OBJECTIVE: Radiographic assessment of sacroiliac joints (SIJs) according to the modified New York (mNY) criteria is key in the classification of axial spondyloarthritis but has moderate interreader agreement. We aimed to investigate the improvements of the reliability in scoring SIJ radiographs after applying an online real-time iterative calibration (RETIC) module, in addition to a slideshow and video alone. METHODS: Nineteen readers, randomized to 2 groups (A or B), completed 3 calibration steps: (1) review of manuscripts, (2) review of slideshow and video with group A completing RETIC, and (3) re-review of slideshow and video with group B completing RETIC. The RETIC module gave instant feedback on readers' gradings and continued until predefined reliability ([Formula: see text]) targets for mNY positivity/negativity were met. Each step was followed by scoring different batches of 25 radiographs (exercises I to III). Agreement ([Formula: see text]) with an expert radiologist was assessed for mNY positivity/negativity and individual lesions. Improvements by training strategies were tested by linear mixed models. RESULTS: In exercises I, II, and III, mNY [Formula: see text] were 0.61, 0.76, and 0.84, respectively, in group A; and 0.70, 0.68, and 0.86, respectively, in group B (ie, increasing, mainly after RETIC completion). Improvements were observed for grading both mNY positivity/negativity and individual pathologies, both in experienced and, particularly, inexperienced readers. Completion of the RETIC module in addition to the slideshow and video caused a significant [Formula: see text] increase of 0.17 (95% CI 0.07-0.27; P = 0.002) for mNY-positive and mNY-negative grading, whereas completion of the slideshow and video alone did not ([Formula: see text] = 0.00, 95% CI -0.10 to 0.10; P = 0.99). CONCLUSION: Agreement on scoring radiographs according to the mNY criteria significantly improved when adding an online RETIC module, but not by slideshow and video alone.

A E F Hadsbjerg MD M Østergaard MD PhD DMSc Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center for Head and Orthopaedics Righospitalet Glostrup and Department of Internal Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

A E F Hadsbjerg MD M Østergaard MD PhD DMSc Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center for Head and Orthopaedics Righospitalet Glostrup and Department of Internal Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark;

B Möller MD Department of Rheumatology and Immunology Inselspital University Hospital Bern Bern Switzerland

J Paschke MSc CARE Arthritis Edmonton Alberta Canada

K Bubova MD M Gregová MD Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

K Gorican MD MSK Radiology Unit Radiology Section Diagnostic Department Geneva University Hospital Geneva Switzerland

K Pintaric MD Z Snoj MD Institute of Radiology UMC Ljubljana Ljubljana Slovenia

M de Hooge Rheumatology Department Ghent University Hospital Ghent Belgium

M J Nissen MD Rheumatology Department Geneva University Hospital Geneva Switzerland

R G Lambert MD PhD Department of Radiology and Diagnostic Imaging University of Alberta Edmonton Alberta Canada

R Micheroli MD A Ciurea MD A Bernatschek MD M Donzallaz MD Department of Rheumatology University Hospital of Zürich Zurich Switzerland

S J Pedersen MD PhD S Krabbe MD PhD A J Mathew MD PhD M Wetterslev MD PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Center for Head and Orthopaedics Righospitalet Glostrup Denmark

S Wichuk MSc Division of Rheumatology University of Alberta Edmonton Alberta Canada

W P Maksymowych MD PhD CARE Arthritis and Division of Rheumatology University of Alberta Edmonton Alberta Canada

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