Evidence map›Paper›PMID 40320174›Full record

ArticleRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology2025

Radiographic classification of mandibular osteoradionecrosis: A blinded prospective multi-disciplinary interobserver diagnostic performance study.

Zaphanlene Kaffey, Sarah Mirbahaeddin, Kareem Wahid, Serageldin Kamel, Michael Vouffo, Adegbenga O Otun, Zayne Belal, Ruth A Aponte Wesson, Patrick P Carriere, Cem Dede and 20 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors.

Zaphanlene KaffeyDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Division of Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Sarah MirbahaeddinDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Kareem WahidDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
Serageldin KamelDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Michael VouffoDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Adegbenga O OtunDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Zayne BelalDepartment of Radiation Oncology, The University of Pennsylvania, Philadelphia, USA.
Ruth A Aponte WessonDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Patrick P CarriereDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Cem DedeDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Anastasios ManiakasDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Ryan P GoepfertDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Adam S GardenDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Anna LeeDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Karen Y ChoiDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Joani M ChristensenDepartment of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Christie LincolnDepartment of Neuroradiology The University of Texas MD Anderson Cancer Center, Houston, USA.
Gohar S ManzarDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Stephanie O DudzinskiDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Rehema ThomasDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Hunter MehrensDepartment of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
Richard C CardosoDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Dawid SchellingerhoutDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Neuroradiology The University of Texas MD Anderson Cancer Center, Houston, USA.
Erin WatsonDepartment of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada.
Melissa M ChenDepartment of Neuroradiology The University of Texas MD Anderson Cancer Center, Houston, USA.
Stephen Y LaiDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Clifton D FullerDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: cdfuller@mdanderson.org.
Amy C MorenoDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: akmoreno@mdanderson.org.
Laia Humbert-VidanDivision of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: lhumbert@mdanderson.org.
MD Anderson Head and Neck Cancer Symptom Working Group

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI DIANE BODURKA · 1985 to 2026
$290.8M
Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Establish Objective Clinical Outcome Measures for Mandibular OsteoradionecrosisR01DE025248 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI LAI, STEPHEN Y · 2016 to 2020
$2.9M
Quantitative Imaging Biomarker Prospective Validation of Dynamic Contrast-Enhanced MRI as a Metric of Orodental Injury After Radiotherapy (QI-ProVE-MRI)U01DE032168 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Clifton David Fuller, STEPHEN Y LAI · 2023 to 2026
$2.8M
SCH: Personalized Rescheduling of Adaptive Radiation Therapy for Head & Neck CancerR01CA257814 · NCI · RICE UNIVERSITY · PI FULLER, CLIFTON DAVID, SCHAEFER, ANDREW J · 2021 to 2024
$1.8M
Image Guided Cancer Therapy Training ProgramT32CA261856 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Kristy Brock, Clifton David Fuller · 2022 to 2026
$1.2M
Provider and Patient-generated Remote Oro-Dental Health Electronic Data Capture for Algorithmic Longitudinal Evaluation and Risk-Assessment (PROHEALER)K01DE030524 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI MORENO, AMY CATHERINE · 2022 to 2024
$479k
Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Establish Objective Clinical Outcome Measures for Mandibular OsteoradionecrosisR56DE025248 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI LAI, STEPHEN Y · 2015 to 2015
$470k
NCI NIH HHS P30 CA016672NCI NIH HHS R01 CA257814NCI NIH HHS T32 CA261856NIDCR NIH HHS K01 DE030524NIDCR NIH HHS R01 DE025248NIDCR NIH HHS R56 DE025248NIDCR NIH HHS U01 DE032168
6 · The paper itself

Abstract

BACKGROUND & PURPOSE: Osteoradionecrosis (ORN) of the jaw is a severe complication affecting up to 15% of head and neck cancer patients treated with radiotherapy. The ClinRad system, endorsed by ASCO/ISOO/MASCC, incorporates radiographic features for ORN severity classification, but variability in imaging use and specialty expertise may impact diagnostic accuracy. This study benchmarks physician performance in diagnosing and staging ORN across specialties and imaging modalities. MATERIALS &

methodsA retrospective diagnostic validation study was conducted at MD Anderson Cancer Center, involving 20 physicians from oral oncology, radiation oncology, surgery, and neuroradiology. Participants reviewed 85 de-identified imaging sets (CT and orthopantogram (OPG)) from 30 patients with confirmed ORN, diagnosing and staging cases using the ClinRad system. ROC analysis assessed diagnostic accuracy, while intra- and inter-observer agreement was measured using Cohen's and Fleiss kappa statistics.

resultsPaired CT-OPG imaging significantly improved diagnostic performance across specialties (p < 0.001), with AUC values ranging from 0.79 (residents) to 0.98 (surgeons). However, inter- and intra-rater agreement remained low, with median Fleiss kappa values of 0.22, 0.13, and 0.05 for ClinRad stages 0/1, 2, and 3, respectively. No specialty demonstrated significantly superior diagnostic accuracy (p > 0.05).

conclusionThis study establishes a benchmark for radiographic ORN detection, revealing diagnostic variability across specialties. Findings emphasize the need for standardized imaging protocols, interdisciplinary training, and multimodal imaging to improve diagnostic accuracy.

Indexed as

Head and Neck NeoplasmsMandibular DiseasesOsteoradionecrosisAgedFemaleHumansMaleMiddle AgedObserver VariationProspective StudiesRadiography, PanoramicRetrospective StudiesTomography, X-Ray ComputedClinradEarly detectionInterobserver variabilityOral oncologyOsteoradionecrosisRadiographic staging

Identifiers

PMID40320174
PMCPMC12158629

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.