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Assessing the intra- and inter-reader reliability of dynamic ultrasound images in power Doppler ultrasonography
  1. J M Koski1,
  2. S Saarakkala2,
  3. M Helle3,
  4. U Hakulinen2,
  5. J O Heikkinen2,
  6. H Hermunen4,
  7. P Balint5,
  8. G A Bruyn6,
  9. E Filippucci7,
  10. W Grassi7,
  11. A Iagnocco8,
  12. R Luosujärvi9,
  13. B Manger10,
  14. E De Miguel11,
  15. E Naredo12,
  16. A K Scheel13,
  17. W A Schmidt14,
  18. I Soini15,
  19. M Szkudlarek16,
  20. L Terslev17,
  21. J Uson18,
  22. S Vuoristo19,
  23. H R Ziswiler20
  1. 1Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
  2. 2Department of Nuclear Medicine, Mikkeli Central Hospital, Mikkeli, Finland
  3. 3Department of Pathology, Mikkeli Central Hospital, Mikkeli, Finland
  4. 4Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
  5. 5Department of Third General and Paediatric Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  6. 6Department of Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  7. 7Department of Rheumatology, Universita Politecnica delle Marche, Ancona, Italy
  8. 8Department of Rheumatology, University La Sapienza, Rome, Italy
  9. 9Department of Rheumatology, University Hospital, Helsinki, Finland
  10. 10Department of Rheumatology, University of Erlanger, Erlanger, Germany
  11. 11Department of Rheumatology, Hospital La Paz, Madrid, Spain
  12. 12Department of Rheumatology, Research Unit, and Epidemiology Unit, Severo Ochoa Hospital, Madrid, Spain
  13. 13Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Germany
  14. 14Department of Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
  15. 15Department Radiology, Rheumatism Foundation Hospital, Heinola, Finland
  16. 16Department of Rheumatology, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark
  17. 17Department of Rheumatology, The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
  18. 18Department of Rheumatology, Hospital de Mostoles, Madrid, Spain
  19. 19Department of Pediatry, Rheumatism Foundation Hospital, Heinola, Finland
  20. 20Department of Rheumatology and Clinical Immunology, Inselspital, Bern, Switzerland
  1. Correspondence to:
    J Koski
    Mikkeli Central Hospital, Porrassalmenkatu 35–37, Fin-50100 Mikkeli, Finland; f.koski{at}


Objective: To assess the intra-reader and inter-reader reliabilities of interpreting ultrasonography by several experts using video clips.

Method: 99 video clips of healthy and rheumatic joints were recorded and delivered to 17 physician sonographers in two rounds. The intra-reader and inter-reader reliabilities of interpreting the ultrasound results were calculated using a dichotomous system (normal/abnormal) and a graded semiquantitative scoring system.

Results: The video reading method worked well. 70% of the readers could classify at least 70% of the cases correctly as normal or abnormal. The distribution of readers answering correctly was wide. The most difficult joints to assess were the elbow, wrist, metacarpophalangeal (MCP) and knee joints. The intra-reader and inter-reader agreements on interpreting dynamic ultrasound images as normal or abnormal, as well as detecting and scoring a Doppler signal were moderate to good (κ = 0.52–0.82).

Conclusions: Dynamic image assessment (video clips) can be used as an alternative method in ultrasonography reliability studies. The intra-reader and inter-reader reliabilities of ultrasonography in dynamic image reading are acceptable, but more definitions and training are needed to improve sonographic reproducibility.

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  • See linked article, p 1590

  • The study was supported by an EVO grant.

  • Competing interests: None.

  • This study has been approved by the local ethics committee and all patient and volunteers gave their informed consent.

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