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Clinicians' heuristic assessments of radiographs compared with Kellgren-Lawrence and Ahlbäck ordinal grading: An exploratory study of knee radiographs using paired comparisons

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@article{3cecdd25f15448498e10854ae1bcfab9,
title = "Clinicians' heuristic assessments of radiographs compared with Kellgren-Lawrence and Ahlb{\"a}ck ordinal grading: An exploratory study of knee radiographs using paired comparisons",
abstract = "Objectives Ordinal scales provide means for communicating the severity of a condition, but they are affected by cognitive biases, they introduce statistical problems and they sacrifice resolution. Clinicians discern more details than contained in scales, for example, when assessing radiographs, but clinicians' distinctions are often based on experience-based rules of thumb, that is, heuristics. The objectives of this study are to compare clinicians' heuristic assessments to ordinal grading, to identify case elements that influence clinicians' judgements and to present a method for quantifying heuristic assessments. Design Clinicians were presented with 17 207 random pairs from a set of 1087 knee radiographs. For each pair, the radiograph with more severe osteoarthritis was selected. The Bradley-Terry model was used to calculate an osteoarthritis strength parameter for each radiograph. Similarly, strength parameters were determined for 12 morphological features with five additional features being considered either present or absent. All radiographs were also graded according to conventional ordinal systems (Kellgren-Lawrence and Ahlb{\"a}ck). Relations between clinicians' judgements and (1) the heuristics-based osteoarthritis strength, (2) conventional ordinal systems and (3) morphological features were investigated. Results Receiver operating characteristic analysis showed that the Bradley-Terry model provided a good description of clinicians' assessments (area under the curve (AUC)=0.97, 95% CI 0.968 to 0.972). Morphological features (AUC=0.90, 95% CI 0.900 to 0.908) provided a superior description of clinicians' choices compared with conventional ordinal systems (AUC=0.88, 95% CI 0.878 to 0.887 and AUC=0.80, 95% CI 0.796 to 0.809) for Ahlb{\"a}ck and Kellgren-Lawrence, respectively). The features most strongly associated with osteoarthritis strength were medial joint space width, flattening of the medial femoral and tibial condyles, medial osteophytes and alignment. Conclusions Heuristics-based assessments give a better distinction than conventional grading systems of knee osteoarthritis. The example presents a general approach to evaluate which features are part of experts' heuristics. The data suggest that experts discern more details than included in conventional ordinal grading systems. Quantitative heuristic assessments may replace ordinal scales.",
keywords = "Heuristics, Humans, Knee Joint/diagnostic imaging, Matched-Pair Analysis, Osteoarthritis, Knee/diagnostic imaging, Radiography, research methods, statistics &amp, radiology &amp, diagnostic radiology, imaging, knee, musculoskeletal disorders",
author = "Pedersen, {Mads M{\o}ller} and Mongelard, {Kristian Breds Geoffroy} and Anne M{\o}rup-Petersen and Christensen, {Karl Bang} and Anders Odgaard",
note = "Publisher Copyright: {\textcopyright} Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = mar,
day = "8",
doi = "10.1136/bmjopen-2020-041793",
language = "English",
volume = "11",
pages = "e041793",
journal = "BMJ Paediatrics Open ",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

RIS

TY - JOUR

T1 - Clinicians' heuristic assessments of radiographs compared with Kellgren-Lawrence and Ahlbäck ordinal grading

T2 - An exploratory study of knee radiographs using paired comparisons

AU - Pedersen, Mads Møller

AU - Mongelard, Kristian Breds Geoffroy

AU - Mørup-Petersen, Anne

AU - Christensen, Karl Bang

AU - Odgaard, Anders

N1 - Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3/8

Y1 - 2021/3/8

N2 - Objectives Ordinal scales provide means for communicating the severity of a condition, but they are affected by cognitive biases, they introduce statistical problems and they sacrifice resolution. Clinicians discern more details than contained in scales, for example, when assessing radiographs, but clinicians' distinctions are often based on experience-based rules of thumb, that is, heuristics. The objectives of this study are to compare clinicians' heuristic assessments to ordinal grading, to identify case elements that influence clinicians' judgements and to present a method for quantifying heuristic assessments. Design Clinicians were presented with 17 207 random pairs from a set of 1087 knee radiographs. For each pair, the radiograph with more severe osteoarthritis was selected. The Bradley-Terry model was used to calculate an osteoarthritis strength parameter for each radiograph. Similarly, strength parameters were determined for 12 morphological features with five additional features being considered either present or absent. All radiographs were also graded according to conventional ordinal systems (Kellgren-Lawrence and Ahlbäck). Relations between clinicians' judgements and (1) the heuristics-based osteoarthritis strength, (2) conventional ordinal systems and (3) morphological features were investigated. Results Receiver operating characteristic analysis showed that the Bradley-Terry model provided a good description of clinicians' assessments (area under the curve (AUC)=0.97, 95% CI 0.968 to 0.972). Morphological features (AUC=0.90, 95% CI 0.900 to 0.908) provided a superior description of clinicians' choices compared with conventional ordinal systems (AUC=0.88, 95% CI 0.878 to 0.887 and AUC=0.80, 95% CI 0.796 to 0.809) for Ahlbäck and Kellgren-Lawrence, respectively). The features most strongly associated with osteoarthritis strength were medial joint space width, flattening of the medial femoral and tibial condyles, medial osteophytes and alignment. Conclusions Heuristics-based assessments give a better distinction than conventional grading systems of knee osteoarthritis. The example presents a general approach to evaluate which features are part of experts' heuristics. The data suggest that experts discern more details than included in conventional ordinal grading systems. Quantitative heuristic assessments may replace ordinal scales.

AB - Objectives Ordinal scales provide means for communicating the severity of a condition, but they are affected by cognitive biases, they introduce statistical problems and they sacrifice resolution. Clinicians discern more details than contained in scales, for example, when assessing radiographs, but clinicians' distinctions are often based on experience-based rules of thumb, that is, heuristics. The objectives of this study are to compare clinicians' heuristic assessments to ordinal grading, to identify case elements that influence clinicians' judgements and to present a method for quantifying heuristic assessments. Design Clinicians were presented with 17 207 random pairs from a set of 1087 knee radiographs. For each pair, the radiograph with more severe osteoarthritis was selected. The Bradley-Terry model was used to calculate an osteoarthritis strength parameter for each radiograph. Similarly, strength parameters were determined for 12 morphological features with five additional features being considered either present or absent. All radiographs were also graded according to conventional ordinal systems (Kellgren-Lawrence and Ahlbäck). Relations between clinicians' judgements and (1) the heuristics-based osteoarthritis strength, (2) conventional ordinal systems and (3) morphological features were investigated. Results Receiver operating characteristic analysis showed that the Bradley-Terry model provided a good description of clinicians' assessments (area under the curve (AUC)=0.97, 95% CI 0.968 to 0.972). Morphological features (AUC=0.90, 95% CI 0.900 to 0.908) provided a superior description of clinicians' choices compared with conventional ordinal systems (AUC=0.88, 95% CI 0.878 to 0.887 and AUC=0.80, 95% CI 0.796 to 0.809) for Ahlbäck and Kellgren-Lawrence, respectively). The features most strongly associated with osteoarthritis strength were medial joint space width, flattening of the medial femoral and tibial condyles, medial osteophytes and alignment. Conclusions Heuristics-based assessments give a better distinction than conventional grading systems of knee osteoarthritis. The example presents a general approach to evaluate which features are part of experts' heuristics. The data suggest that experts discern more details than included in conventional ordinal grading systems. Quantitative heuristic assessments may replace ordinal scales.

KW - Heuristics

KW - Humans

KW - Knee Joint/diagnostic imaging

KW - Matched-Pair Analysis

KW - Osteoarthritis, Knee/diagnostic imaging

KW - Radiography

KW - research methods

KW - statistics &amp

KW - radiology &amp

KW - diagnostic radiology

KW - imaging

KW - knee

KW - musculoskeletal disorders

UR - http://www.scopus.com/inward/record.url?scp=85102257381&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2020-041793

DO - 10.1136/bmjopen-2020-041793

M3 - Journal article

C2 - 34006025

AN - SCOPUS:85102257381

VL - 11

SP - e041793

JO - BMJ Paediatrics Open

JF - BMJ Paediatrics Open

SN - 2044-6055

IS - 3

M1 - e041793

ER -

ID: 66400052