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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

Sabrina Mauf, Ulrike Held, Dominic Gascho, Rilana Baumeister, Patricia Flach, Thi Dan-Linh Nguyen-Kim, Michael J Thali & Thorsten Jentzsch

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.
   
citation Mauf S, Held U, Gascho D, Baumeister R, Flach P, Nguyen-Kim T D L, Thali M J, Jentzsch T. 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 Sci Int 2019; 303:109942.
   
type journal paper/review (English)
date of publishing 12-09-2019
journal title Forensic Sci Int (303)
ISSN electronic 1872-6283
pages 109942
PubMed 31586908
DOI 10.1016/j.forsciint.2019.109942