title: Consistency between physical medicine and rehabilitation specialists and a radiologist in interpretation of lumbosacral radiographs.
abstract: OBJECTIVE
  To investigate intra- and inter-observer reliability among physical medicine and rehabilitation specialists and a radiologist in interpretation of plain lumbar spine X-ray films in patients with low back pain.
  
  
  METHODS
  Three assessors (A: a resident of PM&R, B: an experienced PM&R specialist, C: an experienced radiologist) read the standard lumbosacral plain radiographs of 79 patients with 2-3 month time interval. Each assessor recorded the presence or absence of abnormalities on the radiograph according to a standardized assessment form.
  
  
  RESULTS
  For assessors B and C, all kappa values were > 0.40. Transitional vertebrae abnormalities reached to the highest agreement ratio. The intrarater agreement showed higher kappas than the interrater agreement. The radiologists had the highest intrarater agreement, closely followed by the experienced PM&R specialist. Agreement among three assessors was substantial in sacralisation, lumbarisation and facet joint pathologies.
  
  
  CONCLUSIONS
  We usually obtained a good intrarater agreement, especially for the experienced PM&R specialist and the radiologist indicating that experience increases diagnostic consistency. Besides the systematic differences in radiographic interpretation between the assessors, institutional specific conditions (esp. patient profile and regularities) may cause the phycians to pay more attention to a specific group of pathologies.
authors.affiliation: Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, Bilkent, Ankara, Turkey. matask@gata.edu.tr
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Taskaynatan
authors.forename: Selvinaz
authors.initials: S
authors.lastname: Kızılırmak
authors.forename: Birol
authors.initials: B
authors.lastname: Balaban
authors.forename: Ugur
authors.initials: U
authors.lastname: Bozlar
authors.forename: Ahmet S
authors.initials: AS
authors.lastname: Goktepe
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozgul
authors.forename: Arif K
authors.initials: AK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000000981:diagnostic imaging