Vertical or horizontal orientation of foot radiographs does not affect image interpretation

This study determined whether the orientation of dorsoplantar and oblique foot radiographs has an effect on radiograph interpretation. A test set of 50 consecutive foot radiographs were selected (25 with fractures, and 25 normal), and duplicated in the horizontal orientation. The images were randomly arranged, numbered 1 through 100, and analysed by six image interpreters. Vertical and horizontal area under the ROC curve, accuracy, sensitivity and specificity were calculated for each image interpreter. There was no significant difference in the area under the ROC curve, accuracy, sensitivity or specificity of image interpretation between images viewed in the vertical or horizontal orientation. While conventions for display of radiographs may help to improve the development of an efficient visual search strategy in trainees, and allow for standardisation of publication of radiographic images, variation from the convention in clinical practice does not appear to affect the sensitivity or specificity of image interpretation.