title: Reliability and Accuracy of Cross-sectional Radiographic Assessment of Severe Knee Osteoarthritis: Role of Training and Experience.
abstract: To dêtermine the reliability of radiographic assessment of knee osteoarthritis (OA) by nonclinician readers compared to an experienced radiologist.
  
  
  
  The radiologist trained 3 nonclinicians to evaluate radiographic characteristics of knee OA. The radiologist and nonclinicians read preoperative films of 36 patients prior to total knee replacement. Intrareader and interreader reliability were measured using the weighted κ statistic and intraclass correlation coefficient (ICC). Scores κ < 0.20 indicated slight agreement, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, and 0.81-1.0 almost perfect agreement.
  
  
  
  Intrareader reliability among nonclinicians (κ) ranged from 0.40 to 1.0 for individual radiographic features and 0.72 to 1.0 for Kellgren-Lawrence (KL) grade. ICC ranged from 0.89 to 0.98 for the Osteoarthritis Research Society International (OARSI) summary score. Interreader agreement among nonclinicians ranged from κ of 0.45 to 0.94 for individual features, and 0.66 to 0.97 for KL grade. ICC ranged from 0.87 to 0.96 for the OARSI Summary Score. Interreader reliability between nonclinicians and the radiologist ranged from κ of 0.56 to 0.85 for KL grade. ICC ranged from 0.79 to 0.88 for the OARSI Summary Score.
  
  
  
  Intrareader and interreader agreement was variable for individual radiograph features but substantial for summary KL grade and OARSI Summary Score. Investigators face tradeoffs between cost and reader experience. These data suggest that in settings where costs are constrained, trained nonclinicians may be suitable readers of radiographic knee OA, particularly if a summary score (KL grade or OARSI Score) is used to determine radiographic severity.
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Kristina
authors.initials: K
authors.lastname: Klara
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Collins
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Ellen
authors.initials: E
authors.lastname: Gurary
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Elman
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Derek S
authors.initials: DS
authors.lastname: Stenquist
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School. jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: INTERREADER RELIABILITY; KNEE OSTEOARTHRITIS; RADIOGRAPHY; RELIABILITY