MRI diagnosis of fracture of the scaphoid bone: impact of a new practice where the images are read by radiographers.
OBJECTIVE
To investigate whether magnetic resonance imaging (MRI) radiographers are able to evaluate MRI examinations with regard to scaphoid fractures to save patients unnecessary immobilization and clinical and radiographic examinations, and to reduce the costs for the hospital as well as society in general.


METHODS
Over a 1-year period 224 consecutive patients with a suspected clinical scaphoid fracture but negative radiography were referred for MRI and examined within 11 hours. The MR images were primarily evaluated by the MRI radiographer on duty. Other fractures and bone edema were not reported because these were not part of the work-up protocol agreed upon by the radiology and the orthopedic departments. The following weekday a final report was provided by a radiologist. For the economical analysis the official price-list for Danish hospital service was used.


RESULTS
The MRI radiographers reported 43 scaphoid fractures, whereas the radiologist ultimately diagnosed only 36 scaphoid fractures (16.1% of patients) (sensitivity, 100%; specificity, 96.3%). Six of the seven false-positive fractures occurred in patients with edema of the scaphoid. The seventh false-positive was a fracture of the capitate. The hospital saved at least 20,000 and the social care system 70.000.


CONCLUSIONS
It is possible to provide an acute MRI service to patients with clinically suspected fracture of the scaphoid and a normal plain radiograph. The MR images can be primarily read by sufficiently trained MR radiographers. This new work-up protocol reduces the cost for society.
Moller
Jakob M
JM
Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
Larsen
Lone
L
Bovin
Jan
J
Lausten
Gunnar S
GS
Hasselqvist
Maria
M
Jensen
Claus Munk
CM
Ropke
Ian
I
Thomsen
Henrik S
HS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002983:Clinical Competence; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003718:Denmark; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011871:Radiology; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology