Soft-copy versus hard-copy interpretation of voiding cystourethrography in neonates, infants, and children

OBJECTIVE. Our aim is to determine whether agreement occurs between soft-copy (at a review workstation) and hard-copy (on laser-printed film) interpretations of fluoroscopic voiding cystourethrograms in neonates, infants, and children. SUBJECTS AND METHODS. Voiding cystourethrography was performed on 74 children (range, 2 weeks to 11 years old; mean, 3 years 6 months) for the evaluation of vesicoureteral reflux. The right and left ureters were scored separately by two observers on a scale of 0-5 using the international grading standard. Differences were tested for statistical significance with a marginal homogeneity test, and the strength of agreement was assessed using the kappa statistic. RESULTS. Of the 148 ureters evaluated, 39 showed vesicoureteral reflux and 109 showed no vesicoureteral reflux on both soft copy and hard copy. For 128 of 148 evaluations, interpretations of soft copy and hard copy produced agreement as to the grade of vesicoureteral reflux. For 11 of the 20 ureters with divergent interpretations, hard copy was scored one grade lower than soft copy; for the remaining nine ureters, hard copy was scored one grade higher than soft copy. No score differed by more than one grade. We found no statistically significant difference between soft-copy and hard-copy scores (p = .65), and agreement using the kappa statistic was substantial (.68). CONCLUSION. Soft- copy interpretation of voiding cystourethrograms is similar to hard-copy interpretation for vesicoureteral reflux.