A recent document by the ATS/ERS/JRS/ALAT classifies HRCT patterns of fibrotic lung disease into definite UIP, possible UIP and inconsistent with UIP (1). Management guidelines in this report focus on 'definite IPF' usually diagnosed from typical UIP appearances on HRCT. Guidance on the management of 'possibly IPF' (based upon the possible UIP HRCT appearances) is less clear. Moreover, honeycombing and a definite UIP pattern on CT are indicators of a poor prognosis in patients with fibrotic lung disease (2, 3, 4, 5, 6, 7) Clearly high levels of observer agreement are necessary for these HRCT categories to be clinically useful. Thus the aim of this study is to determine the observer agreement for honeycombing and a definite UIP pattern on HRCT in a large group of pulmonary physicians. This study represents a physician-only arm to a larger study asking the same clinical questions of a large group of radiologists.

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