Article Text

Download PDFPDF

Original article
Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT
  1. Simon L F Walsh1,
  2. Lucio Calandriello2,
  3. Nicola Sverzellati3,
  4. Athol U Wells4,
  5. David M Hansell5
  6. on behalf of The UIP Observer Consort
    1. 1Department of Radiology, Kings College Hospital Foundation Trust, London, UK
    2. 2Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University, “A. Gemelli” Hospital, Rome, Italy
    3. 3Department of Clinical Sciences, Section of Radiology, University of Parma, Parma, Italy
    4. 4Interstitial Lung Diseases Unit, Royal Brompton Hospital, London, UK
    5. 5Department of Radiology, Royal Brompton Hospital, London, UK
    1. Correspondence to Dr Simon L F Walsh, Department of Radiology, Kings College Hospital Foundation Trust, Denmark Hill, London SE5 9RS, UK; slfwalsh{at}


    Objectives To establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience.

    Materials and methods 112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories—UIP, possibly UIP and inconsistent with UIP). The presence of honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entire observer group and in subgroups stratified by observer experience, were evaluated.

    Results Interobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10–20 years’ experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of honeycombing, traction bronchiectasis and emphysema were 0.59±0.12, 0.42±0.15 and 0.43±0.18, respectively.

    Conclusions Interobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, irrespective of their experience, and did not vary with patient age or the MDT diagnosis.

    • Interstitial Fibrosis
    • Imaging/CT MRI etc
    • Idiopathic pulmonary fibrosis

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Linked Articles