UNASSIGNED: The reliability of interpretation of coronary angiography as a diagnostic tool was investigated. Furthermore, the impact of interobserver variability of coronary lesions on clinical decision-making was assessed. One of our motivations to do this research was the research gaps and our aim to have up-to-date information regarding interobserver variability among different cardiologists.
UNASSIGNED: Our objective was to quantify interobserver variability among cardiologists who have seen angiograms independently. Disagreement among cardiologists in the visual assessment of invasive coronary angiography of coronary artery stenosis is not uncommon in previous studies. Three cardiologists with extensive experience in coronary angiography, including the primary cardiologist of each patient, read the angiograms of 200 patients from Toronto General Hospital independently.
UNASSIGNED: Our research showed the mean agreement among all participating observers was 77.4%; therefore, the interobserver variability of coronary angiography interpretation was 22.6%.
UNASSIGNED: Coronary angiography is still the gold-standard technique for guidance regarding coronary lesions. Sometimes, coronary angiography results in underestimation or overestimation of a lesion\'s functional severity. Interobserver variability should also be considered when interpreting the severity of coronary stenoses via invasive coronary angiography. This research shows that interobserver variability regarding coronary angiograms is still present (22.6%).
Plain language summary: The gold-standard method for diagnosing coronary stenosis, invasive coronary angiography has some challenges too. One of these challenges has been the difference among various cardiologists regarding determination of severity of each coronary stenosis. In this study, we focused on differences in interobserver variability in coronary angiography interpretation. Three cardiologists who were experienced in coronary angiography read each patient’s coronary angiogram separately. Overall, 200 patients with a history of angiography at Toronto General Hospital were selected randomly. The research showed that overall agreement among all participating cardiologists with regard to the reading of coronary angiograms was 77.4%. In other words, interobserver variability of 22.6% was seen among the readers.

BACKGROUND: Endoscopy scoring is a key component in the diagnosis of ulcerative colitis (UC) and Crohn\'s disease (CD). Variability in endoscopic scoring can impact patient trial eligibility and treatment effect measurement. In this study, we examine inter- and intraobserver variability of inflammatory bowel disease endoscopic scoring systems in a systematic review and meta-analysis.
METHODS: We included observational studies that evaluated the inter- and intraobserver variability using UC (endoscopic Mayo Score [eMS], Ulcerative Colitis Endoscopic Index of Severity [UCEIS]) or CD (Crohn\'s Disease Endoscopic Index of Severity [CDEIS], Simple Endoscopic Score for Crohn\'s Disease [SES-CD]) systems among adults (≥18 years of age) and were published in English. The strength of agreement was categorized as fair, moderate, good, and very good.
RESULTS: A total of 6003 records were identified. After screening, 13 studies were included in our analysis. The overall interobserver agreement rates were 0.58 for eMS, 0.66 for UCEIS, 0.80 for CDEIS, and 0.78 for SES-CD. The overall heterogeneity (I2) for these systems ranged from 93.2% to 99.2%. A few studies assessed the intraobserver agreement rate. The overall effect sizes were 0.75 for eMS, 0.87 for UCEIS, 0.89 for CDEIS, and 0.91 for SES-CD.
CONCLUSIONS: The interobserver agreement rates for eMS, UCEIS, CDEIS, and SES-CD ranged from moderate to good. The intraobserver agreement rates for eMS, UCEIS, CDEIS, and SES-CD ranged from good to very good. Solutions to improve interobserver agreement could allow for more accurate patient assessment, leading to richer, more accurate clinical management and clinical trial data.
This study examined the inter- and intraobserver variability of inflammatory bowel disease endoscopic scoring systems (endoscopic Mayo Score, Ulcerative Colitis Endoscopic Index of Severity, Crohn’s Disease Endoscopic Index of Severity, Simple Endoscopic Score for Crohn’s Disease) in a systematic review and meta-analysis.

A significant interobserver variability (IOV) for clinical target volume of the primary tumor (CTVp) delineation was shown in a previous national review project. Since then, international expert consensus guidelines (CG) for the delineation of CTVp were published. The aim of this follow-up study was to 1) objectify the extent of implementation of the CG, 2) assess its impact on delineation quality and consistency, 3) identify any remaining ambiguities.
All Belgian RT departments were invited to complete an online survey and submit CTVp for 5 reference cases. Organs at risk and GTV of the primary tumor were predefined. Margins, volumes, IOV between all participating centers (IOVall) and IOV compared to a reference consensus delineation (IOVref) were calculated and compared to the previous analysis. A qualitative analysis was performed assessing the correct interpretation of the CG for each case.
17 RT centers completed both survey and delineations, of which 88% had implemented CG. Median DSCref for CTVp_total was 0.80-0.92. IOVall and IOVref improved significantly for the centers following CG (p = 0.005). IOVref for CTVp_high was small with a DSC higher than 0.90 for all cases. A significant volume decrease for the CTVp receiving 70 Gy was observed. Interpretation of CG was more accurate for (supra)glottic carcinoma. 60% of the radiation oncologists thinks clarification of CG is indicated.
Implementation of consensus guidelines for CTVp delineation is already fairly advanced on a national level, resulting in significantly increased delineation uniformity. The accompanying substantial decrease of CTV receiving high dose RT calls for caution and correct interpretation of CG. Clarification of the existing guidelines seems appropriate especially for oropharyngeal and hypopharyngeal carcinoma.

Positron emission tomography with computed tomography (PET/CT) and magnetic resonance imaging (MRI) could improve accuracy in target volume determination for gastrointestinal cancers. A systematic search of the PubMed database was performed, focusing on studies published within the last 20 years. Articles were considered eligible for the review if they included patients with anal canal, esophageal, rectal or pancreatic cancer, as well as PET/CT or MRI for radiotherapy treatment planning, and if they reported interobserver variability or changes in treatment planning volume due to different imaging modalities or correlation between the imaging modality and histopathologic specimen. The search of the literature retrieved 1396 articles. We retrieved six articles from an additional search of the reference lists of related articles. Forty-one studies were included in the final review. PET/CT seems indispensable for target volume determination of pathological lymph nodes in esophageal and anal canal cancer. MRI seems appropriate for the delineation of primary tumors in the pelvis as rectal and anal canal cancer. Delineation of the target volumes for radiotherapy of pancreatic cancer remains challenging, and additional studies are needed.

This study evaluates the impact of second-opinion review of multiparametric prostate MRI for cancer detection by a multidisciplinary review board at a tertiary care center when compared with the initial community radiologist interpretation.
Cases were collected retrospectively from multidisciplinary prostate MRI rounds from 2017 to 2020 at a single tertiary care center. Patients with suspected prostate cancer or on active surveillance were referred for consideration of TRUS/MRI-fusion biopsy based on community-read prostate MRIs. All MRIs were re-read by subspecialized abdominal radiologists and a PI-RADS score assigned. Targeted fusion and 8-12 core systematic biopsy was performed in patients with PIRADS ≥ 3 lesions. Cohen kappa values were used to quantify interobserver agreement. Positive predictive value (PPV) was used to determine accuracy of PI-RADS score for detection of clinically significant prostate cancer (csPCa) (ISUP Grade Group ≥ 2).
Three hundred and thirty-two lesions in 303 patients were reviewed and 252 lesions in 198 patients biopsied. The PI-RADS score was concordant in 60.5% of lesions, downgraded in 17.8%, and upgraded in 7.8%. Agreement between community and tertiary center interpretation was fair (κ = 0.354), with greater agreement for PI-RADS ≥ 4 (κ = 0.523) than PI-RADS ≥ 3 (κ = 0.456), and peripheral zone (κ = 0.419) than transition zone lesions (κ = 0.251). Prevalence of csPCa in biopsied lesions was 40.9%.
There is variability in community and tertiary care center interpretation of prostate MRI in cancer detection, with higher concordance rates for higher grade and peripheral zone lesions. These differences demonstrate the added value of multidisciplinary round review and highlight the need for ongoing education and feedback.

Volume delineation is a well-recognised potential source of error in radiotherapy. Whilst it is important to quantify the degree of interobserver variability (IOV) in volume delineation, the resulting impact on dosimetry and clinical outcomes is a more relevant endpoint. We performed a literature review of studies evaluating IOV in target volume and organ-at-risk (OAR) delineation in order to analyse these with respect to the metrics used, reporting of dosimetric consequences, and use of statistical tests.
Medline and Pubmed databases were queried for relevant articles using keywords. We included studies published in English between 2000 and 2014 with more than two observers.
119 studies were identified covering all major tumour sites. CTV (n=47) and GTV (n=38) were most commonly contoured. Median number of participants and data sets were 7 (3-50) and 9 (1-132) respectively. There was considerable heterogeneity in the use of metrics and methods of analysis. Statistical analysis of results was reported in 68% (n=81) and dosimetric consequences in 21% (n=25) of studies.
There is a lack of consistency in conducting and reporting analyses from IOV studies. We suggest a framework to use for future studies evaluating IOV.