in question.

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Analysis of Normal Ankle Radiographic Angles

10.21203/rs.3.rs-34939/v1 ◽

2020 ◽

Author(s):

Weixin Zheng ◽

Junhua Du ◽

Yao Lu ◽

Jingqi Liang ◽

Yan Zhang ◽

...

Keyword(s):

Surgical Planning ◽

Interobserver Reliability ◽

Weight Bearing ◽

Lateral View ◽

Reference Points ◽

Basic Information ◽

Foot And Ankle ◽

Radiographic Measurements ◽

The Mean ◽

Standard Weight

Abstract Background Understanding the position of the normal ankle is the key before every successfully surgical planning. The aims of our study were to quantify the normal ankle angles, measures and reference points systematically on ankle radiographs. Methods A total of 900 angles and 300 basic information were measured on 100 healthy ankles. The radiographic measurements were performed on standard weight-bearing anteroposterior (AP) and lateral view of the ankle. A total of 6 angles were made from the AP view, 3 angles from the lateral view. All angles were measured by 2 foot and ankle surgeons, independent of each other. For intraobserver reliability, after six weeks, the same angles were measured by each observer. Results A total of 900 angles and 300 basic information were measured on 100 healthy ankles. The mean age of the subjects was 33.0 ± 9.1years, with 57 females(57%) and 43 males(43%), with 44 left feet(44%) and 56 right feet(56%). Intraobserver is reliability greater than 0.8 and the interobserver reliability greater than 0.8. The following angles were measured from the AP of ankle: TAS’s angle, TT’s angle, TC’s angle, TMM’s angle, TLM’s angle, MA’s angle. The following angles were measured from the lateral view: TLS’s angle, Kite angle, TTA’s angle. Conclusions Our study will provide a set of standard angle measures. The range of angles can be used as a reference for preoperative design and intraoperative and postoperative evaluations.

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Interobserver Reliability Using the Phonetic Level Evaluation With Severely and Profoundly Hearing-Impaired Children

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3405.989 ◽

1991 ◽

Vol 34 (5) ◽

pp. 989-999 ◽

Cited By ~ 6

Author(s):

Stephanie Shaw ◽

Truman E. Coggins

Keyword(s):

Interrater Reliability ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Hearing Impaired ◽

Intraclass Correlation Coefficients ◽

Assessment Measure ◽

Impaired Children ◽

Speech Assessment ◽

Hearing Impaired Children

This study examines whether observers reliably categorize selected speech production behaviors in hearing-impaired children. A group of experienced speech-language pathologists was trained to score the elicited imitations of 5 profoundly and 5 severely hearing-impaired subjects using the Phonetic Level Evaluation (Ling, 1976). Interrater reliability was calculated using intraclass correlation coefficients. Overall, the magnitude of the coefficients was found to be considerably below what would be accepted in published behavioral research. Failure to obtain acceptably high levels of reliability suggests that the Phonetic Level Evaluation may not yet be an accurate and objective speech assessment measure for hearing-impaired children.

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