Please indicate your level of medical training:

No medical training Medical Student Medical/Surgical resident Radiology Resident/TY Transitional 1st Year 2nd Year 3rd Year 4th Year Radiology fellow Radiology attending Other

Approximately how many months of training/practice do you have in the interpretation of MRIs of the lumbar spine?

What is your country of primary practice?

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Please rate your agreement with the following statement:

I can accurately grade the severity of degenerative changes on an MRI of the lumbar spine.

Please rate your agreement with the following statement:

I have good internal consistency in grading the severity of degenerative changes on an MRI of the lumbar spine (my grading cutoffs never vary).

Please rate your agreement with the following statement:

My interpretations are concordant with those of other radiologists in grading the severity of degenerative changes on an MRI of the lumbar spine (our reports always perfectly agree).

Instructions

In the first set of cases, you will be shown coned-down images from an MRI of the lumbar spine. For each case, you will be provided with a single axial and a single sagittal T2 weighted image (you will not be able to scroll). The level of the axial image will be indicated by a cross-reference line. The lumbosacral junction (L5-S1) will be visible at the lower aspect of the sagittal image.

For each case, please make the following determinations:

• What is the size/degree of the posterior disc contour abnormality at the indicated level? Although you will see examples of disc bulges, protrusions, and extrusions, please ignore the differences between their morphologies. Only grade the size of the contour abnormality.

• What is the degree of spinal canal narrowing at the indicated level? This narrowing may be caused by the disc abnormality, developmental narrowing, ligamentum flavum hypertrophy, and other causes. Please provide a grading of the degree of overall narrowing.

You will be asked to grade these findings using the following criteria: Normal, Minimal, Mild, Mild-to-moderate, Moderate, Moderate-to-severe, and Severe.

After making a selection, you will be shown the correct answer, as determined by consensus by six academic musculoskeletal radiologists. Although you should consider each case carefully, you will receive a point (1) for the consensus response and partial credit (0.75) within one answer choice from the consensus response. At the end of the module, you will be provided with a summary of your results.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

Please grade the degree of disc contour abnormality and spinal canal narrowing.

In the second set of cases, you will be shown coned-down images from an MRI of the lumbar spine. For each case, you will be provided with a highly magnified image of a neural foramen from a sagittal T1 weighted series(you will not be able to scroll).

For each case, please make the following determination: What is the degree of neuroforaminal narrowing at this level? You will be asked to grade these findings using the following criteria: Normal, Minimal, Mild, Mild-to-moderate, Moderate, Moderate-to-severe, and Severe. After making a selection, you will be shown the correct answer, as determined by consensus by six academic musculoskeletal radiologists. Although you should consider each case carefully, you will receive a point (1) for the consensus response and partial credit (0.75) within one answer choice from the consensus response. At the end of the module, you will be provided with a summary of your results.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Please grade the degree of neuroforaminal narrowing.

Thank you for completing this module. We hope that it has helped you in learning to grade the severity of degenerative changes.

Please rate your agreement with the following statement:

This module has improved my ability to grade degenerative changes in the spine.

Please rate your agreement with the following statement:

I can accurately grade the severity of degenerative changes on an MRI of the lumbar spine.

Please rate your agreement with the following statement:

I have good internal consistency in grading the severity of degenerative changes on an MRI of the lumbar spine (my grading cutoffs never vary).

Please rate your agreement with the following statement:

My interpretations are concordant with those of other radiologists in grading the severity of degenerative changes on an MRI of the lumbar spine (our reports always perfectly agree)