title: Reading radiographs in pairs or in chronological order influences radiological progression in osteoarthritis.
abstract: OBJECTIVE
  To determine the influence of the order in which a series of radiographs were read on the sensitivity to change over a 2-yr follow-up period in patients with osteoarthritis (OA) at multiple sites.
  
  
  METHODS
  Radiographs of 20 patients with OA in at least two joint sites were obtained at baseline and after 2 yr, and scored according to the consensus of two readers. Joint space narrowing (JSN) and osteophytes were graded (0-3) in the hand, hip and tibiofemoral joints. The cervical (C2-7) and lumbar spine disc spaces (L1-S1) were graded (0-3) for disc space narrowing (DSN) and anterior osteophytes. Films were read by two different procedures: in pairs, with an unknown time sequence and in chronological order. Radiological progression was defined as an increase of at least one grade in JSN, DSN or osteophyte total scores. The two procedures were compared using standardized response means (SRM).
  
  
  RESULTS
  The SRM for changes in JSN or DSN progression scores in the hands, hips, knees and spine were, respectively, 0.00, 0.00, 0.32, 0.13 and 0.38, 0.32, 0.56, 0.18 for the paired and chronological readings. The SRM for changes in osteophyte progression scores in the hands, hips, knees and spine were, respectively, 0.39, 0.20, 0.32, 0.38 and 0.41, 0.37, 0.56, 0.66 for the paired and chronological readings.
  
  
  CONCLUSIONS
  When assessing radiological progression in OA, reading a series of radiographs in chronological order tended to be more sensitive to change over a 2-yr follow-up period than reading in pairs with an unknown time sequence.
authors.affiliation: Department of Rheumatology, Leiden University Medical Centre, C4-R, PO Box 9600, 2300 RC Leiden, The Netherlands. S.A.Scheepers@lumc.nl
authors.forename: S
authors.initials: S
authors.lastname: Botha-Scheepers
authors.forename: I
authors.initials: I
authors.lastname: Watt
authors.forename: F C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: M
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D000328:Adult; D000368:Aged; D002910:Chronology as Topic; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000473:pathology; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000473:pathology; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging