Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study

BACKGROUND: Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor. Ultrasound imaging has shown that people with chronic lower back pain demonstrate both a significant decrease in shear strain, and a 25% increase in thickness of the thoracolumbar fascia. There is sparse data on whether medical practitioners agree on the level of disorganisation in ultrasound images of thoracolumbar fascia. The purpose of this study was to establish inter-rater reliability of the ranking of architectural disorganisation of thoracolumbar fascia on a scale from ‘very disorganised’ to ‘very organised’. METHODS: An exploratory analysis was performed using a fully crossed design of inter-rater reliability. Thirty observers were recruited, consisting of 21 medical doctors, 7 physiotherapists and 2 radiologists, with an average of 13.03 ± 9.6 years of clinical experience. All 30 observers independently rated the architectural disorganisation of the thoracolumbar fascia in 30 ultrasound scans, on a Likert-type scale with rankings from 1 = very disorganised to 10 = very organised. Internal consistency was assessed using Cronbach’s alpha. Krippendorff’s alpha was used to calculate the overall inter-rater reliability. RESULTS: The Krippendorf’s alpha was .61, indicating a modest degree of agreement between observers on the different morphologies of thoracolumbar fascia.The Cronbach’s alpha (0.98), indicated that there was a high degree of consistency between observers. Experience in ultrasound image analysis did not affect constancy between observers (Cronbach’s range between experienced and inexperienced raters: 0.95 and 0.96 respectively). CONCLUSIONS: Medical practitioners agree on morphological features such as levels of organisation and disorganisation in ultrasound images of thoracolumbar fascia, regardless of experience. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia

Ultrasonic treatment of experimental animal tumours.

Studies on the effects of ultrasound on several solid tumours in experimental animals have indicated that tumour growth rates can be reduced. These data are generally consistent with a thermal mechanism of action. Application of combined ultrasound and X-irradiation have shown that with some experimental animal tumours the radiation dose required to locally control 50% of the tumours can be reduced by ultrasound. These results were also consistent with a thermal mechanism of action hypothesis. Fractionated X-irradiation was not enhanced as much as single dose. Pulsing the ultrasound with the same time-average intensity resulted in the same radiosensitivity enhancement. The combined effects of ultrasound and cancer chemotherapy drugs have been studied in mouse leukaemia. The treatment was applied in vitro with cells in suspension. Subsequent to treatment, the cells were inoculated into host mice and survival was monitored. Cytotoxic action of 5 of 10 drugs studied was enhanced by ultrasound. A thermal mechanism of action apparently was not involved. Cavitation in the suspension probably played a role in the cytotoxic enhancement. Experimental data are consistent with the concept that ultrasound causes rapidly reversible cell damage which, in the presence of cytotoxic drugs, is not so readily reversed and results in significant loss of lethal potential of the malignant cells to the host