Detection of chest trauma with whole-body low-dose linear slit digital radiography: a multireader study

The objective of our study was to compare the performance of low-dose linear slit digital radiography (DR) with computed radiography (CR) for the detection of trauma sequelae in the chest including rib fractures, pneumothorax, and lung contusion.

Eighty trauma victims (62 males, 18 females; mean age, 51.5 years) with a total of 612 rib fractures and 80 consecutive patients without rib fractures (59 males, 21 females; mean age, 39.5 years) were retrospectively analyzed. All patients had undergone whole-body linear slit DR and consecutive chest CT, and 87 patients underwent follow-up CR of the chest within 24 hours of DR and CT. Four blinded readers assessed image quality, rib fracture localization with diagnostic confidence, and the presence of pneumothorax and lung contusion on linear slit DR and CR images. Sensitivity for rib fractures and image quality were compared using the Wilcoxon's test. For the detection of pneumothorax and lung contusion, the difference in the areas under the receiver operating characteristic curves were calculated.

The rate of correctly identified rib fractures was higher (true-positive findings per image, 2.55 vs 2.21, respectively; p = 0.02), the rate of missed fractures was lower (false-negative findings per image, 4.98 vs 6.19; p = 0.02), and the diagnostic confidence was greater (2.03 vs 1.73 on a 3-point scale; p = 0.01) with linear slit DR than with CR, respectively. Image quality and performance for detecting pneumothorax and lung contusion with both techniques were not statistically different (p = 0.22, 0.85, and 0.55, respectively).

Linear slit DR is a reliable substitute for CR in the initial evaluation of chest trauma, with better sensitivity for detecting rib fractures and similar performance in assessing pneumothorax and lung contusion.