Assessment of Low‐cost Teleradiology for Grading Elbow Dysplasia

Abstract

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.

Intraobserver and interobserver agreement on the radiographical diagnosis of canine cranial cruciate ligament rupture

“…Depending on the parameters, the intraobserver and interobserver agreement ranged from fair to almost perfect 21 . In a study on teleradiology for grading elbow dysplasia, interobserver agreement between a radiologist and an orthopaedic surgeon was low (k=0.12) 22 . Whereas for hip dysplasia, the interpretation of standard hip extended radiographs by experienced observers resulted in a slight to almost perfect intraobserver agreement, the overall interobserver agreement was far worse (k=0.52) compared with the interpretation of stifles, even though the hip dysplasia study only included experienced observers 18 …”

“…This is important because it has already been demonstrated for several other orthopaedic disorders that the consensus on the assessment of radiographs is oten low, which might lead to erroneous diagnosis and treatment and in the end, can afect the clinical outcome. [18][19][20][21][22] Additionally, accurate phenotypical classiication is important as misclassiication can lead to non-conclusive results in genetic studies. 23…”

“…The purpose of this study was to examine the intraobserver and interobserver agreement and the influence of level of expertise on the interpretation of radiographic images of the stifle in dogs with and without CCLR. This is important because it has already been demonstrated for several other orthopaedic disorders that the consensus on the assessment of radiographs is often low, which might lead to erroneous diagnosis and treatment and in the end, can affect the clinical outcome 18–22 . Additionally, accurate phenotypical classification is important as misclassification can lead to non‐conclusive results in genetic studies 23 …”

DICOM Standard Conformance in Veterinary Medicine in Germany: a Survey of Imaging Studies in Referral Cases

“…In veterinary referral cases, when a veterinary practitioner refers an animal patient to a veterinary clinic for further diagnostic imaging or treatment, the initial radiographs are usually transmitted on digital media (compact disk, USB flash drive) or via email or cloud services [6][7][8]. Based on the growing proportion of digital imaging in the last decade, there is increasing exchange of digital imaging data and metadata between practices and clinics; teleradiology is also well established in veterinary medicine [9][10][11].…”

Interobserver agreement in interpretation of radiographic pulmonary changes in dogs in relation to radiology training

“…Interobserver variations in veterinary diagnostic imaging have been reported in a number of studies (LAMB;DU;MANTIS, 2007;HAMMOND et al, 2008;DUKES-McEWAN;FRENCJ;COCORAN, 2002). However, there are few studies that emphasize the effects of differences in training (LAMB; DU; MANTIS, 2007;ZWINGENBERGER et al, 2011).…”