Low-dose xenogeneic mesenchymal stem cells target canine osteoarthritis through systemic immunomodulation and homing.

BACKGROUND: As current therapies for canine osteoarthritis (OA) provide mainly symptomatic improvement and fail to address the complex pathology of the disease, mesenchymal stem cells (MSCs) offer a promising biological approach to address both aspects of OA through their immunomodulatory properties. METHODS: This study aimed to investigate the safety and efficacy of xenogeneic MSCs in dogs with OA at different dose levels after intravenous injection. OA was surgically induced in the right stifle joint. Thirty-two male and female dogs were divided into three treatment groups and a control group. Regular general physical examinations; lameness, joint, radiographic, and animal caretaker assessments; pressure plate analyses; and blood analyses were performed over 42 days. At study end, joint tissues were evaluated regarding gross pathology, histopathology, and immunohistochemistry. In a follow-up study, the biodistribution of intravenously injected 99mTc-labeled equine peripheral blood-derived MSCs was evaluated over 24h in three dogs after the cruciate ligament section. RESULTS: The dose determination study showed the systemic administration of ePB-MSCs in a canine OA model resulted in an analgesic, anti-inflammatory, and joint tissue protective effect associated with improved clinical signs and improved cartilage structure, as well as a good safety profile. Furthermore, a clear dose effect was found with 0.3 × 106 ePB-MSCs as the most effective dose. In addition, this treatment was demonstrated to home specifically towards the injury zone in a biodistribution study. CONCLUSION: This model-based study is the first to confirm the efficacy and safety of systemically administered xenogeneic MSCs in dogs with OA. The systemic administration of a low dose of xenogeneic MSCs could offer a widely accessible, safe, and efficacious treatment to address the complex pathology of canine OA and potentially slow down the disease progression by its joint tissue protective effect.

COAST Development Group's international consensus guidelines for the treatment of canine osteoarthritis.

This report describes consensus guidelines and recommendations for the treatment of canine osteoarthritis (OA) according to the "Canine OsteoArthritis Staging Tool excluding radiography" (COASTeR) stage of OA, by the COAST Development Group. The recommendations are based on evidence-based medicine and clinical experience and are proposed with international relevance in mind. The aim is to provide veterinarians with a practical reference to consolidated information and to support the development of patient-specific OA management protocols and informed treatment choices based on the stage of OA.

Effect of dog-related parameters on the flexion test outcome: A large cohort retrospective study on physiological and orthopedic pathological-related factors.

Objectives: This retrospective study evaluates the dog-related factors of variation influencing the outcome of the flexion test (FT), when performed to localize pain to a joint area, on a large group of canine orthopedic patients. Materials and methods: The selection criteria for this retrospective study were dogs undergoing a FT in a referral orthopedic clinic between 2009 and 2020 with a complete medical record. The canine FT, described in a previously published protocol, was performed on dogs presented with an orthopedic problem. In summary, a dog's joint, identified as suspected of an orthopedic problem according to the clinical examination, was flexed for 1 min before walking 15 m on a hard and even surface. The FT was considered positive if the lameness increased after the application of the FT and negative when it remained unchanged. Statistical analysis was performed to determine which of the following criteria could influence the outcome of the flexion test: age, gender, neutered status, weight category, tested joint and initial lameness score. Results: Over 1,161 patients' files were collected and analyzed for this research. The FT showed 82.8% (95%IC: 80.5-84.9) of true positives and 17.2% of false negatives. None of the patient's intrinsic characteristics influenced the outcome of the test (age, gender, neutered status, and weight category). The orthopedic parameters, such as the initial lameness score and the tested joint, showed to have a statistically significant influence on the outcome of the test. Clinical relevance: The FT is an easy-to-perform technique presenting reliable results on most joints. This test presents an interest when performed in addition to a complete orthopedic examination to localize pain to a joint area. Only the orthopedic pathological-related parameters such as the lameness score and the tested joint seem to influence the outcome of the FT. The FT is not influenced by the physiological-related characteristic of the patient (age, weight category, sex, and neutered status).

Intraobserver and interobserver agreement on the radiographical diagnosis of canine cranial cruciate ligament rupture.

Even though radiography is one of the most frequently used imaging techniques for orthopaedic disorders, it has been demonstrated that the interpretation can vary between assessors. As such, the purpose of this study was to examine the intraobserver and interobserver agreement and the influence of level of expertise on the interpretation of radiographs of the stifle in dogs with and without cranial cruciate ligament rupture (CCLR). Sixteen observers, divided in four groups according to their level of experience, evaluated 30 radiographs (15 cases with CCLR and 15 control stifles) twice. Each observer was asked to evaluate joint effusion, presence and location of degenerative joint disease, joint instability and whether CCLR was present or absent. Overall, intraobserver and interobserver agreement ranged from fair to almost perfect with a trend towards increased agreement for more experienced observers. Additionally, it was found that stifles that were classified with high agreement have either overt disease characteristics or no disease characteristics at all, in comparison to the ones that are classified with a low agreement. Overall, the agreement on radiographic interpretation of CCLR was high, which is important, as it is the basis of a correct diagnosis and treatment.

COMPUTED TOMOGRAPHIC FINDINGS IN CANINE ELBOWS ARTHROSCOPICALLY DIAGNOSED WITH EROSION OF THE MEDIAL COMPARTMENT: AN ANALYTICAL METHOD COMPARISON STUDY.

Medial compartment erosion is an advanced stage of medial coronoid disease, an important cause of elbow lameness in dogs, with treatment and the expected prognosis depending on the extent of the cartilage lesions. The identification of specific computed tomographic (CT) findings might facilitate the nonsurgical diagnosis and add to treatment decision making. Aims of this retrospective, analytical, method comparison study were to describe CT findings in elbows of dogs arthroscopically diagnosed with medial compartment erosion and to compare CT vs. arthroscopic findings. A total of 56 elbows met inclusion criteria. Elbows with focal (n = 13), diffuse (n = 11), and complete (n = 32) erosion were compared. Prevalence findings for CT lesions were as follows: periarticular osteophytosis (100%), abnormal shape of the medial coronoid process of the ulna (96.4%), and subchondral bone defect of the medial part of the humeral condyle (MHC; 96.4%). The three groups significantly differed for presence of medial coronoid process fragmentation, radial head subchondral bone sclerosis, and widening of the humeroulnar joint space. No significant agreement was found between CT and arthroscopy for presence of a subchondral bone defect of the MHC. A significant agreement was found between CT and arthroscopy for presence of fragmentation of the medial coronoid process. However, some of the calcified body/fragment(s) visualized on CT in the region of the medial coronoid process could not be identified via arthroscopy. Findings indicated that an accurate estimation of the extent of the elbow cartilage lesions still requires arthroscopic joint inspection.

Arthroscopic, Computed Tomography, and Radiographic Findings in 25 Dogs With Lameness After Arthroscopic Treatment of Medial Coronoid Disease.

OBJECTIVE: To describe the radiographic, computed tomography (CT), and arthroscopic findings in the elbow of dogs admitted for elbow lameness after previous arthroscopic treatment of medial coronoid disease (MCD). STUDY DESIGN: Retrospective case series. ANIMALS: Client-owned dogs (n = 25) admitted for elbow lameness after arthroscopic treatment. METHODS: Clinical records (2005-2009), including radiographs, CT images, and arthroscopic findings, from the first and second presentation of dogs diagnosed with medial coronoid disease were searched and reviewed. RESULTS: Twenty-nine joints were included in this study. The mean age at first treatment was 2.2 years. Second presentation was at a mean of 2.7 years later and progressive osteoarthritis and cartilage damage was noticed in all joints. Arthroscopic findings included a calcified body in 11/29 joints (38%), multiple small calcified bodies in 1/29 joint (3%), loose scar tissue in 12/29 joints (42%), and immobile scar tissue in 2/29 joints (7%). Three of 29 joints (10%) did not have any calcified body or loose scar tissue found but had erosion of the medial compartment as the only pathology diagnosed in the coronoid region. Characteristics of flexor enthesopathy were identified in 9/29 joints (31%). CONCLUSION: Arthroscopic treatment of MCD, even with limited cartilage lesions, may not resolve lameness in some dogs. Calcified bodies or loose scar tissue near the medial coronoid process are a frequent followup finding in these joints.

Improved canine exome designs, featuring ncRNAs and increased coverage of protein coding genes.

By limiting sequencing to those sequences transcribed as mRNA, whole exome sequencing is a cost-efficient technique often used in disease-association studies. We developed two target enrichment designs based on the recently released annotation of the canine genome: the exome-plus design and the exome-CDS design. The exome-plus design combines the exons of the CanFam 3.1 Ensembl annotation, more recently discovered protein-coding exons and a variety of non-coding RNA regions (microRNAs, long non-coding RNAs and antisense transcripts), leading to a total size of ≈ 152 Mb. The exome-CDS was designed as a subset of the exome-plus by omitting all 3' and 5' untranslated regions. This reduced the size of the exome-CDS to ≈ 71 Mb. To test the capturing performance, four exome-plus captures were sequenced on a NextSeq 500 with each capture containing four pre-capture pooled, barcoded samples. At an average sequencing depth of 68.3x, 80% of the regions and well over 90% of the targeted base pairs were completely covered at least 5 times with high reproducibility. Based on the performance of the exome-plus, we estimated the performance of the exome-CDS. Overall, these designs provide flexible solutions for a variety of research questions and are likely to be reliable tools in disease studies.

TTA Rapid: Description of the Technique and Short Term Clinical Trial Results of the First 50 Cases.

OBJECTIVE: To (1) describe a modified technique for tibial tuberosity advancement (TTA) in dogs with cranial cruciate ligament (CCL) rupture and (2) report short term outcome and complications. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs with unilateral CCL rupture (n = 50). METHODS: TTA was performed with a novel implant to achieve advancement of the tibial crest. The technical protocol, specific implants and instrumentation, and the short term outcome are described. RESULTS: Various breeds (mean ± SD weight, 31.9 ± 13.3 kg) were included. Mean age at treatment was 64 ± 30.6 months. Minor complications occurred in 30% and major complications in 4% of the cases. Forty-eight (96%) dogs had a good to excellent outcome 3 months after surgery. CONCLUSION: The modified technique is a viable alternative to other osteotomy techniques.

Ultrasonographical examination of feline adrenal glands: intra- and inter-observer variability.

Interpretation of ultrasonographical measurements requires an understanding of the source and the magnitude of variation. A substantial part of the variation can be attributed to the observer, the equipment or the animal. The aim of this study was to evaluate which adrenal gland measurement is the least variable within and between observers. Three experienced ultrasonographers examined six cats at three different times on the same day, more than 1 h apart, according to a strict scanning protocol. Seven ultrasonographical measurements were performed on each adrenal gland (maximal length on sagittal images, maximal height at the cranial and caudal poles on sagittal and transverse images, and maximal width of the cranial and caudal poles on transverse images). Height measurements in both planes showed the lowest variability within and between observers compared with length and width measurements. Descriptive ultrasonographical features, such as echogenicity of the gland, presence of hyperechoic spots or layering assessment, demonstrated satisfactory-to-good intra- and inter-observer agreement, whereas the shape assessment showed very poor inter-observer agreement. The results of this study describe a reliable scanning protocol that can be the basis for future adrenal ultrasonographical examinations for cats suspected of adrenal disease (eg, hyperaldosteronism, hyperadrenocorticism, sex hormone-producing tumours).

Magnetic resonance imaging of primary and concomitant flexor enthesopathy in the canine elbow.

Flexor enthesopathy is a recently recognized elbow disorder in dogs and considered to be an important differential diagnosis for elbow lameness. Primary and concomitant forms of the disease have been previously described and treatments differ for the two forms. The goal of this prospective study was to compare magnetic resonance imaging (MRI) findings for dogs with primary flexor enthesopathy (n = 17), concomitant flexor enthesopathy (n = 23), elbow dysplasia alone (n = 13), and normal elbows (n = 7). Each elbow joint underwent MRI using the same low-field scanner. Sequences included transverse and sagittal T1-weighted (before and after IV contrast), transverse and sagittal T2-weighted, and dorsal STIR. For each elbow, MRI lesions were recorded based on a consensus of two observers unaware of group status. Magnetic resonance imaging lesions involving flexor tendons were found in 100% of clinically affected joints with primary flexor enthesopathy and 96% of clinically affected joints with concomitant flexor enthesopathy. Thickened flexor muscles were the most common lesions, followed by hyperintense tendon signal and contrast enhancement. Irregular, thickened medial humeral epicondyle, edema, and calcified body lesions were less frequently observed. Magnetic resonance imaging characteristics of flexor enthesopathy were not found in normal joints or those affected by elbow dysplasia alone. No significant differences in frequencies and details of individual MRI characteristics were found between primary and concomitant flexor enthesopathy groups. Findings indicated that MRI is a sensitive technique for detection of flexor enthesopathy lesions in dogs, however, MRI characteristics do not allow differentiation of primary versus concomitant forms of the disease.

Computed tomography of canine elbow joints affected by primary and concomitant flexor enthesopathy.

Flexor enthesopathy is an important differential diagnosis for elbow lameness in dogs. The disorder can be a primary cause of elbow lameness or concomitant with other elbow pathology. Since treatment differs for primary and concomitant forms of flexor enthesopathy, a noninvasive method for distinguishing between them is needed. In the current prospective study, computed tomographic (CT) examination was performed before and after IV injection of contrast in 17 dogs with primary flexor enthesopathy, 24 dogs with concomitant flexor enthesopathy, 13 dogs with elbow dysplasia, and seven normal dogs. Dogs were assigned to groups based on results of clinical examination and at least three other imaging modalities. Computed tomographic lesions consistent with flexor enthesopathy were found in all clinically affected joints with primary flexor enthesopathy and in 29 of the 30 clinically affected joints with concomitant flexor enthesopathy. Those lesions were not found in sound elbows or joints affected by elbow dysplasia. Flexor lesions detected in dogs with primary flexor enthesopathy were not significantly different from those detected in dogs with the concomitant form. Findings indicated that CT can be applied to detect flexor enthesopathy, but a distinction between the primary and concomitant forms was not always possible. Authors recommend the use of multiple diagnostic techniques for treatment planning in affected dogs.

The prevalence of nine genetic disorders in a dog population from Belgium, the Netherlands and Germany.

The objective of this study was to screen a dog population from Belgium, the Netherlands and Germany for the presence of mutant alleles associated with hip dysplasia (HD), degenerative myelopathy (DM), exercise-induced collapse (EIC), neuronal ceroid lipofuscinosis 4A (NCL), centronuclear myopathy (HMLR), mucopolysaccharidosis VII (MPS VII), myotonia congenita (MG), gangliosidosis (GM1) and muscular dystrophy (Duchenne type) (GRMD). Blood samples (K3EDTA) were collected for genotyping with Kompetitive Allele Specific PCR (n = 476). Allele and genotype frequencies were calculated in those breeds with at least 12 samples (n = 8). Hardy-Weinberg equilibrium was tested. Genetic variation was identified for 4 out of 9 disorders: mutant alleles were found in 49, 15, 3 and 2 breeds for HD, DM, EIC and NCL respectively. Additionally, mutant alleles were identified in crossbreeds for both HD and EIC. For HD, DM, EIC and NCL mutant alleles were newly discovered in 43, 13, 2 and 1 breed(s), respectively. In 9, 2 and 1 breed(s) for DM, EIC and NCL respectively, the mutant allele was detected, but the respective disorder has not been reported in those breeds. For 5 disorders (HMLR, MPS VII, MG, GM1, GRMD), the mutant allele could not be identified in our population. For the other 4 disorders (HD, DM, EIC, NCL), prevalence of associated mutant alleles seems strongly breed dependent. Surprisingly, mutant alleles were found in many breeds where the disorder has not been reported to date.

Radiographic features of primary and concomitant flexor enthesopathy in the canine elbow.

Primary flexor enthesopathy is a recently recognized elbow disorder and should be considered in the differential diagnosis of elbow lameness. For treatment planning purposes, it is important to make a distinction between primary and concomitant forms of the disease. The purpose of this prospective study was to compare radiographic findings for dogs with primary flexor enthesopathy (n = 17), concomitant flexor enthesopathy (n = 24), elbow dysplasia (n = 13), and normal dogs (n = 7). All dogs underwent a complete radiographic examination and each radiographic image was evaluated for the presence or absence of following characteristics: irregular medial humeral epicondyle, spur and calcified body. Additionally, the presence or absence of other elbow disorders (medial coronoid process disease, osteochondritis dissecans, ununited anconeal process, incongruity, subtrochlear sclerosis, and osteoarthritis) was recorded. Radiographic characteristics of flexor enthesopathy were found in 86% of painful joints in the primary flexor enthesopathy group and in 100% of painful joints in the concomitant flexor enthesopathy group. Radiographic characteristics of flexor enthesopathy were not found in sound elbow and elbow dysplasia groups. Frequencies and details of individual radiographic characteristics did not differ between primary and concomitant flexor enthesopathy groups. Findings support the use of radiography as a first screening method for detection of flexor enthesopathy, but not as a technique for distinguishing primary vs. concomitant forms.

Canine mesenchymal stem cells: state of the art, perspectives as therapy for dogs and as a model for man.

Interest in mesenchymal stem cells (MSCs) both for regenerative and reparative therapies in dogs is emerging, as the current treatment options for several conditions often do not result either in the desired clinical outcome or in the patients' return to normal function. In addition, canine MSCs have been evaluated in some experimental and preclinical studies on efficacy and safety testing of novel treatments for humans, since the dog is considered to be a superior model for humans than rodents. Although these MSCs can be derived from several sources, clinical use has favoured bone marrow and adipose tissue because of their relative ease of stem cell recovery and the minimal donor-site morbidity. Before any type of stem cell can be applied clinically, its unequivocal characterization by a set of specific functional or phenotypic markers is crucial. However, no uniform characterization criteria are available for canine MSCs so far. Moreover, although multi-lineage potential of canine MSCs has been demonstrated in a limited number of studies, research on the differentiation potential of MSCs towards tenocytes is still lacking in canine medicine. In contrast, this latter subject has been explored already in human as well as in equine medicine, demonstrating the need for a specific 'niche', i.e. factors with a positive influence on the MSC differentiation. Since most of these factors are still unknown regarding canine MSC, critical basic knowledge is urgently required to motivate and correctly translate the potential therapeutic applications of these stem cells in both dog and man.

Worldwide screening for canine hip dysplasia: where are we now?

OBJECTIVE: To critically review the different screening systems used for canine hip dysplasia (CHD) and their impact on the prevalence of the disease. STUDY DESIGN: Critical literature review. METHODS: Literature search through PubMed (November 1959-October 2011) and the Orthopedic Foundation for Animals (OFA), Fédération Cynologique Internationale (FCI), British Veterinary Association/Kennel Club (BVA/KC), and Pennsylvania Hip Improvement Program (PennHIP) websites. RESULTS: The OFA, FCI, and BVA/KC screening methods, which use the hip-extended radiographic projection, have had relatively minor success on CHD prevalence. These screening approaches are prone to conflicting data regarding interobserver agreement. The PennHIP and Dorsolateral Subluxation (DLS) systems, both distraction methods, have not reported on prevalence but seem to be important heritable traits in genomic screening of dysplastic dogs. CONCLUSION: A shift towards genome screening yields a promising future combating CHD, although further investigation towards fine-mapping in the search for genes, responsible for CHD, is necessary.

Computed tomography findings in 32 joints affected with severe elbow incongruity and fragmented medial coronoid process.

OBJECTIVE: To describe the computed tomography (CT) findings in dogs with severe elbow incongruity combined with a fragmented medial coronoid process (FCP) and compare these with normal joints and congruent joints affected by FCP. STUDY DESIGN: Clinical study. ANIMALS: Client-owned dogs with elbow lameness (n = 40) and purpose bred dogs (n = 5; controls). METHODS: The CT features of 32 severely incongruent joints with concomitant FCP were compared with those of 32 congruent elbow joints affected with FCP and 10 normal joints. RESULTS: In severely incongruent elbow joints, a radioulnar step and widened joint spaces were visible on each CT plane. Additional features typically seen in severely incongruent elbows were a cyst at the radioulnar transition and fragmentation of the axial border of the medial coronoid incisure. None of these features appeared in normal or in congruent FCP joints. CONCLUSION: On CT, several features associated with severe elbow incongruity and concomitant FCP were detected, which were not found in normal joints or congruent joints affected by FCP.

Arthroscopic findings in 32 joints affected by severe elbow incongruity with concomitant fragmented medial coronoid process.

OBJECTIVE: To report arthroscopic findings in dogs with severe elbow incongruity combined with fragmented medial coronoid process (FCP) and compare these findings in normal joints and congruent joints affected by FCP. STUDY DESIGN: Clinical study. ANIMALS: Dogs with elbow lameness (n = 40) and purpose bred dogs (5; controls). MATERIALS AND METHODS: Arthroscopic features of 32 severely incongruent joints with concomitant FCP were compared with 32 congruent elbow joints affected with FCP and 10 normal joints. A radioulnar step of ≥ 3 mm on radiographs and computed tomography (CT) scans was the selection criterion for a severely incongruent joint. Intraarticular structures were visually assessed at various sites within the joint. Regions of interest were: the radioulnar transition, humeroradial and humeroulnar joint space, trochlear notch, primary and secondary lesions of the medial coronoid process, and radial head. RESULTS: Incongruent joints had a radioulnar step and changes at the cartilage in the center of the trochlear notch, an irregular radioulnar transition, and an abnormal surface of the radial head. Coronoid pathology was present in every pathologic joint. CONCLUSION: Arthroscopy allowed detection of several features that were signs or consequences of severe elbow incongruity or accompanying inflammation. After a prominent radioulnar step, cartilage changes involving the radial head and trochlear notch were most frequently seen.

Sensitivity and specificity of radiography for detection of elbow incongruity in clinical patients.

Elbow incongruity is an important factor regarding the treatment and prognosis of elbow dysplasia. Our purpose was to determine the sensitivity and specificity for radiographic detection of elbow incongruity in clinical patients, to establish inter- and intraobserver variation for different parameters, and to evaluate the possibility of radiographic grading of incongruity. Standard radiographic projections were acquired from 29 incongruent and nine congruent elbows of dogs of various ages and breeds. Computed tomography (CT) was used to diagnose and grade the incongruity. All radiographs were evaluated by four observers for detection and grading of elbow incongruity. Sensitivity, specificity, inter- and intraobserver variability were calculated. The mean sensitivity for detection of incongruity was very good (88.8%) with a mean specificity of 91.7%. Correct grading of incongruity was difficult. The radioulnar step and the widening of the humeroulnar and humeroradial joint space were seen most frequently. Intraobserver and interobserver variability were fair to excellent (Kappa = 0.372-0.809), depending on the investigated parameters. Radiography is valuable to screen for elbow incongruity. In over 91% of the patients, a clear distinction could be made between a congruent and an incongruent joint grading was not possible.

Accuracy of pressure plate kinetic asymmetry indices and their correlation with visual gait assessment scores in lame and nonlame dogs.

OBJECTIVE: To determine the accuracy of pressure plate kinetic asymmetry indices (ASIs) for diagnosis of unilateral hind limb lameness in dogs and their correlation with visual gait assessment (VGA) scores. ANIMALS: 9 healthy dogs and 16 dogs with previously diagnosed unilateral rupture of the cranial cruciate ligament and concurrent unilateral hind limb lameness. PROCEDURES: Dogs were walked over a pressure plate to determine paw contact area (PCA), peak vertical pressure (PVP), peak vertical force (PVF), and vertical impulse (VI) of both hind limbs. An ASI was calculated for each gait variable. Simultaneously, gait was assessed visually and scored by use of a numeric rating scale (0 to 10). The ASI of each variable was tested for its usefulness in discrimination between lame and nonlame dogs and for correlation with VGA scores. RESULTS: Sensitivity and specificity of ASIs to discriminate between lame and nonlame dogs were excellent for PVF, VI, and PCA; these values were substantially lower for ASI of PVP. Cutoff values to discriminate between lame and nonlame dogs were determined by use of ASIs for PVF, VI, and PCA; however, this could not be done for ASI of PVP. Correlations between ASIs of PVF, VI, and PCA and VGA scores were higher than correlation between the ASIs of PVP and VGA scores. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that ASIs of PVF and VI determined via analysis of pressure plate measurements were reliable indicators of clinical lameness in dogs, but the ASI of PVP was not. The ASI of PCA is an interesting new variable for assessment of limb loading symmetry.

The effect of a technical quality assessment of hip-extended radiographs on interobserver agreement in the diagnosis of canine hip dysplasia.

Experienced and inexperienced observers evaluated the assessability of 50 radiographs (25 dogs) and determined the hip status (dysplasia/nondysplasia and final scoring according Fédération Cynologique Internationale [FCI]-criteria) individually. A radiographic technical quality assessment was performed in a separate reading session. Interobserver agreement in determining dysplasia/nondysplasia and FCI-scoring did not significantly increase with the increasing quality of a radiograph, irrespective whether these observers are experienced or not. There was a significant agreement between the technical quality assessment and assessability (P < 0.0005). Despite the effort to objectify radiographic quality and to present high-quality radiographs to observers, interobserver agreement on dysplasia/nondysplasia and final scoring, remains low, even in the experienced group. Although increased radiographic quality narrows the range of scoring, the range remains unacceptably high.