Observer variation in skeletal radiology.

The factors that affect observer variation in bone radiology are analysed from data in the literature and on the basis of studies carried out at McMaster University on the hands and sacroiliac joints. A plea is made for presenting results in terms of Kappa statistics so that agreement due purely to chance is eliminated. In the conclusions the main variables that affect concordance are listed so that strategies can be developed to reduce observer variation. This is important in serial studies to ensure that the observer variations are smaller than the effect one wishes to measure.