Salem Khaled Hamed, Ladenburger Andreas, Schoth Felix, Ohnsorge Jörg Axel
Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Egypt.
Department of Orthopaedic Surgery, RWTH Aachen University, Germany.
J Clin Orthop Trauma. 2019 Jul-Aug;10(4):645-649. doi: 10.1016/j.jcot.2018.09.010. Epub 2018 Sep 21.
Digital radiographs of the whole spine are made using marginally superimposed imaging plates exposed simultaneously to be combined by interpolation of the overlapping area. Post-processing artefacts in these radiographs leading to the misdiagnosis of implant breakage have not yet been described in the literature.
An erroneous fusion of a digital spine x-ray after scoliosis surgery created an image showing two broken rods, whereas both rods proved complete continuity intraoperatively. Following an interdisciplinary error analysis, the chain of errors was systematically reconstructed. Using the digital imaging material of patients operatively treated the same way; the reproducibility of the error was analyzed. Erroneous image fusions were produced by slight displacement of existing, not yet combined x-ray images of these patients.
Under certain requirements, the false impression of implant breakage could be reproduced. Especially in the case of missing or malpositioned radiopaque markers, the hazard to overlook an erroneous image fusion is present. Within the post-processing step performed by qualified staff, control is indispensable and manual correction can be crucial.
This experimental study and causal analysis show the clinical relevance of post-processing artefacts in digital radiography. To prevent false diagnosis and maltreatment, the knowledge of possible sources of error is indispensable.
全脊柱数字X线片是通过对同时曝光的边缘重叠成像板进行插值组合来制作的。这些X线片中导致植入物断裂误诊的后处理伪影在文献中尚未见报道。
脊柱侧弯手术后数字脊柱X线片的错误融合产生了一张显示两根杆断裂的图像，而术中两根杆均显示完全连续。经过多学科错误分析，系统地重建了错误链。使用以相同方式进行手术治疗的患者的数字成像材料，分析了错误的可重复性。通过轻微移动这些患者现有的、尚未组合的X线图像产生错误的图像融合。
在一定条件下，植入物断裂的假象可以重现。特别是在不透射线标记物缺失或位置不当的情况下，存在忽视错误图像融合的风险。在由合格人员执行的后处理步骤中，控制是必不可少的，手动校正可能至关重要。
本实验研究和因果分析表明了数字X线摄影中后处理伪影的临床相关性。为防止误诊和不当治疗，了解可能的错误来源是必不可少的。
