title: Digital image enhancement improves diagnosis of nondisplaced proximal femur fractures.
abstract: Today most emergency room radiographs are computerized, making digital image enhancement a natural advancement to improve fracture diagnosis. We compared the diagnosis of nondisplaced proximal femur fractures using four different image enhancement methods using standard DICOM (Digital Imaging and Communications in Medicine) after window-leveling optimization. Twenty-nine orthopaedic residents and specialists reviewed 28 pelvic images consisting of 25 occult proximal femur fractures and three images with no fracture, using four different image filters and the original DICOM image. For intertrochanteric fractures, the Retinex filter outperforms the other filters and the original image with a correct fracture type diagnosis rate of 50.6%. The Retinex filter also performs well for diagnosis of other fracture types. The Retinex filter had an interobserver agreement index of 53.5%, higher than the other filters. Sensitivity of fracture diagnosis increased to 85.2% when the Retinex filter was combined with the standard DICOM image. Correct fracture type diagnosis per minute for the Retinex filter was 1.43, outperforming the other filters. The Retinex filter may become a valuable tool in clinical settings for diagnosing fractures.
  
  
  METHODS
  Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Chaim Sheba Medical Center, Ramat Gan, Israel. botser@gmail.com
authors.forename: Itamar Busheri
authors.initials: IB
authors.lastname: Botser
authors.forename: Amir
authors.initials: A
authors.lastname: Herman
authors.forename: Ram
authors.initials: R
authors.lastname: Nathaniel
authors.forename: Dan
authors.initials: D
authors.lastname: Rappaport
authors.forename: Aharon
authors.initials: A
authors.lastname: Chechik
mesh_terms: D000465:Algorithms; D001175:Arthrography / Q000379:methods* / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital; D015588:Observer Variation; D012680:Sensitivity and Specificity
references.citation: Pract Proced Aesthet Dent. 2004 Aug;16(7):477-8
references.pmid: 15485159
references.citation: Radiology. 1988 Mar;166(3):883-5
references.pmid: 3340789
references.citation: Med Phys. 2000 Jan;27(1):56-65
references.pmid: 10659738
references.citation: Injury. 1997 May;28(4):299-301
references.pmid: 9282186
references.citation: Injury. 1998 Jan;29(1):61-3
references.pmid: 9659484
references.citation: Eur Radiol. 2005 Jan;15(1):165-9
references.pmid: 15647955
references.citation: BMJ. 2006 Jul 1;333(7557):27-30
references.pmid: 16809710
references.citation: Ann Acad Med Singap. 2002 Sep;31(5):607-10
references.pmid: 12395646
references.citation: J Am Dent Assoc. 1996 Apr;127(4):469-73
references.pmid: 8655867
references.citation: J Bone Joint Surg Am. 1993 Mar;75(3):395-401
references.pmid: 8444918
references.citation: Arch Emerg Med. 1992 Mar;9(1):23-7
references.pmid: 1567525
references.citation: Nuklearmedizin. 1998 Mar;37(2):80-2
references.pmid: 9547756
references.citation: Injury. 2005 Jun;36(6):788-92
references.pmid: 15910835
references.citation: Acad Radiol. 1994 Oct;1(2):93-9
references.pmid: 9419471
references.citation: Radiology. 1990 Feb;174(2):509-15
references.pmid: 2404320
references.citation: Am J Emerg Med. 2002 May;20(3):234-7
references.pmid: 11992346
references.citation: J Bone Joint Surg Br. 1990 May;72(3):379-82
references.pmid: 2341431
references.citation: N Z Med J. 1996 Jun 28;109(1024):235-7
references.pmid: 8769034
references.citation: J Bone Joint Surg Br. 1987 Mar;69(2):251-3
references.pmid: 3818756
references.citation: Br J Radiol. 1985 Aug;58(692):756-9
references.pmid: 3842279
references.citation: Ann Emerg Med. 1992 Dec;21(12):1511-4
references.pmid: 1443854
references.citation: Radiology. 1988 Dec;169(3):839-41
references.pmid: 3187009
references.citation: Am J Emerg Med. 1992 Jan;10(1):64-8
references.pmid: 1736920
references.citation: Invest Radiol. 1989 Sep;24(9):643-6
references.pmid: 2807816
references.citation: J Thorac Imaging. 1990 Jan;5(1):85-91
references.pmid: 2299707
references.citation: Lakartidningen. 2004 Jul 22;101(30-31):2423-5
references.pmid: 15314940
references.citation: Acta Orthop. 2005 Aug;76(4):524-30
references.pmid: 16195069
references.citation: J Oral Maxillofac Surg. 1991 Oct;49(10):1038-43
references.pmid: 1890516
references.citation: Dentomaxillofac Radiol. 1996 Jan;25(1):34-8
references.pmid: 9084283
references.citation: Digitale Bilddiagn. 1989 Mar;9(1):31-5
references.pmid: 2706888
references.citation: Injury. 2006 Feb;37(2):185-9
references.pmid: 16249001
references.citation: J Bone Joint Surg Br. 1994 Jan;76(1):158-9
references.pmid: 8300666
references.citation: Oral Surg Oral Med Oral Pathol. 1991 Jun;71(6):763-9
references.pmid: 2062529
references.citation: Radiology. 1995 Oct;197(1):263-7
references.pmid: 7568834
references.citation: IEEE Trans Image Process. 2006 Sep;15(9):2820-30
references.pmid: 16948325
references.citation: J Trauma. 1991 Feb;31(2):296-8
references.pmid: 1994099
references.citation: Orthopedics. 1994 Apr;17(4):327-30
references.pmid: 7818641
references.citation: J Thorac Imaging. 1990 Jan;5(1):92-5
references.pmid: 2299708
references.citation: Orthopedics. 1994 Jul;17(7):578
references.pmid: 7937370