Reliability and validity of cervical vertebral maturation and hand-wrist radiographs

Objective: The purpose of this project was to determine the reliability and validity of Cervical Vertebral Maturation (CVM) versus Hand-wrist (HW) evaluations completed by orthodontists when evaluating a sample of patients including those of pre-, peak and post-peak growth status. Methods: Available lateral cephalometric and hand-wrist radiographs from the Ohio State University Orthodontic Archival Database were identified based on their quality. The images were scanned to produce JPEG images of high resolution. A presentation was developed that described evaluation of HW and CVM status using Greulich and Pyle's and the Baccetti, Franchi, and McNamara's revised method, respectively. Thirteen orthodontic residents evaluated the 30 selected radiographs (15 CVM, 15 HW) to classify the maturation status of each patient. After a 2 week washout period the residents again evaluated the radiographs. The classifications were then compared to the results of expert examiners for CVM and HW who served as the gold standard for each method. Results: Weighted kappa scores indicated that the residents performed well on the CVM and HW for both accuracy and reliability (weighted Kappa scores: 0.85 for CVM accuracy; 0.83 for HW accuracy; 0.82 for CVM intra-evaluator reliability; 0.86 for HW intra-evaluator reliability). For accuracy, the exact percent agreement with the expert evaluators was 56.4% for the cervical vertebral maturation method and 22.2% for the hand and wrist method. For reliability, the residents agreed with themselves 63.1% of the time for the cervical vertebral maturation method and 41.7% of the time for the hand and wrist method. Conclusions: Overall, the data indicates that with only limited training, orthodontic residents can develop excellent reliability when reading CVM and HW radiographs. When examined for accuracy, the CVM method performed better and to an acceptable level, while the HW method fell short of expectations for this novice group.