University of Alberta, Edmonton, Alberta, Canada.
Arthritis Care Res (Hoboken). 2014 Jan;66(1):55-62. doi: 10.1002/acr.22083.
To develop and validate a reference image module aimed at calibration of readers using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) to assess radiographic progression in spondyloarthritis.
Our working group comprised 6 rheumatologists and 3 musculoskeletal radiologists. The following developmental steps were conducted: (1) review of the literature to identify aspects of the mSASSS requiring methodologic clarity; (2) independent assessment of baseline and 2-year radiographs from 25 patients using the mSASSS (pilot exercise); (3) development of a training module (the Spondyloarthritis Radiography [SPAR] module) that clarifies definitions, rules, and scoring methodology and a set of reference radiographic images; (4) scoring exercise 1 by 6 readers on 39 patients, where baseline and 2-year radiographs were scored blinded to time point; and (5) revision of the SPAR module followed by scoring exercise 2 conducted by the same 6 readers on 35 patients. Reliability of status and 2-year change scores was assessed by the intraclass correlation coefficient (ICC) method.
ICCs for change scores for the radiologist reader pair improved from 0.46 to 0.62 after minimal calibration with the SPAR module. Recalibration from exercise 1 to exercise 2 with the SPAR module led to substantial improvement in interreader reliability for change in mSASSS score from ICC 0.44 (range 0.31-0.62) to ICC 0.62 (range 0.34-0.84). Simultaneous assessment of anteroposterior and lateral lumbar radiographs did not enhance reliability or detection of progression.
Calibration according to the SPAR module led to improved reliability in the scoring of the mSASSS, even for expert readers.
开发和验证一个参考图像模块，旨在使用改良的 Stoke 强直性脊柱炎脊柱评分（mSASSS）校准读者，以评估脊柱关节炎的放射学进展。
我们的工作组由 6 名风湿病学家和 3 名肌肉骨骼放射科医生组成。进行了以下开发步骤：（1）回顾文献，以确定 mSASSS 需要方法学明确的方面；（2）使用 mSASSS 对 25 名患者的基线和 2 年 X 线片进行独立评估（试点练习）；（3）开发一个培训模块（脊柱关节炎放射学[SPAR]模块），阐明定义、规则和评分方法以及一组参考放射图像；（4）由 6 名读者对 39 名患者进行评分练习 1，基线和 2 年 X 线片在不了解时间点的情况下进行评分；（5）修订 SPAR 模块，然后由同一 6 名读者对 35 名患者进行评分练习 2。状态和 2 年变化评分的可靠性通过组内相关系数（ICC）法评估。
经过 SPAR 模块的最小校准，放射科医生读者对变化评分的 ICC 从 0.46 提高到 0.62。使用 SPAR 模块从练习 1 重新校准到练习 2，导致 mSASSS 评分变化的读者间可靠性显着提高，ICC 从 0.44（范围 0.31-0.62）提高到 0.62（范围 0.34-0.84）。同时评估前后和侧位腰椎 X 线片并没有提高可靠性或检测进展。
根据 SPAR 模块进行校准可提高 mSASSS 评分的可靠性，即使对专家读者也是如此。
