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New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment

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International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Purpose

The aim of this multi-reader feasibility study was to evaluate new post-processing CT imaging tools in rib fracture assessment of forensic cases by analyzing detection time and diagnostic accuracy.

Materials and methods

Thirty autopsy cases (20 with and 10 without rib fractures in autopsy) were randomly selected and included in this study. All cases received a native whole body CT scan prior to the autopsy procedure, which included dissection and careful evaluation of each rib. In addition to standard transverse sections (modality A), CT images were subjected to a reconstruction algorithm to compute axial labelling of the ribs (modality B) as well as “unfolding” visualizations of the rib cage (modality C, “eagle tool”). Three radiologists with different clinical and forensic experience who were blinded to autopsy results evaluated all cases in a random manner of modality and case.

Results

Rib fracture assessment of each reader was evaluated compared to autopsy and a CT consensus read as radiologic reference. A detailed evaluation of relevant test parameters revealed a better accordance to the CT consensus read as to the autopsy. Modality C was the significantly quickest rib fracture detection modality despite slightly reduced statistic test parameters compared to modalities A and B.

Conclusion

Modern CT post-processing software is able to shorten reading time and to increase sensitivity and specificity compared to standard autopsy alone. The eagle tool as an easy to use tool is suited for an initial rib fracture screening prior to autopsy and can therefore be beneficial for forensic pathologists.

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Authors and Affiliations

  1. Institute of Forensic Medicine, University Hospital of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany

    Philip A. Glemser, Anna Heger, Astrid Krauskopf & Kathrin Yen

  2. Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Philip A. Glemser, Michael Pfleiderer, Jan Tremper, Heinz-Peter Schlemmer & David Simons

Authors
  1. Philip A. Glemser
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  2. Michael Pfleiderer
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  3. Anna Heger
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  4. Jan Tremper
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  5. Astrid Krauskopf
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  6. Heinz-Peter Schlemmer
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  7. Kathrin Yen
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  8. David Simons
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Corresponding authors

Correspondence to Philip A. Glemser or David Simons.

Ethics declarations

The institutional review board approved this study in December 2014. The study was in full compliance with the Declaration of Helsinki in its current form.

Conflict of interest

The post-processing software for this study was provided by Siemens Healthcare (Forchheim, Germany). None of the investigators are employees of Siemens Healthcare.

Siemens Healthcare had no access to the image data and no control over the inclusion of imaging data, data analysis, and the manuscript.

The dkfz has a cooperation with Siemens Healthcare, Germany. This includes a specific collaboration agreement with the aim of a joint collaboration in the field of CT research in oncology as well as consultancies within the Siemens Advisory Board on oncologic imaging.

The Institute of Forensic Medicine Heidelberg has a cooperation with Siemens Healthcare, Germany. This includes a specific collaboration agreement with the aim of a joint collaboration in the field of forensic medicine with financing of research projects.

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Glemser, P.A., Pfleiderer, M., Heger, A. et al. New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment. Int J Legal Med 131, 489–496 (2017). https://doi.org/10.1007/s00414-016-1412-6

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  • DOI: https://doi.org/10.1007/s00414-016-1412-6

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