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Proceedings Paper

Is Grannum grading of the placenta reproducible?
Author(s): Mary Moran; John Ryan; Patrick C. Brennan; Mary Higgins; Fionnuala M. McAuliffe
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Paper Abstract

Current ultrasound assessment of placental calcification relies on Grannum grading. The aim of this study was to assess if this method is reproducible by measuring inter- and intra-observer variation in grading placental images, under strictly controlled viewing conditions. Thirty placental images were acquired and digitally saved. Five experienced sonographers independently graded the images on two separate occasions. In order to eliminate any technological factors which could affect data reliability and consistency all observers reviewed images at the same time. To optimise viewing conditions ambient lighting was maintained between 25-40 lux, with monitors calibrated to the GSDF standard to ensure consistent brightness and contrast. Kappa (κ) analysis of the grades assigned was used to measure inter- and intra-observer reliability. Intra-observer agreement had a moderate mean κ-value of 0.55, with individual comparisons ranging from 0.30 to 0.86. Two images saved from the same patient, during the same scan, were each graded as I, II and III by the same observer. A mean κ-value of 0.30 (range from 0.13 to 0.55) indicated fair inter-observer agreement over the two occasions and only one image was graded consistently the same by all five observers. The study findings confirmed the lack of reproducibility associated with Grannum grading of the placenta despite optimal viewing conditions and highlight the need for new methods of assessing placental health in order to improve neonatal outcomes. Alternative methods for quantifying placental calcification such as a software based technique and 3D ultrasound assessment need to be explored.

Paper Details

Date Published: 13 March 2009
PDF: 6 pages
Proc. SPIE 7263, Medical Imaging 2009: Image Perception, Observer Performance, and Technology Assessment, 72631W (13 March 2009); doi: 10.1117/12.810993
Show Author Affiliations
Mary Moran, School of Medicine and Medical Science, Univ. College Dublin (Ireland)
John Ryan, School of Medicine and Medical Science, Univ. College Dublin (Ireland)
Patrick C. Brennan, School of Medicine and Medical Science, Univ. College Dublin (Ireland)
Mary Higgins, School of Medicine and Medical Science, Univ. College Dublin (Ireland)
National Maternity Hospital (Ireland)
Fionnuala M. McAuliffe, School of Medicine and Medical Science, Univ. College Dublin (Ireland)
National Maternity Hospital (Ireland)


Published in SPIE Proceedings Vol. 7263:
Medical Imaging 2009: Image Perception, Observer Performance, and Technology Assessment
Berkman Sahiner; David J. Manning, Editor(s)

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