Inter-rater Reliability and Measurement Error of Sonographic Muscle Architecture Assessments

Document Type


Publication Date



Objectives -- Sonography of muscle architecture provides physicians and researchers with information about muscle function and muscle‐related disorders. Inter‐rater reliability is a crucial parameter in daily clinical routines. The aim of this study was to assess the inter‐rater reliability of sonographic muscle architecture assessments and quantification of errors that arise from inconsistent probe positioning and image interpretation.

Methods -- The medial gastrocnemius muscle of 15 healthy participants was measured with sagittal B‐mode ultrasound scans. The muscle thickness, fascicle length, superior pennation angle, and inferior pennation angle were assessed. The participants were examined by 2 investigators. A custom‐made foam cast was used for standardized positioning of the probe. To analyze inter‐rater reliability, the examinations of both raters were compared. The impact of probe positioning was assessed by comparison of foam cast and freehand scans. Error arising from picture interpretation was assessed by comparing the investigators' analyses of foam cast scans independently. Reliability was expressed as the intraclass correlation coefficient (ICC), inter‐rater variability (IRV), Bland‐Altman analysis (bias ± limits of agreement [LoA]), and standard error of measurement (SEM).

Results -- Inter‐rater reliability was good overall (ICC, 0.77–0.90; IRV, 9.0%–13.4%; bias ± LoA, 0.2 ± 0.2–1.7 ± 3.0). Superior and inferior pennation angles showed high systematic bias and LoA in all setups, ranging from 2.0° ± 2.2° to 3.4° ± 4.1°. The highest IRV was found for muscle thickness (13.4%). When the probe position was standardized, the SEM for muscle thickness decreased from 0.1 to 0.05 cm.

Conclusions -- Sonographic examination of muscle architecture of the medial gastrocnemius has good to high reliability. In contrast to pennation angle measurements, length measurements can be improved by standardization of the probe position.


This article was originally published in Journal of Ultrasound in Medicine, volume 33, issue 5, in 2014. DOI: 10.7863/ultra.33.5.769

Peer Reviewed



American Institute of Ultrasound in Medicine