Protocol - Arthritis/Osteoarthritis
This protocol is divided into two parts. The first part contains detailed instructions for obtaining knee, hand, and pelvic radiographs using the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study. The second part of the protocol is the Kellgren-Lawrence Grading Scale©. This scale is a tool used by radiologists to determine the extent of osteo-arthritic findings seen via radiographs. Radiologists look at the amount of spacing between joints, bone formation, and bone contour when determining the Kellgren-Lawrence Grade©.
The Skin, Bone, Muscle and Joint Working Group (WG) recommends the knee, hand, and hip as the most critical areas to examine for osteoarthritis in genome wide association studies (GWAS) and other large population-based studies. Study investigators will need to tailor the area of examination according to their specific study hypotheses.
The Working Group recommends using the Osteoarthritis Initiative radiographic procedure manual for obtaining radiographs. This manual provides guidance for obtaining radiographs of the knee, hand, and pelvis of adults. However, please note that not all sites must be done.
Additionally, the Working Group recommends using the Kellgren-Lawrence Grading Scale© once a radiograph is obtained. The Kellgren-Lawrence Grading Scale© grades are for each joint and are not combined or averaged. Each grade provides information on the level of osteoarthritis at each joint location.
Part I: Summary of the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study
The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs is designed for obtaining radiographs by use of conventional radiographic equipment with exposure of radiographic film. The manual also contains information for applying its procedures with the use of digital radiographic equipment.
The manual contains information for preparing X-ray participants, proper participant positioning, and information for assisting participants in maintaining proper positioning.
In addition, the manual contains instructions for obtaining unilateral posteroanterior (PA) fixed flexion knee radiographs with fluoroscopy, PA semiflexed knee radiographs with fluoroscopy, lateral knee radiographs for controls, and unilateral and bilateral hand radiographs (including pictures of proper and improper positioning), positioning of the X-ray tube, documentation, and quality control.
Instructions for obtaining the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs can be found in the Source section. Sections 3.3 and 3.6–3.8 of this manual are for obtaining knee radiographs. The first part of section 3.4 (pages 24–36) is for obtaining hand radiographs, whereas the second part of section 3.4 (pages 37–42) is for obtaining pelvic radiographs, which include the hip joints.
Osteoarthritis Initiative instruments are under copyright: ©2010 OAIOnline, produced by the Coordinating Center, University of California San Francisco.
Part II: Kellgren-Lawrence Grading Scale©
Once the radiograph(s) is obtained, the PhenX Skin, Bone, Muscle and Joint Working Group recommends that a radiologist use the Kellgren-Lawrence Grading Scale© for interpretation.
Kellgren-Lawrence Grading Scale©
[ ] Grade 1: doubtful narrowing of joint space and possible osteophytic lipping
[ ] Grade 2: definite osteophytes, definite narrowing of joint space
[ ] Grade 3: moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour
[ ] Grade 4: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour
Copyright ©2010 American College of Radiology Imaging Network (ACRIN)
Protocol Name from Source
Personnel and Training Required
A trained X-ray technician is required to administer the radiograph, and radiographs (X-rays) must be interpreted (“read”) by a trained radiologist.
Conventional or digital X-ray machine and the related standard implementation equipment, such as lead vests for patients. Standard equipment used by radiologists to view radiographs is also required.
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||Yes|
Mode of Administration
Noninvasive radiologic assessment
For the Osteoarthritis Initiative manual: Adults, age 45 to 79
For the Kellgren-Lawrence Grading Scale®: Adults, Older Adults
The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative was chosen because it was a large-scale study of 5,000 male and female participants with well established standards and quality control procedures.
The Kellgren-Lawrence Grading Scale® was chosen because it has been vetted against other radiographic grading scales and is considered the gold standard in radiographic interpretation for the presence of osteoarthritis. This scale has been widely and routinely used in both clinical and research settings for several years.
|Common Data Elements (CDE)||Joint Arthritis Radiography Scale||3158223||CDE Browser|
|Logical Observation Identifiers Names and Codes (LOINC)||Arthritis osteoarthritis proto||62900-6||LOINC|
|Human Phenotype Ontology||Osteoaerthritis||HP:0002758||HPO|
Process and Review
The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study (version 2.1 August 2006).
Information regarding this manual can also be obtained through:
San Francisco Coordinating Center
185 Berry St.
Lobby 4, Suite 5700
San Francisco, CA 94107
©2010 OAIOnline, produced by the Coordinating Center, University of California San Francisco
The Kellgren-Lawrence Grading Scale© can be found on the American College of Radiology Imaging Network (ACRIN) website.
Copyright ©2010 American College of Radiology Imaging Network (ACRIN)
Kellgren, J. H., & Lawrence, J. S. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases,16, 494–502.
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX170201010000||Hand scan image name (ID)||N/A|
|PX170201030000||Kellgren-Lawrence score for hand||N/A|
|PX170201070000||Hip scan image name (ID)||N/A|
|PX170201090000||Kellgren-Lawrence score for hip||N/A|
|PX170201040000||Knee scan image name (ID)||N/A|
|PX170201060000||Kellgren-Lawrence score for knee||N/A|
|PX170201020000||Left or right hand scanned||Variable Mapping|
|PX170201080000||Left or right hip scanned||Variable Mapping|
|PX170201050000||Left or right knee scanned||N/A|
November 12, 2010
This is a measure to obtain unilateral or bilateral knee, hand, and pelvic (for hip joint) radiographs (X-rays) and to interpret the radiographs to determine the level of osteoarthritis.
This measure can be used to determine the level of osteoarthritis, one of the most common joint conditions affecting adults and older adults.
arthritis, knee osteoarthritis, hand osteoarthritis, hip osteoarthritis, pelvis, radiographs, X-rays, joint narrowing, joint spacing, The Osteoarthritis Initiative (OAI), Kellgren-Lawrence Grading Scale, K-L Grade, gerontology, aging, geriatrics, bone, joint