title: Impact of specialty and level of training on CT measurement of femoral version: an interobserver agreement analysis.
abstract: BACKGROUND
  To determine the interobserver agreement on femoral version measurements between an orthopedic attending, orthopedic senior and junior residents, and an attending radiologist.
  
  
  METHODS
  Postoperative computed tomography (CT) scanograms of 267 patients who underwent femoral intramedullary (IM) nailing with corresponding radiology attending reads for femoral version were collected and de-identified. Femoral version measurements performed by a trauma fellowship-trained attending orthopedic surgeon (ORTHO), a senior orthopedic resident (PGY4), a junior orthopedic resident (PGY1), and a musculoskeletal fellowship-trained attending radiologist (RADS) were compared via Pearson's interclass correlation coefficient to assess interobserver level of agreement.
  
  
  RESULTS
  Version measurements provided by the two attending physicians exhibited the highest level of agreement (r = 0.661, p < 0.01). The orthopedic attending and the senior resident had the next highest level of agreement (r = 0.543, p < 0.01). The first-year orthopedic resident had the weakest agreement across the board: with the orthopedic attending, the radiology attending, and the senior resident.
  
  
  CONCLUSIONS
  Regardless of specialty, experience and higher levels of training produce stronger agreement when measuring femoral version. Residents in training, especially those who are junior, produce weak agreement when compared to their senior colleagues.
  
  
  METHODS
  Level III, diagnostic study.
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th Street, Suite 1402, New York, NY, 10003, USA, yoonrich@gmail.com.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Yoon
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.forename: Neeraj M
authors.initials: NM
authors.lastname: Patel
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sirkin
authors.forename: Mark C
authors.initials: MC
authors.lastname: Reilly
authors.forename: Frank A
authors.initials: FA
authors.lastname: Liporace
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D015588:Observer Variation; D009985:Orthopedics / Q000193:education* / Q000592:standards; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data*; D055815:Young Adult