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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, Sabrina; Held, Ulrike; Gascho, Dominic; Baumeister, Rilana; Flach, Patricia; Nguyen-Kim, Thi Dan-Linh; Thali, Michael J; Jentzsch, Thorsten (2019). 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. Forensic Science International, 303:109942.

Abstract

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.

Abstract

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > Institute of Legal Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Pathology and Forensic Medicine
Language:English
Date:12 September 2019
Deposited On:17 Oct 2019 11:56
Last Modified:22 Apr 2020 21:16
Publisher:Elsevier
ISSN:0379-0738
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.forsciint.2019.109942
PubMed ID:31586908

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