title: Evaluation of Rib Fractures on a Single-in-plane Image Reformation of the Rib Cage in CT Examinations.
abstract: This study aimed to evaluate the diagnostic performance of using a reformatted single-in-plane image reformation of the rib cage for the detection of rib fractures in computed tomography (CT) examinations, employing different levels of radiological experience.
  
  
  
  We retrospectively evaluated 10 consecutive patients with and 10 patients without rib fractures, whose CT scans were reformatted to a single-in-plane image reformation of the rib cage. Eight readers (two radiologists, two residents in radiology, and four interns) independently evaluated the images for the presence of rib fractures using a reformatted single-in-plane image and a multi-planar image reformation. The time limit was 30 seconds for each read. A consensus of two radiologist readings was considered as the reference standard. Diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) was assessed and evaluated per rib and per location (anterior, lateral, posterior). To determine the time limit, we prospectively analyzed the average time it took radiologists to assess the rib cage, in a bone window setting, in 50 routine CT examinations. McNemar test was used to compare the diagnostic performances.
  
  
  
  Single image reformation was successful in all 20 patients. The sensitivity, specificity, PPV, and NPV for the detection of rib fractures using the conventional multi-planar read were 77.5%, 99.2%, 89.9%, and 98.0% for radiologists; 46.3%, 99.7%, 92.5%, and 95.3% for residents; and 29.4%, 99.4%, 82.5%, and 93.9% for interns, respectively. Sensitivity, PPV, and NPV increased across all three groups of experience, using the reformatted single-in-plane image of the rib cage (radiologists: 85.0%, 98.6%, and 98.7%; residents: 80.0%, 92.8%, and 98.2%; interns: 66.9%, 89.9%, and 97.1%), whereas specificity did not change significantly (99.9%, 99.4%, and 99.3%). The diagnostic performance of the interns and residents was significantly better when evaluating the single-in-plane image reformations (P < .01). The diagnostic performance of the radiologists was better when evaluating the single-in-plane image reformations; however, there was no significant difference (statistical power: 0.32).
  
  
  
  The diagnostic performance for the detection of rib fractures, using CT images that have been reformatted to a single-in-plane image, improves for readers from different educational levels when the evaluation time is restricted to 30 seconds or less.
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Dankerl
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Seuss
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ellmann
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cavallaro
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany. Electronic address: matthias.hammon@uk-erlangen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hammon
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011859:Radiography / Q000592:standards; D000072177:Radiologists / Q000592:standards; D012015:Reference Standards; D012189:Retrospective Studies; D000070602:Rib Cage / Q000000981:diagnostic imaging; D012253:Rib Fractures / Q000000981:diagnostic imaging*; D012272:Ribs / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Computed tomography; diagnostic performance; educational level; in-plane; post processing; rib fracture