[Magnetic resonance imaging of the scaphoid bone]

Can junior doctors in orthopaedic surgery interpret magnetic resonance imaging (MRI) scans of the scaphoid bone and thereby avoid that patients undergo unnecessary immobilization and repeated controls?

Patients suspected of having a fracture of the scaphoid bone and with a negative x-ray were included in the study. The MRI was performed within a few days, and the patient received the results of the MRI the same day in the ambulatory. The junior doctor had received training in MRI diagnosis and was not allowed to confer with another doctor. Subsequently, the junior doctor's medical opinion was reviewed by a radiologist, and the treatment was adjusted if there was a discrepancy concerning the diagnosis. Among the 98 eligible patients, 13 had their MRIs reviewed by the junior doctor in tandem with a specialist; therefore, only 85 patients were included in the study.

Junior doctors found three out of five scaphoid fractures and misinterpreted six. Specificity reached 92.5% and the sensitivity 60%. The junior doctors as well as the radiologists found 11 fractures of the distal radius that had not been detected prior to the MRI.

We cannot recommend that junior doctors in orthopaedic surgery interpret MRI scans. Since studies have showed that is it cost-effective to offer early MRI, we will continue doing so, but will wait for the final report from the radiologists before initiating treatment.