objective: to determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ilds) based on hrct scans and the impact of observer expertise, clinical data and confidence level on such agreement. methods: two thoracic radiologists and two general radiologists independently reviewed the hrct images of 58 patients with ilds on two distinct occasions: prior to and after the clinical anamnesis. the radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. one of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. in the coefficient analyses, the kappa statistic was used. results: the thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. the thoracic radiologists agreed on the most likely diagnosis in 48.3% (κ = 0.42) and 62.1% (κ = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (κ = 0.32) and 36.2% (κ = 0.30) of the cases. for the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. that for the general radiologist was 0.38 and 0.42.the thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. conclusions: interobserver and intraobserver agreement in the diagnosis of ilds based on hrct scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.