Journal article
Flat chest projection in the detection and visualization of rib fractures: A cross-sectional study comparing curved and multiplanar reformation of computed tomography images in different reader groups.
- Mauf S Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM), University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Electronic address: sabrina.mauf@gmail.com.
- Held U Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland. Electronic address: ulrike.held@uzh.ch.
- Gascho D Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM), University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Electronic address: dominic.gascho@virtopsy.com.
- Baumeister R Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM), University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Electronic address: rilana_baumeister@hotmail.de.
- Flach P Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM), University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Electronic address: patricia.flach@kssg.ch.
- Nguyen-Kim TD Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: thidanlinh.nguyen@usz.ch.
- Thali MJ Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine (ZIFM), University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland. Electronic address: michael.thali@irm.uzh.ch.
- Jentzsch T Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland. Electronic address: thorsten.jentzsch@gmail.com.
- 2019-10-07
Published in:
- Forensic science international. - 2019
CT
Chest trauma
Curved planar reformation (CPR)
Multiplanar reformation (MPR)
Musculoskeletal
radiology systems
Adult
Aged
Cross-Sectional Studies
False Positive Reactions
Female
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Observer Variation
Pathologists
Radiologists
Rib Fractures
Surgeons
Tomography, X-Ray Computed
Young Adult
English
BACKGROUND
Rib fractures are common and potentially life-threatening. Fast and correct detection as well as comprehensive visual overview of rib fractures are of clinical and forensic importance. This study compared two computed tomography (CT) reformation methods, curved planar reformation (CPR) with conventional multiplanar reformation (MPR), regarding detection of rib fractures in different readers.
METHODS
Twelve postmortem CT datasets were retrospectively assessed for rib fractures using CPR and MPR. After defining the gold-standard regarding side, level, localization, and quantity of fractures, four reader groups per two readers consisting of radiologists, trauma surgeons, forensic pathologists, and laypersons, were evaluated for sensitivity, proportion of false positives, time to fracture detection, and subjective preference.
RESULTS
Overall sensitivity for fracture detection did not vary significantly between both methods. However, it was significantly higher in trauma surgeons and laypersons when reading CPR compared to MPR (70.7% vs. 62.0%, p=0.038 and 33.7% vs. 22.1%, p=0.003 respectively). It was significantly lower in radiologists (63.8% vs. 76.8%, p=0.001). Forensic pathologists performed similarly with both methods (53.6% vs. 56.5%, p=0.549). All non-radiologists preferred the use of CPR (75%). All readers found CPR to provide better visual overview (100%).
CONCLUSION
CPR may increase rib fracture detection rates of non-radiologists (i.e. trauma surgeons and laypersons) and provides a better visual overview. However, radiologists achieve higher fracture detection rates when allowed to work with the software tools they are more experienced with. The overall sensitivity was improvable and better visualization methods are warranted in order to avoid misdiagnosis and medicolegal errors regarding rib fracture detection.
Rib fractures are common and potentially life-threatening. Fast and correct detection as well as comprehensive visual overview of rib fractures are of clinical and forensic importance. This study compared two computed tomography (CT) reformation methods, curved planar reformation (CPR) with conventional multiplanar reformation (MPR), regarding detection of rib fractures in different readers.
METHODS
Twelve postmortem CT datasets were retrospectively assessed for rib fractures using CPR and MPR. After defining the gold-standard regarding side, level, localization, and quantity of fractures, four reader groups per two readers consisting of radiologists, trauma surgeons, forensic pathologists, and laypersons, were evaluated for sensitivity, proportion of false positives, time to fracture detection, and subjective preference.
RESULTS
Overall sensitivity for fracture detection did not vary significantly between both methods. However, it was significantly higher in trauma surgeons and laypersons when reading CPR compared to MPR (70.7% vs. 62.0%, p=0.038 and 33.7% vs. 22.1%, p=0.003 respectively). It was significantly lower in radiologists (63.8% vs. 76.8%, p=0.001). Forensic pathologists performed similarly with both methods (53.6% vs. 56.5%, p=0.549). All non-radiologists preferred the use of CPR (75%). All readers found CPR to provide better visual overview (100%).
CONCLUSION
CPR may increase rib fracture detection rates of non-radiologists (i.e. trauma surgeons and laypersons) and provides a better visual overview. However, radiologists achieve higher fracture detection rates when allowed to work with the software tools they are more experienced with. The overall sensitivity was improvable and better visualization methods are warranted in order to avoid misdiagnosis and medicolegal errors regarding rib fracture detection.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.forsciint.2019.109942
- PMID 31586908
- Persistent URL
- https://sonar.rero.ch/global/documents/135062
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