{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:10:14Z","timestamp":1790079014368,"version":"4.0.1"},"reference-count":24,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Clinical cellulite grading relies on inspection and palpation and is susceptible to examiner variability. A single experienced assessor previously evaluated a five-grade infrared thermographic classification, but its reproducibility across raters was unknown. To assess inter-rater and intra-rater reliability of a standardized thermographic grading workflow applied by trained novice raters. Methods: This secondary reliability study included 78 anterior FLIR P620 scans. Five raters analyzed each scan twice, one week apart, using standardized FLIR Tools settings and a \u0394T-based 0\u2013IV scale. The prespecified principal agreement analysis used Gwet\u2019s AC2 with quadratic weights across the full 0\u2013IV scale; a sensitivity analysis recalculated AC2 using only the observed categories. Confidence intervals were estimated by scan-level bootstrap. Results: The scans yielded 780 ratings, all within grades 0\u2013II. Full five-rater exact agreement was 26.9% and 33.3% in rounds 1 and 2, respectively, while within-one-grade agreement was 89.7% and 92.3%. Observed-category AC2, which restricts quadratic weighting to the grades represented in the data (0\u2013II), was 0.786 (95% CI 0.730\u20130.840) and 0.845 (0.794\u20130.885). The corresponding prespecified full-scale AC2 values calculated across the theoretical 0\u2013IV weighting range were 0.949 (0.936\u20130.962) and 0.963 (0.951\u20130.972). Intra-rater exact agreement ranged from 66.7% to 97.4%, with 100% agreement within one grade for all raters. Conclusions: The workflow demonstrated reproducible ordinal grading within the lower severity categories represented in the dataset, although exact five-rater agreement remained limited. The findings do not establish reliability for grades III\u2013IV, diagnostic accuracy, or clinical utility.<\/jats:p>","DOI":"10.3390\/jcm15187305","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inter- and Intra-Rater Reliability of a Standardized Infrared Thermographic Cellulite Severity Classification System: A Multi-Rater Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0074-1880","authenticated-orcid":false,"given":"Patrycja","family":"Szczepa\u0144ska-Ciszewska","sequence":"first","affiliation":[{"name":"WSEI University, 4 Projektowa Street, 20-209 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2602-1128","authenticated-orcid":false,"given":"Wojciech Micha\u0142","family":"Glinkowski","sequence":"additional","affiliation":[{"name":"Center of Excellence \u201cTeleOrto\u201d for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0239-1637","authenticated-orcid":false,"given":"Andrzej","family":"\u015aliwczy\u0144ski","sequence":"additional","affiliation":[{"name":"WSEI University, 4 Projektowa Street, 20-209 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4117-2605","authenticated-orcid":false,"given":"Magdalena","family":"G\u0142owacka","sequence":"additional","affiliation":[{"name":"WSEI University, 4 Projektowa Street, 20-209 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-2528","authenticated-orcid":false,"given":"Anna","family":"Erkiert-Polguj","sequence":"additional","affiliation":[{"name":"Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, 91-151 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agata","family":"Kmita","sequence":"additional","affiliation":[{"name":"Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, 91-151 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Rybak","sequence":"additional","affiliation":[{"name":"Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, 91-151 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2059-7380","authenticated-orcid":false,"given":"Barbara","family":"Algiert-Zieli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, 91-151 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Koserczyk","sequence":"additional","affiliation":[{"name":"Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, 91-151 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s40257-015-0129-5","article-title":"Cellulite: An evidence-based review","volume":"16","author":"Luebberding","year":"2015","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1524-4725.1978.tb00416.x","article-title":"So-called cellulite: An invented disease","volume":"4","year":"1978","journal-title":"J. Dermatol. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ijwd.2018.09.002","article-title":"Treatment for cellulite","volume":"5","author":"Sadick","year":"2019","journal-title":"Int. J. Women\u2019s Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gomes-Ferreira, M., and Olivas-Menayo, J. (2023). Cellulite: Etiology and Treatment. Post-Maternity Body Changes: Obstetric Fundamentals and Surgical Reshaping, Springer International Publishing.","DOI":"10.1007\/978-3-030-43840-1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"442","DOI":"10.5114\/ada.2018.77235","article-title":"Cellulite: A cosmetic or systemic issue? Contemporary views on the etiopathogenesis of cellulite","volume":"35","author":"Tokarska","year":"2018","journal-title":"Postep. Dermatol. Alergol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"686","DOI":"10.32383\/farmpol\/132457","article-title":"Przyczyny wyst\u0119powania cellulitu","volume":"76","author":"Zakrzewski","year":"2020","journal-title":"Farm. Pol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ojad050","DOI":"10.1093\/asjof\/ojad050","article-title":"Cellulite: Current Understanding and Treatment","volume":"5","author":"Gabriel","year":"2023","journal-title":"Aesthet. Surg. J. Open Forum"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"242","DOI":"10.12788\/j.sder.2018.056","article-title":"Updates on the understanding and treatment of cellulite","volume":"37","author":"Hogan","year":"2018","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1097\/DSS.0000000000001993","article-title":"Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients","volume":"45","author":"Hexsel","year":"2019","journal-title":"Dermatol. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"NP521","DOI":"10.1093\/asj\/sjaa226","article-title":"Comparison of Cellulite Severity Scales and Imaging Methods","volume":"41","author":"Young","year":"2021","journal-title":"Aesthet. Surg. J."},{"key":"ref_11","first-page":"30","article-title":"Diagnostic scales and methods for assessing the severity of gynoid lipodystophy","volume":"2","author":"Borzuchowska","year":"2024","journal-title":"J. Health Policy Outcomes Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1111\/jdv.19796","article-title":"Beyond visual inspection: The value of infrared thermography in skin diseases, a scoping review","volume":"38","author":"Speeckaert","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1007\/s10103-022-03530-2","article-title":"Infrared thermography as valuable tool for gynoid lipodystrophy (cellulite) diagnosis","volume":"37","author":"Barbaroto","year":"2022","journal-title":"Lasers Med. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s10973-018-7232-9","article-title":"Non-contact thermal imaging as potential tool for personalized diagnosis and prevention of cellulite","volume":"133","author":"Bauer","year":"2018","journal-title":"J. Therm. Anal. Calorim."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mazurkiewicz, J., Bauer, J., Mosion, M., Migasiewicz, A., and Podbielska, H. (2018). Severity of Cellulite Classification Based on Tissue Thermal Imagining. Artificial Intelligence and Soft Computing, Springer.","DOI":"10.1007\/978-3-319-91262-2_17"},{"key":"ref_16","first-page":"e231","article-title":"Evaluation of the cellulite using a thermal infra-red camera","volume":"19","author":"Nkengne","year":"2013","journal-title":"Ski. Res. Technol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/srt.12301","article-title":"Thermographic mapping of the skin surface in biometric evaluation of cellulite treatment effectiveness","volume":"23","author":"Koprowski","year":"2017","journal-title":"Ski. Res. Technol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Szczepa\u0144ska-Ciszewska, P., \u015aliwczy\u0144ski, A., Mruk, B., Glinkowski, W.M., Wicher, P., Sulimski, A., and Wicher, A. (2026). Validation of Infrared Thermal Imaging for Grading of Cellulite Severity: Correlation with Clinical and Anthropometric Assessments. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020913"},{"key":"ref_19","unstructured":"Gwet, K.L. (2014). Handbook of Inter-Rater Reliability: The Definitive Guide to Measuring the Extent of Agreement Among Raters, Advanced Analytics. [4th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1348\/000711006X126600","article-title":"Computing inter-rater reliability and its variance in the presence of high agreement","volume":"61","author":"Gwet","year":"2008","journal-title":"Br. J. Math. Stat. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wongpakaran, N., Wongpakaran, T., Wedding, D., and Gwet, K.L. (2013). A comparison of Cohen\u2019s Kappa and Gwet\u2019s AC1 when calculating inter-rater reliability coefficients: A study conducted with personality disorder samples. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-61"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/19312458.2011.568376","article-title":"Agreement and Information in the Reliability of Coding","volume":"5","author":"Krippendorff","year":"2011","journal-title":"Commun. Methods Meas."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1037\/h0031619","article-title":"Measuring nominal scale agreement among many raters","volume":"76","author":"Fleiss","year":"1971","journal-title":"Psychol. Bull."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s13167-020-00199-x","article-title":"Implementation of artificial intelligence and non-contact infrared thermography for prediction and personalized automatic identification of different stages of cellulite","volume":"11","author":"Bauer","year":"2020","journal-title":"EPMA J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7305\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:33:07Z","timestamp":1790076787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":24,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187305"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187305","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}