title: Interreader reliability in assessment of nailfold capillary abnormalities by beginners: pilot study of an intensive videocapillaroscopy training program.
abstract: OBJECTIVE
  To test the learning curve of rheumatologists with different experience in videocapillaroscopy (VCP) attending an intensive training program focused on interpretation of the main capillary nailfold abnormalities, the scleroderma (systemic sclerosis, SSc) pattern, and the normal pattern, and to determine their interreader agreement with an experienced investigator.
  
  
  METHODS
  Five investigators (1 senior, 1 junior, and 3 beginners) participated in the exercise. The study was composed of 2 steps. First, an independent investigator selected representative VCP images of normal patterns and capillary abnormalities. The second step included the training program, which ran 4 hours per day for 7 days. The senior rheumatologist taught investigators to recognize and interpret the normal pattern, the capillary abnormalities, and the different types of SSc pattern. These abnormalities were considered: homogeneously enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhemorrhages, neoangiogenesis, avascular areas, and capillary density.
  
  
  RESULTS
  A total of 300 VCP images were read from all the investigators. Both κ values and overall agreement percentages of qualitative and quantitative assessments showed progressive improvement from poor to excellent from the beginning to the end of the exercise. The sensitivity and specificity of the participants in the assessment of SSc pattern at the last lecture session were high.
  
  
  CONCLUSIONS
  Our pilot study suggests that after an intensive 1-week training program, novice investigators with little or no experience in VCP are able to interpret the main capillary abnormalities and SSc pattern and to achieve good interreader agreement rates.
authors.affiliation: Clinica Reumatologica Università Politecnica delle Marche, Jesi, Ancona, Italy. dr.gmarwin@gmail.com
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertolazzi
authors.forename: Marika
authors.initials: M
authors.lastname: Tardella
authors.forename: Andrea
authors.initials: A
authors.lastname: Becciolini
authors.forename: Marco
authors.initials: M
authors.lastname: DI Carlo
authors.forename: Marta
authors.initials: M
authors.lastname: Dottori
authors.forename: Walter
authors.initials: W
authors.lastname: Grassi
authors.forename: Rossella
authors.initials: R
authors.lastname: De Angelis
mesh_terms: D002196:Capillaries / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D015588:Observer Variation; D010865:Pilot Projects; D015397:Program Evaluation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000503:physiopathology; D014741:Video Recording / Q000379:methods