Henry Chou MD, Presenter: Nothing to Disclose

Scott David Steenburg MD, Abstract Co-Author: Nothing to Disclose

Jeffrey William Dunkle MD, Abstract Co-Author: Nothing to Disclose

Sean D. Gussick MD, Abstract Co-Author: Nothing to Disclose

Matthew James Petersen MD, Abstract Co-Author: Nothing to Disclose

Marc D. Kohli MD, Abstract Co-Author: Research Grant, Koninklijke Philips NV Research Grant, Siemens AG

Changyu Shen PhD, Abstract Co-Author: Nothing to Disclose

Hongbo Lin MS, Abstract Co-Author: Nothing to Disclose

Physicians often order both a three-view study of the hand and four-view study of the ipsilateral wrist following hand and/or wrist injury. Because hand radiographs include visualization of the carpus, we set out to determine whether a modified study using fewer wrist radiographs performs comparably to the traditional hand and wrist series in the evaluation of acute hand and wrist abnormalities.

This retrospective study was approved by the institutional review board, and the need to obtain informed consent was waived. Two hundred forty patients (50% male; age range 18-92y) with unilateral three-view hand (posteroanterior, oblique, and lateral) and four-view wrist (posteroanterior, oblique, lateral, and ulnar deviation) radiographs obtained concurrently in the emergency setting were included in this study. Four experienced emergency radiologists, blinded to the original report and clinical records, interpreted the original seven images. The patients’ radiographs were then recombined to include only the three hand images and a single ulnar deviated wrist view. These were interpreted by the same radiologists following an eight week delay and in random sequence to reduce memory bias. Two radiologists independently evaluated each patient’s studies. Data analysis was performed using kappa statistics to measure agreement between the seven- and four-view image interpretations.

A total of 479 reports were generated in each of the seven- and four-view image sets, with 142 (29.6%) of the seven-view and 125 (26.1%) of the four-view reports conveying certain or suspected acute osseous findings. Statistical analysis yielded an average inter-method kappa coefficient of 0.818 for the four radiologists, which represents strong agreement between the seven- and four-view interpretations.

The modified four-view hand and wrist radiographic series produces diagnostic results comparable to the traditional hand and wrist series in the acute clinical setting.

A modified four-view hand and wrist radiographic study is effective for assessing acute hand and wrist injury while reducing cost, time, and radiation dose.

Chou, H, Steenburg, S, Dunkle, J, Gussick, S, Petersen, M, Kohli, M, Shen, C, Lin, H, Streamlining Emergent Hand and Wrist Radiography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002225.html