千种灰度——影像显示在隐匿性舟状骨骨折诊断中的作用——一项初步研究。
Thousand shades of gray - The role of imaging display in diagnosis of occult scaphoid fractures - A pilot study.
作者信息
Feldman Viktor, Atzmon Ran, Dubin Jeremy, Bein Orit, Palmanovich Ezequiel, Ohana Nissim, Farkash Uri
机构信息
Meir Hospital, Orthopedic Department, Sapir Medical Center, Tchernichovsky St 59, Kefar Sava, 4428164, Kfar Saba, Israel.
Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava, 4428164, Tel Aviv, Israel.
出版信息
J Orthop. 2022 Sep 28;34:327-330. doi: 10.1016/j.jor.2022.09.012. eCollection 2022 Nov-Dec.
INTRODUCTION
Most hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays.
METHODS
Wrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied.
RESULTS
Study population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display ( = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively.
DISCUSSION
The scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture.
引言
大多数医院和诊所使用商业级显示器来查看腕部X光片。目前尚无证据表明用于评估X光片的成像显示器所起的作用。本研究的目的是比较商业级显示器和医疗级显示器对舟骨骨折的诊断率。
方法
从急诊科回顾性收集有舟骨骨折临床体征但平片未见异常（疑似舟骨骨折）患者的腕部X光片，并由四位骨科资深医生分别使用商业级和医疗级显示器对骨折的X光征象进行解读。研究骨折诊断率的差异。同时也研究了观察者间和观察者内的变异性。
结果
共解读了175张高质量的腕部X光片。在商业级显示器上观察到平均48.25例（27%）舟骨骨折，而在医疗级显示器上为66例（38.2%）（P = 0.076）。观察者间的总体一致性可定义为中等一致性（κ = 0.527，准确率 = 0.77）。分别在商业级和医疗级显示器上查看X光片时，所有观察者之间完全一致的情况在86例（49.1%）和89例（50.9%）中出现。
讨论
与非医疗级显示器相比，医疗级显示器对舟骨骨折的检出率在统计学上并无显著更高，但我们确实发现了倾向于医疗级显示器的趋势。我们发现，在相当多的病例中，我们的观察者识别出了最初被急诊医生评估为“疑似骨折”的骨折征象。作为一项初步研究，我们发现有证据支持需要进行一项前瞻性研究，将观察结果与诸如MRI等金标准模式进行比较。我们认为，使用医疗级显示器可以提高临床疑似舟骨骨折病例的诊断率，并更好地处理疑似舟骨骨折的临床情况。
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