Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.

Altmetrics measure the digital attention received by a research output. They allow us to gauge the immediate social impact of an article by taking real-time measurements of how it circulates in the Internet. While there are several companies offering attention scores, the most extensive are Altmetric.com (Altmetric Attention Score—AAS) and Plum X (Plum Print). As this is an emerging topic, many medical specialities have tried to establish if there is a relationship between an article’s altmetric data and the citations it subsequently receives. The results have varied depending on the research field. In radiology, the social network most used is Twitter and the subspeciality with the highest AAS is neuroimaging. This article will review the process involved from the start when an article is published through to finally obtaining its altmetric score. It will also address the relationship between altmetrics and more traditional approaches focusing on citations in radiology and will discuss the advantages and limitations of these new impact indicators.

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Materials and methods: Clinical data and imaging from 90 patients with biopsy-proven spinal metastases, were provided to 83 specialists from 44 hospitals. Spinal levels involved and the Tomita and modified Bauer scores for each case were determined twice by each clinician, with a minimum of 6-week interval. Clinicians were blinded to every evaluation. Kappa statistic was used to assess intra and inter-observer agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery and radiation oncology), years of experience (67, 8-13, P14), and type of hospital (four levels).Results: For metastases identification, intra-observer agreement was ''substantial'' (0.60 < k < 0.80) at sacrum, and ''almost perfect'' (k > 0.80) at the other levels. Inter-observer agreement was ''almost perfect'' at lumbar spine, and ''substantial'' at the other levels. Intra-observer agreement for the Tomita and Bauer scores was almost perfect. Inter-observer agreement was almost perfect for the Tomita score and substantial for the Bauer one. Results were similar across specialties, years of experience and type of hospital. Conclusion: Agreement in the assessment of metastatic spine disease is high. These scoring systems can improve communication among clinicians involved in oncology care.