• Doktor K
• Lind Vilholm M
• Hardardóttir A
• Wulff Christensen H
• Lauritsen J

• Affiliation / Odense University Hospital. Orthopedic Department
• Affiliation / Private Practice
• Affiliation / University of Southern Denmark. Department of Sports Science and Clinical Biomechanics
• Affiliation / University of Southern Denmark. Institute of Clinical Medicine
• Affiliation(G) / Denmark / Herning
• Affiliation(G) / Denmark / Odense
• Affiliation(G) / Iceland / Reykjavik
• Diagnostic Imaging / standards
• Lumbar Vertebrae / diagnostic imaging
• Observer Variation
• Open Access Document
• Practice Guidelines as Topic
• Primary Care
• Quality Control

Background: The Commission of the European Communities has published guidelines to be used as a gold standard for quality assessment of diagnostic radiographic images. Image quality and radiation dose must be monitored and optimally balanced for diagnostic purposes on patients. The objective of the current study was to assess intra- and inter-observer reproducibility in less experienced observers using the proposed European Guidelines on Quality Criteria for Diagnostic Radiographic Images in a quality assessment of lumbar spine radiographs in primary chiropractic practice in Denmark.

Methods: Two observers initially evaluated lumbar spine radiographs randomly selected from fifty chiropractic clinics, all connected to the national PACS server (KirPACS) in Denmark. All evaluations were performed twice by both observers using a four-week interval and for compliance with the European Quality Criteria for Diagnostic Radiographic Images. Inter- and intra-observer reproducibility was calculated using kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed.

Results: The strength of the inter-observer agreement of general image quality at baseline ranged from moderate agreement (k = 0.47) to substantial agreement (k = 0.68). After four weeks, the inter-observer agreement still ranged from moderate agreement (k = 0.59) to substantial agreement (k = 0.71), but with increased agreement for both kappa coefficients. In relation to intra-observer agreement of general image quality, the strength for observer A ranged from moderate (k = 0.58) to substantial (k = 0.72) and the strength for observer B overall was substantial (k = 0.63–0.75).

Conclusion: The European Guidelines on Quality Criteria for Diagnostic Radiographic Images are considered a gold-standard and used in a method for quality assurance within the Danish chiropractic profession. The inter-rater and intra-rater agreements in this study, using the CEC-criteria, were found mostly acceptable. With appropriate attention to clear understanding of the individual criteria and sufficient training, this method is found to be reliable, even using less experienced observers, to carry out Diagnostic Radiographic Image Quality-assurance in primary care settings.

Author keywords: Agreement — Reliability — Reproducibility — EU-quality criteria —  EU-guidelines — Lumbar spine —  Radiographs — X-rays — Radiography — Chiropractor — Imaging — Primary practice — Primary care

Author affiliations: KD: Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; KD, MLV: Private chiropractic practice, Back Center Midwestern Jutland, Herning, Denmark; KD, HWC: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; AH: Private chiropractic practice, Reykjavik, Iceland; JL: Institute of Clinical Medicine, University of Southern Denmark, Odense, Denmark; JL:Orthopedic Department, Odense University Hospital, Odense, Denmark

This abstract is reproduced with the permission of the publisher; click on the above link for free full text. PubMed Record