title: Agreement among orthodontists experienced with cone-beam computed tomography on the need for follow-up and the clinical impact of craniofacial findings from multiplanar and 3-dimensional reconstructed views.
abstract: BACKGROUND
  In this study, we aimed to assess interrater and intrarater agreement among orthodontic clinicians in their assessments of reported incidental findings in regard to both the need for additional follow-up and the impact on future orthodontic treatment in large-field maxillofacial cone-beam computed tomography (CBCT) imaging.
  
  
  METHODS
  The study sample consisted of 18 nonrandomly selected large-field maxillofacial CBCT volumes containing a reported total of 88 radiographic findings. All scans were associated with formal radiologic reports. However, the suggestions of further follow-up were removed from the radiologic reports so as to not bias the 3 evaluating orthodontists in their subsequent decision making. The evaluators had on average 7.6 years of CBCT usage and self-interpretation experience. Reliability was determined by quantifying the level of agreement between the evaluators' assessments for both research questions for all 88 findings using a binary response (yes/no) as the outcome measure. The Cohen kappa statistic was calculated to quantify intrarater and interrater agreement globally for both statements.
  
  
  RESULTS
  Although interrater agreement was considerable, potential decisions with clinical impact were not consistent. This needs to be considered when interpreting maxillofacial incidental findings. Evaluators demonstrated higher levels of agreement for dentoalveolar findings compared with all other extragnathic regions when assessing clinical significance.
  
  
  CONCLUSIONS
  Among the evaluators who were considered experienced in CBCT, "fair-to-good" interrater agreement and "excellent" intrarater agreement were demonstrated in terms of the need for further follow-up and their potential impact on future orthodontic treatment.
authors.affiliation: Private practice, Red Deer, Alberta, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Assistant professor, Division of Oral Medicine, Pathology and Radiology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Noura
authors.initials: N
authors.lastname: Alsufyani
authors.affiliation: Associate professor, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Giseon
authors.initials: G
authors.lastname: Heo
authors.affiliation: Professor and head, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: carlosflores@ualberta.ca.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003657:Decision Making; D003815:Dentists / Q000523:psychology*; D005147:Facial Bones / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D033162:Incidental Findings; D009668:Nose Diseases / Q000000981:diagnostic imaging; D015588:Observer Variation; D009970:Orthodontics; D010026:Osteosclerosis / Q000000981:diagnostic imaging; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging; D014095:Tooth, Impacted / Q000000981:diagnostic imaging; D014096:Tooth, Supernumerary / Q000000981:diagnostic imaging; D055815:Young Adult