Evaluation of interobserver variability of parenchymal phase of Tc-99m mercaptoacetyltriglycine and Tc-99m dimercaptosuccinic acid renal scintigraphy

Erdoğan, Zeynep; Abdülrezzak, Ümmühan; Silov, Güler; Özdal, Ayşegül; Turhal, Özgül

doi:10.4103/0972-3919.130288

Cited by 3 publications

(6 citation statements)

References 13 publications

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“…Three nuclear medicine experts who have more than 20 years of experience in nuclear medicine were also recruited. It has been recognized that residents may not perform as well as experts due to their lack of training and limited experience …”

Section: Renal Studymentioning

confidence: 99%

“…It has been recognized that residents may not perform as well as experts due to their lack of training and limited experience. 12,13,20 An intervention called CAD was recently introduced by Emory researchers to minimize errors and reduce the interobserver variability among practicing radiologists. The CAD analyzes renal image data and provides a second opinion about the diagnosis with reasoning.…”

Section: Renal Studymentioning

confidence: 99%

“…It has been recognized that residents may not perform as well as experts due to their lack of training and limited experience. 12,13,20…”

Section: Renal Studymentioning

confidence: 99%

“…c Sample mean of 1000 bootstrap standard error estimates. d Proportion of 1000 estimated 95% upper confidence limits computed using formula(20) that are greater than the true value.…”

mentioning

confidence: 99%

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Overall indices for assessing agreement among multiple raters

Jang

Manatunga

Taylor

et al. 2018

Statistics in Medicine

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The need to assess agreement exists in various clinical studies where quantifying inter-rater reliability is of great importance. Use of unscaled agreement indices, such as total deviation index and coverage probability (CP), is recommended for two main reasons: (i) they are intuitive in a sense that interpretations are tied to the original measurement unit; (ii) practitioners can readily determine whether the agreement is satisfactory by directly comparing the value of the index to a prespecified tolerable CP or absolute difference. However, the unscaled indices were only defined in the context of comparing two raters or multiple raters that assume homogeneity of variances across raters. In this paper, we introduce a set of overall indices based on the root mean square of pairwise differences that are unscaled and can be used to evaluate agreement among multiple raters that often exhibit heterogeneous measurement processes in practice. Furthermore, we propose another overall agreement index based on the root mean square of pairwise differences that is scaled and extends the concept of the recently proposed relative area under CP curve in the presence of multiple raters. We present the definitions of overall indices and propose inference procedures in which bootstrap methods are used for the estimation of standard errors. We assess the performance of the proposed approach and demonstrate its superiority over the existing methods when raters exhibit heterogeneous measurement processes using simulation studies. Finally, we demonstrate the application of our methods using a renal study.

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Section: Renal Studymentioning

confidence: 99%

Section: Renal Studymentioning

confidence: 99%

“…It has been recognized that residents may not perform as well as experts due to their lack of training and limited experience. 12,13,20…”

Section: Renal Studymentioning

confidence: 99%

“…c Sample mean of 1000 bootstrap standard error estimates. d Proportion of 1000 estimated 95% upper confidence limits computed using formula(20) that are greater than the true value.…”

mentioning

confidence: 99%

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Overall indices for assessing agreement among multiple raters

Jang

Manatunga

Taylor

et al. 2018

Statistics in Medicine

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“…However, inconsistencies in methodology and inter- and intraobserver variability in the interpretation of DMSA scans have been an ongoing concern. Published studies have reported a variable rate of reproducibility in scan interpretation, ranging from poor [7,8] to high [7,9–12]. Various guidelines have attempted to improve the quality of DMSA scans and interpretation of the results.…”

Section: Introductionmentioning

confidence: 99%

Interobserver variability for interpretation of DMSA scans in the RIVUR trial

Mattoo

Skoog

Gravens-Mueller

et al. 2017

Journal of Pediatric Urology

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Summary Introduction Technetium-99m dimercaptosuccinic acid (DMSA) renal scans are used in the diagnosis of renal scarring. In the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial that randomized 607 children, DMSA renal scans were used for evaluating the presence and the severity of renal scarring. Objective The aim was to determine interobserver variability in reporting of DMSA renal scans in the RIVUR trial. Study design We compared DMSA renal scan reports for renal scarring and acute pyelonephritis from all non-reference local radiologists (ALRs) at study sites with adjudicated as well as non-adjudicated reports from two reference radiologists (RRs) of the RIVUR trial. Two-way comparisons of concordant and discrepant responses were analyzed using an unweighted kappa statistic between the ALR and the adjudicated RR interpretations. All analyses were performed using SAS v 9.4 (SAS institute 2015) and significance was determined at the 0.05 level. Results Of the 2,872 kidneys evaluated, adjudicated RR reports had 119 (4%) kidneys with renal scarring compared with 212 (7%) by the ALRs. For 79% kidneys the grading for scarring reported by ALRs was either upgraded (24%) or downgraded (55%) by RRs. For acute pyelonephritis (n = 2,924), adjudicated RR reports had 85 (3%) kidneys with pyelonephritis compared with 151 (5%) by the ALRs. For 85% kidneys, the grading for pyelonephritis reported by the ALRs was either upgraded (28%) or downgraded (57%) by the RRs. A three-way comparison revealed that all three (RR1, RR2, and ALR) agreed over presence of renal scarring in 19% cases and two of the three agreed in 80% cases (Table). The respective numbers for pyelonephritis were 13% and 84%. The agreement rate for all DMSA scan reports between the RRs and the ALRs was 93%. Discussion The study revealed significant interobserver variability in the reporting of abnormal DMSA renal scans compared with the previously published studies. A noteworthy limitation was a lack of uniformity in local reporting of the scans. Conclusions Our study highlights the need for optimizing the clinical yield of DMSA renal scans by more specific guidelines, particularly for standardized and uniform interpretation.

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Interobserver Variability in Interpretation of Planar and SPECT Tc-99m-DMSA Renal Scintigraphy in Children

Bešlić¹,

Milardović²,

Šadija³

et al. 2017

Acta Inform Med

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Objective:This study objective was to evaluate interobserver agreement between individual pairs of three nuclear medicine physicians in interpretation of renal cortical scintigraphy in children with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right).Materials and Methods:Thirty children were imaged in planar and SPECT mode per protocol upon the injection of Tc-99m DMSA dose adjusted to their body weight. Patients were classified according to diagnoses into four groups. Three nuclear medicine physicians interpreted the findings blindly and independently. Renal defects were interpreted as focal and diffuse, per three renal segments. For the raters we calculated simple percentage agreement, the Cohen kappa statistic with 95% confidence intervals, and the overall kappa defining the levels of reliability as almost perfect or perfect, substantial, moderate, fair and slight agreement.Results:Interobserver agreement in planar interpretation was 77,2% (kappa=0.59; 95% confidence interval, 0.41 to 0.75) and SPECT 72,9% (kappa= 0,57; 95% confidence interval, 0,41 to 0,72). In planar interpretation, all individual pairs had moderate agreements except one that had a substantial agreement. In SPECT, all the pairs had moderate agreements except one that had an almost perfect agreement. Overall agreement per kidney site was on planar 73,4% for the left (kappa=0,54, moderate agreement), and 81,1% for the right kidney (kappa 0,63, substantial agreement). On SPECT, there was 72,2% agreement for the left (kappa=0,59, mode rate agreement), and 73,7% for the right kidney (kappa=0,54, moderate agreement). Overall agreement per diagnoses ranged from 70-88,9% on planar (kappa= -0,04 to 0,79), and 50-100% on SPECT (kappa=-0,02-1,000) indicating agreements from slight to substantial.Discussion:Our results suggest acceptable levels of interobserver agreement in all individual pairs of raters with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right). For the mode of acquisition, we would recommend hybrid imaging SPECT/CT method to be used whenever possible in the detection of renal cortical defects on Tc-99m-DMSA scintigraphy.

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Evaluation of interobserver variability of parenchymal phase of Tc-99m mercaptoacetyltriglycine and Tc-99m dimercaptosuccinic acid renal scintigraphy

Cited by 3 publications

References 13 publications

Overall indices for assessing agreement among multiple raters

Overall indices for assessing agreement among multiple raters

Interobserver variability for interpretation of DMSA scans in the RIVUR trial

Interobserver Variability in Interpretation of Planar and SPECT Tc-99m-DMSA Renal Scintigraphy in Children

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