title: Interobserver agreement of coiling of Med-El cochlear implant: plain x-ray studies.
abstract: OBJECTIVE
  The objective of this study was to describe the interobserver agreement of otologists in judging the extent of cochlear electrode insertion as depicted in plain radiographs done in various projections relative to that of Stenvers (45 degrees from midline).
  
  
  METHODS
  Ten experienced U.S. MED-EL cochlear implant surgeons, unaware of the image history, judged depths of electrode coiling in 12 images.
  
  
  METHODS
  In a bequeathed cranial base specimen, a standard MED-EL Combi 40+ electrode was inserted 3 mm less than fully and stabilized. With a custom cephalostat, the specimen was positioned in the Frankfort horizontal plane. Plain radiographs were made in six projections in 15 degrees increments, from posterior-anterior to near lateral. After the electrode array was withdrawn 5 mm and stabilized, six additional radiographs were similarly taken.
  
  
  RESULTS
  Greater variability of assessed coiling was associated with projections other than Stenvers. The coefficient of variation for the Stenvers projection was significantly less than half that of the anterior-posterior and the other projections studied.
  
  
  CONCLUSIONS
  In plain radiographic assessment of the degree of coiling of the MED-EL electrode, interobserver agreement was best for the Stenvers view.
authors.affiliation: Emory University, Atlanta, Georgia, USA. ntodd@emory.edu
authors.forename: N Wendell
authors.initials: NW
authors.lastname: Todd
authors.forename: Turner I
authors.initials: TI
authors.lastname: Ball
mesh_terms: D002102:Cadaver; D003051:Cochlea / Q000000981:diagnostic imaging*; D003054:Cochlear Implants; D004567:Electrodes, Implanted; D006801:Humans; D015588:Observer Variation; D011856:Radiographic Image Enhancement; D013701:Temporal Bone / Q000000981:diagnostic imaging