Effect of Online Training on the Reliability of Assessing Sacroiliac Joint Radiographs in Axial Spondyloarthritis: A Randomized, Controlled Study

Anna E F Hadsbjerg; Mikkel Østergaard; Joel Paschke; Raphael Micheroli; Susanne J Pedersen; Adrian Ciurea; Michael J Nissen; Kristyna Bubova; Stephanie Wichuk; Manouk de Hooge; Simon Krabbe; Ashish J Mathew; Monika Gregová; Marie Wetterslev; Karel Gorican; Karlo Pintaric; Ziga Snoj; Burkhard Möller; Alexander Bernatschek; Maurice Donzallaz; Robert G Lambert; Walter P Maksymowych

doi:10.3899/jrheum.2024-0075

Effect of Online Training on the Reliability of Assessing Sacroiliac Joint Radiographs in Axial Spondyloarthritis: A Randomized, Controlled Study

J Rheumatol. 2024 Dec 1;51(12):1169-1175. doi: 10.3899/jrheum.2024-0075.

Authors

Anna E F Hadsbjerg¹, Mikkel Østergaard², Joel Paschke³, Raphael Micheroli⁴, Susanne J Pedersen⁵, Adrian Ciurea⁴, Michael J Nissen⁶, Kristyna Bubova⁷, Stephanie Wichuk⁸, Manouk de Hooge⁹, Simon Krabbe⁵, Ashish J Mathew⁵, Monika Gregová⁷, Marie Wetterslev⁵, Karel Gorican¹⁰, Karlo Pintaric¹¹, Ziga Snoj¹¹, Burkhard Möller¹², Alexander Bernatschek⁴, Maurice Donzallaz⁴, Robert G Lambert¹³, Walter P Maksymowych¹⁴

Affiliations

¹ A.E.F. Hadsbjerg, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Righospitalet, Glostrup, and Department of Internal Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; anna.enevold.floeistrup.hadsbjerg@regionh.dk.
² A.E.F. Hadsbjerg, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Righospitalet, Glostrup, and Department of Internal Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³ J. Paschke, MSc, CARE Arthritis, Edmonton, Alberta, Canada.
⁴ R. Micheroli, MD, A. Ciurea, MD, A. Bernatschek, MD, M. Donzallaz, MD, Department of Rheumatology, University Hospital of Zürich, Zurich, Switzerland.
⁵ S.J. Pedersen, MD, PhD, S. Krabbe, MD, PhD, A.J. Mathew, MD, PhD, M. Wetterslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Righospitalet, Glostrup, Denmark.
⁶ M.J. Nissen, MD, Rheumatology Department, Geneva University Hospital, Geneva, Switzerland.
⁷ K. Bubova, MD, M. Gregová, MD, Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine Charles University, Prague, Czech Republic.
⁸ S. Wichuk, MSc, Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.
⁹ M. de Hooge, Rheumatology Department, Ghent University Hospital, Ghent, Belgium.
¹⁰ K. Gorican, MD, MSK Radiology Unit, Radiology Section-Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.
¹¹ K. Pintaric, MD, Z. Snoj, MD, Institute of Radiology, UMC Ljubljana, Ljubljana, Slovenia.
¹² B. Möller, MD, Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, Bern, Switzerland.
¹³ R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ W.P. Maksymowych, MD, PhD, CARE Arthritis, and Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.

PMID: 39278654
DOI: 10.3899/jrheum.2024-0075

Abstract

Objective: Radiographic assessment of sacroiliac joints (SIJs) according to the modified New York (mNY) criteria is key in the classification of axial spondyloarthritis but has moderate interreader agreement. We aimed to investigate the improvements of the reliability in scoring SIJ radiographs after applying an online real-time iterative calibration (RETIC) module, in addition to a slideshow and video alone.

Methods: Nineteen readers, randomized to 2 groups (A or B), completed 3 calibration steps: (1) review of manuscripts, (2) review of slideshow and video with group A completing RETIC, and (3) re-review of slideshow and video with group B completing RETIC. The RETIC module gave instant feedback on readers' gradings and continued until predefined reliability ([Formula: see text]) targets for mNY positivity/negativity were met. Each step was followed by scoring different batches of 25 radiographs (exercises I to III). Agreement ([Formula: see text]) with an expert radiologist was assessed for mNY positivity/negativity and individual lesions. Improvements by training strategies were tested by linear mixed models.

Results: In exercises I, II, and III, mNY [Formula: see text] were 0.61, 0.76, and 0.84, respectively, in group A; and 0.70, 0.68, and 0.86, respectively, in group B (ie, increasing, mainly after RETIC completion). Improvements were observed for grading both mNY positivity/negativity and individual pathologies, both in experienced and, particularly, inexperienced readers. Completion of the RETIC module in addition to the slideshow and video caused a significant [Formula: see text] increase of 0.17 (95% CI 0.07-0.27; P = 0.002) for mNY-positive and mNY-negative grading, whereas completion of the slideshow and video alone did not ([Formula: see text] = 0.00, 95% CI -0.10 to 0.10; P = 0.99).

Conclusion: Agreement on scoring radiographs according to the mNY criteria significantly improved when adding an online RETIC module, but not by slideshow and video alone.

Keywords: diagnostic imaging; education research; medical education; radiography; radiology; spondyloarthritis.

Publication types

Randomized Controlled Trial

MeSH terms

Axial Spondyloarthritis* / diagnostic imaging
Female
Humans
Male
Observer Variation*
Radiography* / methods
Reproducibility of Results
Sacroiliac Joint* / diagnostic imaging