Gieg Samuel D, Schaefer Christopher, Smith Matthew J, Ma Richard, Heil Sally D, Kim H Mike
Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA.
JSES Rev Rep Tech. 2022 Feb 11;2(2):149-154. doi: 10.1016/j.xrrt.2022.01.001. eCollection 2022 May.
Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions.
The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable.
Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability ( > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate ( = 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none.
The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.
肩胛侧位X线片一直常规用于创伤性和非创伤性肩部疾病的初始影像学检查。随着现代成像技术的发展，肩胛侧位片的临床实用性受到质疑。本研究的目的是评估美国肩肘外科医师学会（ASES）成员对肩胛侧位片的使用情况，并确定肩胛侧位片在非创伤性肩部疾病初始评估中的临床实用性。
本研究包括两个部分。第一部分是对ASES成员进行在线调查，询问他们关于对非创伤性肩部疼痛新患者进行影像学评估的3个问题。第二部分是基于临床病例的调查，我们机构的4位肩外科医生被给予50个临床病例，并被要求独立回答关于每个病例最可能的诊断、异常影像学表现、进一步的影像学检查和治疗计划的4个问题。该调查重复进行两次；第一次在没有肩胛侧位片的情况下进行，第二次在4周后增加肩胛侧位片进行。我们获得了每位外科医生在两次调查中的诊断准确性和一致性百分比，以及每个变量的观察者内和观察者间可靠性。
在总共235名回复在线调查的ASES成员中，193名（82.1%）表示他们常规使用肩胛侧位片。获取该视图的最常见原因是更好地描述肩峰形态（75.4%）。基于临床病例的调查显示，4位外科医生在两次调查之间，对于最可能的诊断、异常X线表现和进一步的影像学检查，观察者内可靠性较高（>0.6），而对于治疗计划的观察者内可靠性为中等（κ = 0.548）。两次调查之间，4位外科医生的平均诊断准确性几乎相等（74%对75%）。总体而言，每位外科医生在两次调查中的一致性百分比超过70%。在第一次调查中，4位外科医生均未推荐肩胛侧位片用于进一步的影像学检查；他们都希望进行高级影像学检查（计算机断层扫描、磁共振成像）或不进行任何检查。
在有其他正交视图的情况下增加肩胛侧位X线片似乎并不能提高外科医生的诊断准确性，也不会影响他们对非创伤性肩部疾病治疗计划的决策。在这种情况下，可能需要重新评估肩胛侧位片的临床实用性。
