Ryan L. Lo MD, Presenter: Nothing to Disclose

Shelby James Bennett MD, Abstract Co-Author: Nothing to Disclose

Heber Macmahon MD, Abstract Co-Author: Shareholder, Hologic, Inc Consultant, Riverain Technologies, LLC Royalties, UCTech

It is the current standard of practice to perform chest radiography in patients with suspected rib fractures, however the sensitivity of chest radiographs and rib series for this purpose has not been defined. Therefore, we performed a study to establish the sensitivity and specificity of chest radiography as compared to dedicated rib radiographs using CT scans as the criterion standard for the detection of traumatic rib fractures.

We searched the University of Chicago imaging database from January 2009 to June 2012 for chest radiographs (CXR), rib series, and CT reports mentioning rib fracture. Cases were included in the study if the patient has had at least two of three studies (chest radiograph, rib series, or CT) within two months of each other. All CT studies were reviewed, and were considered positive if an acute rib fracture was seen.

Of the 2,670 reports mentioning rib fractures between January 2009 and June 2012, 178 cases from 174 patients were found that met our criteria. With CT used as the criterion standard, detection of rib fractures on CXR had a sensitivity of 54.7% and a sensitivity of 96.8% and rib series had a sensitivity of 100% and a specificity of 100%. CXR missed 68.8% of rib fractures below the diaphragm whereas rib series did not miss any. Using rib series as the criterion standard, CXR sensitivity was only 42% though specificity 97%.  

Rib series have a much better sensitivity for detecting rib fractures when compared with CXR, especially for rib fractures below the diaphragm.

Rib fracture detection on rib series is superior to CXR, and almost equal to CT and is recommended if there is clinical concern for a rib fracture.

Lo, R, Bennett, S, Macmahon, H, Sensitivity and Specificity of Chest Radiography and Rib Series for Detection of Rib Fractures.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028734.html