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 (κ) targets for mNY positivity/negativity were met. Each step was followed by scoring different batches of 25 radiographs (exercises I to III). Agreement (κ) 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 κ 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 κ 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 (κ = 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.

中文翻译：

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在线培训对中轴型脊柱关节炎骶髂关节 X 线片评估可靠性的影响：一项随机对照研究。


目的 根据改良的纽约 （mNY） 标准对骶髂关节 （SIJ） 进行放射学评估是中轴型脊柱关节炎分类的关键，但读者间一致性中等。我们旨在研究在应用在线实时迭代校准 （RETIC） 模块后，除了单独的幻灯片和视频外，对 SIJ 射线片评分的可靠性的提高。方法 19 名读者，随机分配到 2 组 （A 或 B），完成了 3 个校准步骤：（1） 审阅手稿，（2） 审阅幻灯片和视频，A 组完成 RETIC，以及 （3） 重新审阅幻灯片和视频，B 组完成 RETIC。RETIC 模块对读者的评分提供即时反馈，并一直持续到达到 mNY 阳性/阴性的预定义可靠性 （κ） 目标。每个步骤之后都对不同批次的 25 张 X 光片（练习 I 至 III）进行评分。评估与放射科专家的协议 （κ） 的 mNY 阳性/阴性和单个病变。通过线性混合模型测试了训练策略的改进。结果 在练习 I 、 II 和 III 中，A 组的 mNY κ 分别为 0.61 、 0.76 和 0.84;B 组分别为 0.70、0.68 和 0.86（即增加，主要在 RETIC 完成后）。在有经验的读者，尤其是没有经验的读者中，观察到 mNY 阳性/消极性和个体病理的评分有所改善。除幻灯片和视频外，完成 RETIC 模块导致 κ 显着增加 0.17 （95% CI 0.07-0.27;p = 0.002），而单独完成幻灯片和视频则没有（κ = 0.00,95% CI -0.10 至 0.10;P = 0.99）。 结论 添加在线 RETIC 模块时，根据 mNY 标准对 X 光片评分的一致性显着提高，但不能仅通过幻灯片和视频。