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Dear all Even in my limited experience i have seen Kappa used in several different ways when measuring inter-observer variation in the context of radiology. I would be extremely grateful if somebody could clarify the following few points for me: (a) usually Kappa is used to measure reliability in the interpretation of films by two radiologists i.e. independent individuals within the same profession. Would it be possible to use Kappa to measure reliability between two independent individuals but from different professional groups (i.e. radiographer vs radiologist)? (b) Kappa is used to measure reliability between two individuals who each report on the same batch of films. Would it be possible to use Kappa to measure consistency between two independent groups of people from different professions who shared the burden of reporting on all the films? (c) Finally, if an observers performance is compared with a "gold" standard (e.g. consensus report) then this is a measure of accuracy and Sn and Sp is calculated, rather than a measure of reliability. Is it possible to use Kappa by measuring reliability between the gold standard and an independent observer (i.e. consistently accurate), or is this not possible because you are changing your assumption regarding whether the gold standard is providing the "true" diagnosis or not? Best regards, Stephen Brealey Department of Health Sciences University of York %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%