A comparison of two or three radiographic views in the diagnosis of skull fractures
Department of Radiology, Western Infirmary, Glasgow, UK. Clinical Radiology
(Impact Factor: 1.76).
03/1998; 53(3):215-7. DOI: 10.1016/S0009-9260(98)80104-9
The aim of the study is to determine whether a two rather than a three-view skull series is adequate for diagnosis of a skull fracture given a reliable history of the site of trauma. The radiographs of 50 patients who were diagnosed and managed as having sustained skull fractures were randomly mixed with 200 normal skull series and viewed independently by three observers. For all the film series viewed (a total of 1500 for the three observers), the diagnostic confidence level for two films was 94.4%, and for three films 94.6%. Of a total of 150 skull fracture series viewed as two films, 87 (58%) were correctly diagnosed with a confidence level of 92.7%. When viewed as three films, 92 (61.3%) were correctly diagnosed with a confidence level of 93%. Combined with analysis of false-positive and false-negative results, no statistical difference could be detected between a two or three film skull series. A two-view skull series has no statistically deleterious effect on either diagnostic accuracy or confidence of interpretation when compared with a three-view series given an accurate clinical history.
Available from: bmj.com
Available from: John W Robinson
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ABSTRACT: It is well accepted that collimation is a cost-effective dose-reducing tool for X-ray examinations. This phantom-based study investigated the impact of X-ray beam collimation on radiation dose to the lenses of the eyes and thyroid along with the effect on image quality in facial bone radiography.
A three-view series (occipitomental, occipitomental 30 and lateral) was investigated, and radiation doses to the lenses and thyroid were measured using an Unfors dosemeter. Images were assessed by six experienced observers using a visual grading analysis and a total of 5400 observations were made.
Strict collimation significantly (p<0.0001) reduced the radiation dose to the lenses of the eyes and thyroid when using a fixed projection-specific exposure. With a variable exposure technique (fixed exit dose, to simulate the behaviour of an automatic exposure control), while strict collimation was again shown to reduce thyroid dose, higher lens doses were demonstrated when compared with larger fields of exposure. Image quality was found to significantly improve using strict collimation, with observer preference being demonstrated using visual grading characteristic curves.
The complexities of optimising radiographic techniques have been shown and the data presented emphasise the importance of examining dose-reducing strategies in a comprehensive way.
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ABSTRACT: The objective of this study was to compare the sensitivity and specificity of 2- and 4-film x-ray series when interpreted by pediatric emergency medicine physicians in the diagnosis of skull fracture in children.
A noninferiority crossover study was performed. The skull radiographs of the 50 most recent cases of skull fracture for which a 4-film radiography series was available and 50 controls matched for age were reviewed. Two modules, containing a random sequence of 2- and 4-film series of each child, were constructed to have all children evaluated twice (once with 2 films and once with 4 films). Pediatric emergency physicians evaluated both modules 2 to 4 weeks apart. The interpretation of the 4-film series by a pediatric radiologist served as the criterion standard. The sensitivity and specificity of the 2-film versus the 4-film skull x-ray series, in the identification of fracture, were compared.
Thirteen pediatric emergency physicians participated in the study. For sensitivity, the mean difference between the 2- and 4-view series was higher than the noninferiority margin of 0.055 with an absolute mean difference of 0.060 (4-view minus 2-view series) and a 1-sided 95% higher confidence limit of 0.099. However for specificity, the mean difference was within the margin with an absolute mean difference of 0.011 and a 1-sided 95% higher confidence limit of 0.033.
For children sustaining a head trauma, the 2-film skull radiography series is not as sensitive as the 4-film series in the detection of fracture, when interpreted by pediatric emergency physicians.
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