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Related Experiment Videos

Visual versus quantified digital radiographic determination of bone density.

D E Garland1, K Lewonowski, R H Adkins

  • 1Spinal Injury Service, Rancho Los Amigos Medical Center, Downey, California.

Contemporary Orthopaedics
|May 8, 1993
PubMed
Summary

Physicians can accurately determine bone mineral density (BMD) loss from plain radiographs only at extreme levels (10% or 70% loss). Visual assessment of BMD loss is unreliable for intermediate bone density changes.

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Area of Science:

  • Radiology
  • Orthopedics
  • Bone Densitometry

Background:

  • Quantitative digital radiography (QDR) is a method for assessing bone mineral density (BMD).
  • Plain radiographs are commonly used in clinical practice to evaluate bone health.

Purpose of the Study:

  • To evaluate the accuracy of physicians in visually determining bone mineral density (BMD) loss from plain radiographs.
  • To assess the reliability of radiographic interpretation for quantifying bone loss in spinal cord-injured patients.

Main Methods:

  • Twenty-four spinal cord-injured patients underwent QDR of the left knee.
  • Seven patients with 10-70% BMD loss were selected for standardized AP knee radiographs.
  • Twenty-five orthopaedic surgeons and residents visually estimated BMD loss from these radiographs compared to a control.

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Main Results:

  • Chi-square analysis showed a significant difference between estimated and actual BMD loss (p < .01).
  • Accuracy was only achieved at 10% and 70% bone loss, even with a +/-10% error margin.
  • Visual determination of BMD loss from plain radiographs is unreliable for intermediate levels.

Conclusions:

  • Physicians' visual assessment of bone mineral density loss from plain radiographs is accurate only at very low (10%) or very high (70%) levels.
  • Standardized techniques allow accurate assessment of near-normal or severely affected radiographs (≥70% BMD loss).
  • Relying solely on visual interpretation of plain radiographs for BMD loss estimation is limited.