title: Diagnosis of vertebral fractures on lateral chest X-ray: intraobserver agreement of semi-quantitative vertebral fracture assessment.
abstract: BACKGROUND
  In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays.
  
  
  METHODS
  To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately,blinded and in different time periods. Agreement and Cohens' kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures.
  
  
  RESULTS
  109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95-98%for the two levels of fracturing, with a Cohen's kappa of 0.88-0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81-0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001).
  
  
  CONCLUSIONS
  The results show good agreement and intraobserver reliability on the X-chest compared to the X-Tspine for visualizing vertebral fractures. The results of this study emphasizes that the routinely performed X-chest is reliable in order to diagnose vertebral fractures.
authors.affiliation: Department of Geriatrics, Slotervaart Hospital, Amsterdam, The Netherlands; Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands. Electronic address: Hvanderjagt@spaarneziekenhuis.nl.
authors.forename: H C
authors.initials: HC
authors.lastname: van der Jagt-Willems
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: van Munster
authors.affiliation: Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Leeflang
authors.affiliation: Department of Radiology, Slotervaart Hospital, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Beuerle
authors.affiliation: Department of Geriatrics, Slotervaart Hospital, Amsterdam, The Netherlands.
authors.forename: C R
authors.initials: CR
authors.lastname: Tulner
authors.affiliation: Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*