Wisconsin cystic fibrosis chest radiograph scoring system: Validation and standardization for application to longitudinal studies

This study was designed to achieve a final modeling, validation, and standa rdization plan for the Wisconsin cystic fibrosis (CF) chest radiographic sc oring system. Sixty chest radiographs were selected to reflect a range of s everity of lung pathology in children with CF. Seven experienced volunteer raters (three radiologists and four pediatric pulmonologists) from five ins titutions were recruited to evaluate and score the films. Analysis of score s revealed that the subcomponents of the Wisconsin system showed considerab le variation from rater to rater, but reliability assessment indicated sati sfactory Cronbach's alpha coefficients (0.83-0.90) among the seven raters. It was found that an additive method of total score computation is signific antly more reliable (P < 0.05) than either the original multiplicative mode l or the traditional Brasfield scoring system. Comparison of radiologists a cid pulmonologists revealed a marked, systematic difference in scoring with the former group being more conservative in interpretation of abnormalitie s than the pulmonologists, and some of the raters showing very limited sens itivity. Quantitative chest radiology applied to children with cystic fibrosis studi ed long-term in longitudinal research projects requires the careful use of sensitive scoring methods and careful selection and training of multiple ra ters. This is particularly important since pulmonologists and radiologists can differ systematically in interpreting/scoring abnormalities. (C) 2000 W iley-Liss, Inc.