title: New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment.
abstract: OBJECTIVE
  The aim of this multi-reader feasibility study was to evaluate new post-processing CT imaging tools in rib fracture assessment of forensic cases by analyzing detection time and diagnostic accuracy.
  
  
  METHODS
  Thirty autopsy cases (20 with and 10 without rib fractures in autopsy) were randomly selected and included in this study. All cases received a native whole body CT scan prior to the autopsy procedure, which included dissection and careful evaluation of each rib. In addition to standard transverse sections (modality A), CT images were subjected to a reconstruction algorithm to compute axial labelling of the ribs (modality B) as well as "unfolding" visualizations of the rib cage (modality C, "eagle tool"). Three radiologists with different clinical and forensic experience who were blinded to autopsy results evaluated all cases in a random manner of modality and case.
  
  
  RESULTS
  Rib fracture assessment of each reader was evaluated compared to autopsy and a CT consensus read as radiologic reference. A detailed evaluation of relevant test parameters revealed a better accordance to the CT consensus read as to the autopsy. Modality C was the significantly quickest rib fracture detection modality despite slightly reduced statistic test parameters compared to modalities A and B.
  
  
  CONCLUSIONS
  Modern CT post-processing software is able to shorten reading time and to increase sensitivity and specificity compared to standard autopsy alone. The eagle tool as an easy to use tool is suited for an initial rib fracture screening prior to autopsy and can therefore be beneficial for forensic pathologists.
authors.affiliation: Institute of Forensic Medicine, University Hospital of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany. p.glemser@dkfz.de.|Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. p.glemser@dkfz.de.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Glemser
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pfleiderer
authors.affiliation: Institute of Forensic Medicine, University Hospital of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Heger
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Tremper
authors.affiliation: Institute of Forensic Medicine, University Hospital of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Krauskopf
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Institute of Forensic Medicine, University Hospital of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Yen
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. d.simons@dkfz.de.
authors.forename: David
authors.initials: D
authors.lastname: Simons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005240:Feasibility Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D012253:Rib Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D012984:Software; D036542:Tomography, Spiral Computed; D051598:Whole Body Imaging; D055815:Young Adult
keywords: Computed tomography; Forensic imaging; Post-processing software; Rib fractures