Observer agreement in the reporting of knee and lumbar spine Magnetic Resonance (MR) Imaging examinations: selectively trained MR radiographers and consultant radiologists compared with an index radiologist

Purpose: To assess agreement between trained radiographers and consultant radiologists compared withan index radiologist when reporting on magnetic resonance imaging (MRI) examinations of the knee andlumbar spine and to examine the subsequent effect of discordant reports on patient management andoutcome.

Methods: At York Hospital two MR radiographers, two consultant radiologists and an index radiologistreported on a prospective, random sample of 326 MRI examinations. The radiographers reported inclinical practice conditions and the radiologists during clinical practice. An independent consultant radi-ologist compared these reports with the index radiologist report for agreement. Orthopaedic surgeonsthen assessed whether the discordance between reports was clinically important.

Results: Overall observer agreement with the index radiologist was comparable between observers andranged from 54% to 58%; for the knee it was 46–57% and for the lumbar spine was 56–66%. There was a verysmall observed difference of 0.6% (95% CI −11.9 to 13.0) in mean agreement between the radiographersand radiologists (P = 0.860). For the knee, lumbar spine and overall, radiographers’ discordant reports,when compared with the index radiologist, were less likely to have a clinically important effect on patientoutcome than the radiologists’ discordant reports. Less than 10% of observer’s reports were sufficientlydiscordant with the index radiologist’s reports to be clinically important.

Conclusion: Carefully selected MR radiographers with postgraduate education and training reported inclinical practice conditions on specific MRI examinations of the knee and lumbar spine to a level ofagreement comparable with non-musculoskeletal consultant radiologists.