Impact of specific training in detecting osteoporotic vertebral fractures on routine chest radiographs

Rofo. 2013 Nov;185(11):1074-80. doi: 10.1055/s-0033-1335230. Epub 2013 Sep 2.

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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Austria / epidemiology
  • Female
  • Humans
  • Incidence
  • Internship and Residency / statistics & numerical data
  • Male
  • Middle Aged
  • Osteoporotic Fractures / diagnostic imaging*
  • Osteoporotic Fractures / epidemiology*
  • Professional Competence / statistics & numerical data*
  • Radiography, Thoracic / statistics & numerical data*
  • Radiology / education*
  • Radiology / statistics & numerical data
  • Reproducibility of Results
  • Risk Assessment
  • Sensitivity and Specificity
  • Spinal Fractures / diagnostic imaging*
  • Spinal Fractures / epidemiology*