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Keywords:
Outcomes, Image verification, Education and training, Comparative studies, Conventional radiography, Pelvis, Musculoskeletal bone, Emergency
Authors:
K. G. Ataç, B. Yılmaz, A. Alhan, E. Sanhal, B. Güçlü, S. Gündoğdu; Ankara/TR
DOI:
10.1594/ecr2015/C-2404
Methods and materials
Hip images of anteroposterior radiographs showing both hip joints with or without one-sided fracture of proximal femur including intra capsular and extra capsular pathologies were collected.
X ray image of hips were classified according to their possible evaluation difficulties.
The difficulty degree of the radiographs was graded by an experienced radiologist and an orthopedist with agreement as easy and tough.
Subtle displacement of the fracture borders,
impacted fractures,
suboptimal positioning or suboptimal contrast level due to obesity or underexposure were accepted as possible cause of difficulty for fracture diagnosis.
Two similar sets of 41 digital hip radiographies in AP direction of patients administered with hip trauma and/or pain to ER were retrieved from hospital based PACS.
Images were loaded to a dedicated workstation with performance evaluation software (ViewDEX).
No cases of both sided fracture was included.
Only the proximal femur fracture cases were selected for homogeneity of the research.
First set had 30 fracture cases and 11 cases without fracture.
Second set had 29 fracture cases and 12 cases without fracture.
Identities of the cases were hidden.
Six ER residents of second year were evaluated the images after giving informed consents.
Both series were evaluated by the residents twice.
First set were examine in the beginning of the study and one month later than the short lecture.
Second set were evaluated twice; a week after the short lecture and one month after the one by one education period.
None of them had a previous education about radiographic education of hip joint fracture.
Each trainee reviewed the two set alone after learning how to use the workstation.
A radiologist show them one by one to open the software and answer the questions by clicking on choices using mouse of the computer.
An image of the display showing one case was shown in the figure.
Four multichoice questions about quality of images,
presence of a hip fracture,
type of the fracture and confidence level about diagnosis asked using a dedicated diagnostic workstation with high resolution monitors.
Evaluation time and preferences of window and levels were also recorded and compared.
Short period was comprised the anatomical details of hip joint,
imaging techniques and findings in radiography,
information for proximal femur fractures and a few cases.
This part of the education was given by an experienced radiologist and took an hour.
Second part of the education included 41 cases of fractures which showed to the participants as a first set.
Same radiologist who also gave the short lecture explained and discussed the cases and showed the location and type of the fractures to the residents individually.
In other words,
the first set evaluated by the residents before and after the short lecture was used as an education material for the second part of education period.
Distribution of data was not normal with Kolmogorov-Smirnov test.
One way analyses of variance for groups were investigated by Kruskal-Wallis or Mann-Whitney U tests.