Jensen G F, McNair P, Boesen J, Hegedüs V
Eur J Radiol. 1984 Feb;4(1):1-3.
Observer variation in interpreting radiograph of the spine in 70-year-old Danish women has been examined. The women joined a general health investigation as part of an epidemiologic screening for osteoporosis. Two experienced radiologists examined independently 280 sets of lateral radiographs of the spine to disclose fractures. The radiographs were examined four times, each examined at two different occasions by each radiologist. Overall intra-observer agreement was 88% and 87% when asked for presence or absence of fractures, irrespective of fracture localization. When accidental occurrence of agreement was taken into account (kappa analysis) intra-observer variation was reduced to 64% and 62%. The overall inter-observer agreement was 75%, but reduced to 47% when accidental occurrence of agreement was noted. Kappa analysis in testing observer variation indicates that a considerable part of agreement can be ascribed to chance alone. This seriously questions the hitherto used definition of osteoporosis.
对70岁丹麦女性脊柱X光片解读中的观察者差异进行了研究。这些女性参加了一项一般健康调查，作为骨质疏松症流行病学筛查的一部分。两位经验丰富的放射科医生独立检查了280套脊柱侧位X光片以发现骨折情况。这些X光片被检查了四次，每位放射科医生在两个不同的场合各检查两次。当被问及是否存在骨折时，总体观察者内一致性在不考虑骨折部位的情况下分别为88%和87%。当考虑到偶然一致性（kappa分析）时，观察者内差异降至64%和62%。总体观察者间一致性为75%，但当注意到偶然一致性时降至47%。测试观察者差异的kappa分析表明，相当一部分一致性可能仅归因于偶然。这严重质疑了迄今为止使用的骨质疏松症定义。
