Diagnostic accuracy of fracture detection in suspected non-accidental injury: the effect of edge enhancement and digital display on observer performance

Digital imaging is not superior to film-screen imaging for the detection of periprosthetic osteolysis around total knee arthroplasties

Our aim was to compare the assessment of periprosthetic osteolysis around total knee arthroplasties using digital images against film-screen images. Simulated osteolytic lesions were created around 3 cadaveric total knee arthroplasties images acquired using fluoroscopic-assisted radiography and Computed Tomography. Three surgeons reviewed the film-screen images (AP/Lateral, Oblique, and Computed Tomography (CAT)) and the same images digitally. Combinations of 2 or more images that included the AP/Lateral views had superior performance in both film-screen and digital imaging to AP/Lateral views alone, except for the digital AP/Lateral/OBL combination. Lesion detection and volume appreciation were superior for film versus digital assessment for most angles. The addition of obliques to assessment using digital imaging improved performance, but film-screen remained superior to digital imaging for assessment of periprosthetic osteolysis.

The effect of image quality on the assessment of child abuse photographs

OBJECTIVES

Although child abuse pediatricians are frequently asked to evaluate risk of abuse based on photographs, the effect of photographic quality on this process is presently unknown. Photographs of abused children are often taken by professionals without photographic training, and quality varies widely. This article reports the first study of the effect of image quality on clinical assessment from photographs.

METHODS

A total of 120 images depicting 60 cutaneous lesions were selected for the study. Paired images of single lesions varied in quality of focus, exposure, or framing. Seventy medical and nursing professionals were recruited from the Internet listservs focusing on child abuse. Subjects evaluated the images for quality (1-9 scale), opined if the image was "inadequate for interpretation," and answered a clinical question about the type of lesion displayed. Accuracy was defined as concordance between the subject and the live examiner's written documentation. Adequacy was defined as the proportion of subjects that did not indicate that the photograph was inadequate for interpretation.

RESULTS

Mean accuracy among subjects was 64% and ranged from 35% to 84%. Accuracy was not predicted by subject profession, experience, or self-rated computer skill. Image quality and adequacy were independently associated with increased accuracy.

CONCLUSIONS

Higher-quality images improved accuracy. An examiner's impression that an image is adequate did not guarantee an accurate interpretation. Reliance on photographs alone is not sufficiently accurate in the assessment of cutaneous trauma.

Skeletal imaging of child abuse (non-accidental injury)

In recent years there has been a worldwide increased awareness that children are physically abused by their carers. Radiologists play a vital role in the detection of inflicted injuries. This article reviews the skeletal imaging findings seen in child abuse.