title: Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort.
abstract: OBJECTIVE
  The purpose of our study was to investigate whether advanced, 3D computed tomographic (CT)-generated hip models improves inter-and intra-observer agreement when compared to plain radiographs in identifying femoroacetabular impingement (FAI) morphology.
  
  
  METHODS
  Eight consecutive patients who underwent surgery for FAI pathology were selected for this study. Preoperative CT scan image data were used to create high resolution, 3D hip reconstruction models. Four observers (two attending hip surgeons and radiologists) performed a blinded review of preselected radiographs and 3D CT hip models. Alpha and lateral center-edge angle measurements, location of cam lesion and the presence of a "crossover sign" were assessed. Inter- and intra-observer agreement was determined by calculating the intra-class correlation coefficients (ICC) or kappa coefficients to evaluate agreement for categorical variables.
  
  
  RESULTS
  The parameter that demonstrated the highest and poorest inter-observer agreement was the presence of a "crossover sign" using 3D CT-generated high resolution hip models (ICC = 0.76, p = 0.00) and anteroposterior pelvis radiography, respectively (ICC = 0.20, p = 0.02). Alpha angle values were significantly higher using plain radiographs when compared to 3D hip reconstruction models (61.1° ± 10.4° versus 55.4° ± 14.4°, p = 0.003). Furthermore, when compared to radiographs, 3D hip reconstruction models demonstrated significantly higher intra-observer agreement (ICC = 0.856 versus 0.405, p = 0.005) when determining the presence of a "crossover sign".
  
  
  CONCLUSIONS
  Our findings were suggestive that for most commonly used FAI morphology parameters, CT-generated hip models demonstrated little benefit over plain radiographs in improving inter-observer agreement among providers.
  
  
  METHODS
  III.
authors.affiliation: Raleigh Orthopaedic Clinic, 3001 Edwards Mill, Raleigh, NC, 27612, USA. ecadet@raleighortho.com.
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Cadet
authors.affiliation: Department of Orthopaedic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY, 10032, USA.
authors.forename: Oladapo M
authors.initials: OM
authors.lastname: Babatunde
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, R620, New York, NY, 10032, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Gorroochurn
authors.affiliation: Department of Orthopaedic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY, 10032, USA.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Radiology, Columbia University, 630 W 168th St Suite MC28, New York, NY, 10032, USA.
authors.forename: Agata
authors.initials: A
authors.lastname: Stancato-Pasik
authors.affiliation: Department of Radiology, Columbia University, 630 W 168th St Suite MC28, New York, NY, 10032, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Brown
authors.affiliation: Department of Orthopaedic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY, 10032, USA.
authors.forename: Skylar
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY, 10032, USA.
authors.forename: Philip Burns
authors.initials: PB
authors.lastname: Kaiser
authors.affiliation: Department of Orthopaedic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 622 W 168th Street, PH-11, New York, NY, 10032, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gardner
authors.affiliation: MacSports at McMaster University, 1200 Main Street West, Room 4E17, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging* / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072161:Orthopedic Surgeons; D011859:Radiography; D000072177:Radiologists; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography; Femoroacetabular impingement; Inter-observer agreement; Models