The intraobserver and interobserver variability of common radiographic measurements associated with hip dysplasia from plain and digital radiographs was assessed. Only the interobserver reliability of measuring Hilgenreiner's distance was found to be potentially clinically significant. The average Spearman correlation coefficients between groups were 0.81 acetabular index, 0.80 medial teardrop to medial metaphysis distance, and 0.77 Hilgenreiner's distance. The average difference between digital and plain radiographs was acetabular index 0.97 +/- 0.6 degrees, medial teardrop to medial metaphysis distance 0.5 +/- 0.56 mm, and Hilgenreiner's distance 0.41 +/- 0.78 mm. These values are clinically insignificant; therefore, digital radiographs are as reliable as conventional radiographs in assessing hip dysplasia.
[Show abstract][Hide abstract] ABSTRACT: Radiographic evaluation provides essential information regarding the diagnosis and treatment of musculoskeletal disorders. We evaluated the ability of hip specialists to reliably identify important radiographic features and to make a diagnosis based on plain radiographs alone. Five hip specialists and one fellow performed a blinded radiographic review of 25 control hips, 25 hips with developmental dysplasia (DDH), and 27 with femoroacetabular impingement (FAI). On two separate occasions, readers assessed acetabular version, inclination and depth, position of the femoral head center, head sphericity, head-neck offset, Tönnis grade, and joint congruency. Observers made a diagnosis categorizing each hip as normal, dysplastic, FAI, or combined DDH and FAI (features of both). Reliability was determined using Cohen's kappa coefficient. Intraobserver values were highest for acetabular inclination (kappa = 0.72) and determination of femoral head center position (kappa = 0.77). Interobserver reliability values were highest for acetabular inclination (kappa = 0.61) and Tönnis osteoarthritis grade (kappa = 0.59). All other measurements, including diagnosis, had kappa values less than 0.55. We concluded many of the standard radiographic parameters used to diagnose DDH and/or FAI are not reproducible. Accordingly, a more clear set of definitions and measurements must be developed to allow for more reliable diagnosis of early hip disease.
Clinical Orthopaedics and Related Research 03/2009; 467(3):666-75. DOI:10.1007/s11999-008-0626-4 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Salted and seasoned short-necked clam (Tapes Philippinarum; SNC) and its major ingredients, red hot pepper powder, ginger, garlic and onion were irradiated at 0.5, 1, 2 and 5kGy, respectively, and the microbiological and sensory quality were evaluated. The water activities of SNC and red pepper powder were 0.91 and 0.56, respectively, and others were higher than 0.97. The initial microbial populations of SNC were approximately 3.99, 4.38 and 2.22 log CFU/g for total aerobic bacteria, yeast and mold, and coliform bacteria. The highest contamination of total aerobic bacteria was detected from ground ginger among ingredients at 5.51 log CFU/g. Electron-beam irradiation (0, 0.5, 1, 2 and 5kGy) significantly reduced the initial microbial level of SNC and its ingredients not only immediately after irradiation, but also during storage at 10°C for 4 weeks (p
[Show abstract][Hide abstract] ABSTRACT: The between-observer reliability of repeated anatomic assessments in pediatric orthopedics relies on the precise definition of bony landmarks for measuring angles, indexes, and lengths of joints, limbs, and spine. We have analyzed intra- and interobserver reliability with a new digital measurement system (TraumaCad Wizard™).
Five pediatric orthopedic surgeons measured 50 digital radiographs on three separate days using the TraumaCad system. There were 10 anterior-posterior (AP) pelvic views from developmental dysplasia of the hip (DDH) patients, 10 AP pelvic views from cerebral palsy (CP) patients, 10 AP standing view of the lower limb radiographs from leg length discrepancy (LLD) patients, and 10 AP and 10 lateral spine X-rays from scoliosis patients. All standing view of the lower limb radiographs were calibrated by the software to allow for accurate length measurements, using as reference a 1-inch metal ball placed at the level of the bone. Each observer performed 540 measurements (totaling 2,700). We estimated intra- and interobserver standard deviations for measurements in all categories by specialists and nonspecialists. The intraclass correlation coefficient (ICC) summarized the overall accuracy and precision of the measurement process relative to subject variation. We examined whether the relative accuracy of a measurement is adversely affected by the number of bony landmarks required for making the measurement.
The overall ICC was >0.74 for 13 out of 18 measurements. Accuracy of the acetabular index for DDH was greater than for CP and relatively low for the center-edge angle in CP. Accuracy for bone length was better than for joint angulations in LLD and for the Cobb angle in AP views compared to lateral views for scoliosis. There were no clinically important biases, and most of the differences between specialists and nonspecialists were nonsignificant. The correlation between the results according to the number of bony landmarks that needed to be identified was also nonsignificant.
Digital measurements with the TraumaCad system are reliable in terms of intra- and interobserver variability, making it a useful method for the analysis of pathology on radiographs in pediatric orthopedics.
Journal of Children s Orthopaedics 08/2010; 4(4):331-41. DOI:10.1007/s11832-010-0259-5
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