Inter- and intraexaminer reliability of the Blair protractoview method: examination of a chiropractic radiographic technique

Abstract

Objective: The purpose of this study was to evaluate the inter-and intraexaminer reliability of the Blair protractoview radiographic method. Methods: This retrospective study evaluated 25 participants attending a Blair technique seminar. Participants included chiropractic students and doctors of chiropractic with more than 11 years of experience. Participants evaluated 100 Blair protractoview radiographs (oblique nasium). A κ analysis was used to determine the inter-and intraexaminer reliability because of the nominal categorical value of the variables. For the interexaminer reliability, a κ score was given for each examiner combination. The scores were then averaged to give the total interexaminer reliability. Results: The overall interexaminer reliability showed substantial reliability at 0.62. Withingroup κ values were as follows: no certification = 0.61, proficiency = 0.66, primary level = 0.61, and advanced level = 0.74. The overall intraexaminer reliability showed outstanding reliability at 0.81. Within-group κ values were as follows: no certification = 0.76, proficiency = 0.84, primary level = 0.82, and advanced level = 0.92. All κ values had a P value b .001. Conclusion: The participants in this study showed good inter-and intraexaminer reliability using the Blair protractoview radiographic method.

Inter-Examiner Agreement of the National Upper Cervical Chiropractic Association Analysis of the Atlas Subluxation Complex in a 3-View Upper Cervical Radiographic Series

“…Film selection for this study may not reflect clinical practice since doctors in practice do not get to actively select films based on quality or anatomical anomalies. 1 , 4 This study used a convenience sample of radiographs with optimized quality intended to reduce variability, and all radiographs used were of acceptable quality for NUCCA board-certification films. Thus, this controlled environment does not necessarily reflect actual practice.…”

“…Future studies could consider using a random sample of films or consecutive films, a larger and random sample of NUCCA-certified doctor-examiners, and films showing no misalignment as a control group, and they could allow examiners to review the acceptability of film sets used in the study, as suggested by Hubbard. 4 …”

“…There are several studies that have looked at chiropractic doctors’ ability to reach inter-examiner agreement when analyzing cervical spine radiographs. 1 , 2 , 3 , 4 , 5 , 6 A 1985 study observed large ranges of error in analyses, concluding, “any measured differences produced using this system will be just as likely to be from marking error as from actual atlas position change.” 1 Another study concluded, “the side of atlas laterality (right or left) is in 100% agreement in this study.” 2 Other similar studies concluded adequate reliability in their analysis systems. 3 , 4 , 5 , 6 While these studies contributed to the body of literature, none had a large enough sample size or specifically addressed the reliability between doctors utilizing the National Upper Cervical Chiropractic Association (NUCCA) radiographic analysis protocol.…”

Chiropractic management of essential tremor and migraine: a case report

“…The radiographic series is taken to view the cervical articulations, giving the doctor an opportunity to visualize the state of potential juxtaposition of each cervical articulation. 10,28 This method of radiographic analysis is thought to eliminate the inherent error that may occur with line analysis techniques due to spinal asymmetry (Figs 3 and 4).…”