Impact of Specific Training in Detecting Osteoporotic Vertebral Fractures on Routine Chest Radiographs

Abstract

Purpose: Vertebral fractures are the most common complication of osteoporosis. Routine chest radiographs are a potential screening method, but a significant under-reporting has been described previously. The purpose of this study was to evaluate the effect of a specific training on the detection rate of vertebral fractures of a radiology resident.

Materials and Methods: 936 routine lateral chest radiographs of postmenopausal women were evaluated by a radiology resident (R1) during clinical routine. After the evaluation of 470 radiographs (pre-training group), R1 underwent a specific training based on the teaching initiative of the IOF/ESSR. Afterwards the remaining 466 radiographs were evaluated (post-training group). As a standard of reference, all radiographs were reviewed by two radiologists in consensus (R2 + 3). A semi-quantitative method (spinal fracture index, SFI) was used to assess vertebral fractures.

Results: Kappa-values as statistical measure of agreement between R1 and R2 + 3 for the detection of vertebral fractures (Genant Severity > 0) increased from κ = 0.311 (95 % CI: 0.217 – 0.405; “fair agreement”) in the pre-training group to κ = 0,882 (95 % CI: 0,835 – 0,929; “almost perfect agreement”) in the post-training group. Similar results were observed for severe fractures (Genant Severity > 1). Especially fractures with Genant Severity 1 were not detected by R1 before training.

Conclusion: A brief training is essential to increase the awareness of radiologists to correctly report osteoporotic vertebral fractures and may help to initiate appropriate therapy in patients with vertebral fractures.

Key Points:

• The awareness of radiologists regarding the correct reporting of vertebral fractures is in need of improvement.

• The detection of vertebral fractures improves with targeted training.

• The teaching initiative of the IOF/ESSR is suitable for this.

Citation Format:

• Gruber M., Dinges J., Müller D. et al. Impact of Specific Training in Detecting Osteoporotic Vertebral Fractures on Routine Chest Radiographs. Fortschr Röntgenstr 2013; 185: 1074 – 1080

Zusammenfassung

Ziel: Wirbelkörperfrakturen sind die häufigste Komplikation der Osteoporose. In der klinischen Routine durchgeführte Röntgenthoraxaufnahmen stellen eine mögliche Screeningmethode dar, allerdings wurde die fehlende Beschreibung osteoporotischer Wirbelkörperfrakturen in der Routinediagnostik mehrfach kritisiert. Der Zweck dieser Studie war die Evaluation einer spezifischen Schulung auf die Detektionsrate von Wirbelkörperfrakturen eines Radiologen in der täglichen Befundung.

Material und Methoden: 936 routinemäßige Röntgenthoraxaufnahmen postmenopausaler Frauen wurden durch eine radiologische Assistenzärztin (R1) im Rahmen der Routine befundet. Nach der Auswertung von 470 Aufnahmen (Gruppe vor Training) nahm R1 an einer auf der Lehrinitiative von IOF/ESSR basierenden Schulung teil. Danach wurden die restlichen 466 Aufnahmen (Gruppe nach Training) befundet. Als Referenzstandard wurden alle Bilder von zwei Radiologen (R2 + 3) einvernehmlich begutachtet. Es wurde ein semiquantitatives Verfahren (nach Genant) angewendet, um osteoporotische Wirbelkörperfrakturen zu beurteilen.

Ergebnisse: Der Kappa-Wert als statistisches Maß der Übereinstimmung zwischen R1 und R2 + 3 für detektierte Frakturen (Genant-Grad > 0) stieg von κ = 0,311 (95 % CI: 0,217 – 0,405) im Sinne eines „fair agreement“ in der Gruppe vor Training auf κ = 0,882 (95 % CI: 0,835 – 0,929) im Sinne eines „almost perfect agreement“ in der Gruppe nach Training. Ähnliche Ergebnisse wurden für mittlere/schwere Frakturen (Genant-Grad > 1) beobachtet. Insbesondere wurden vor Schulung Wirbelkörperfrakturen von Genant-Grad 1 übersehen.

Schlussfolgerung: Eine kurze Schulung ist notwendig und ausreichend, um das Bewusstsein eines Radiologen hinsichtlich korrekter Befundung von osteoporotischen Wirbelkörperfrakturen zu verbessern und somit dazu beizutragen, eine geeignete Therapie bei Patienten mit prävalenten Wirbelkörperfrakturen zu veranlassen.

Key words

spine - vertebral fracture - chest radiograph - osteoporosis

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