Intra-and inter-observer reliability of nailfold videocapillaroscopy - A possible outcome measure for systemic sclerosis-related microangiopathy.

OBJECTIVES: Our aim was to assess the reliability of nailfold capillary assessment in terms of image evaluability, image severity grade ('normal', 'early', 'active', 'late'), capillary density, capillary (apex) width, and presence of giant capillaries, and also to gain further insight into differences in these parameters between patients with systemic sclerosis (SSc), patients with primary Raynaud's phenomenon (PRP) and healthy control subjects. METHODS: Videocapillaroscopy images (magnification 300×) were acquired from all 10 digits from 173 participants: 101 patients with SSc, 22 with PRP and 50 healthy controls. Ten capillaroscopy experts from 7 European centres evaluated the images. Custom image mark-up software allowed extraction of the following outcome measures: overall grade ('normal', 'early', 'active', 'late', 'non-specific', or 'ungradeable'), capillary density (vessels/mm), mean vessel apical width, and presence of giant capillaries. RESULTS: Observers analysed a median of 129 images each. Evaluability (i.e. the availability of measures) varied across outcome measures (e.g. 73.0% for density and 46.2% for overall grade in patients with SSc). Intra-observer reliability for evaluability was consistently higher than inter- (e.g. for density, intra-class correlation coefficient [ICC] was 0.71 within and 0.14 between observers). Conditional on evaluability, both intra- and inter-observer reliability were high for grade (ICC 0.93 and 0.78 respectively), density (0.91 and 0.64) and width (0.91 and 0.85). CONCLUSIONS: Evaluability is one of the major challenges in assessing nailfold capillaries. However, when images are evaluable, the high intra- and inter-reliabilities suggest that overall image grade, capillary density and apex width have potential as outcome measures in longitudinal studies.

Simulating acceleration from stereophotogrammetry for medical device design.

When designing a medical device based on lightweight accelerometers, the designer is faced with a number of questions in order to maximize performance while minimizing cost and complexity: Where should the inertial unit be located? How many units are required? How is performance affected if the unit is not correctly located during donning? One way to answer these questions is to use position data from a single trial, captured with a nonportable measurement system (e.g., stereophotogrammetry) to simulate measurements from multiple accelerometers at different locations on the body. In this paper, we undertake a thorough investigation into the applicability of these simulated acceleration signals via a series of interdependent experiments of increasing generality. We measured the dynamics of a reference coordinate frame using stereophotogrammetry over a number of trials. These dynamics were then used to simulate several "virtual" accelerometers at different points on the body segment. We then compared the simulated signals with those directly measured to evaluate the error under a number of conditions. Finally, we demonstrated an example of how simulated signals can be employed in a system design application. In the best case, we may expect an error of 0.028 m/s2 between a derived virtual signal and that directly measured by an accelerometer. In practice, however, using centripetal and tangential acceleration terms (that are poorly estimated) results in an error that is an order of magnitude greater than the baseline. Furthermore, nonrigidity of the limb can increase error dramatically, although the effects can be reduced considerably via careful modeling. We conclude that using simulated signals has definite benefits when an appropriate model of the body segment is applied.