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Published on: December 9, 2022
Utility of a Smart Device Infrared Camera in Localizing Acute Pediatric Long Bone Fractures: A Pilot Study
Manju Korattiyil1, Rachel Long2, Alessandra Guiner3
1From the Division of Pediatric Emergency Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL.
Insights
Infrared thermal imaging (IRT) using smart device attachments shows promise for accurately locating pediatric long bone fractures. This noninvasive method could reduce the need for X-rays, especially in underserved regions.
Area of Science:
- Medical Imaging
- Pediatric Orthopedics
- Biomedical Engineering
Background:
- Musculoskeletal injuries are a common reason for pediatric emergency department visits.
- Infrared thermal imaging (IRT) is a noninvasive, nonradiating technique detecting temperature variations.
- IRT holds potential for identifying musculoskeletal injuries.
Purpose of the Study:
- To evaluate the effectiveness of a smart device infrared camera attachment for localizing acute pediatric long bone fractures.
- Focus on patients under 5 years old.
Main Methods:
- Prospective pilot study comparing IRT images with radiographs.
- IRT images captured using an iPad with an infrared camera attachment.
- Analysis of thermal images (Hi/Lo and Span and Level) to identify the area of maximum temperature (Tmax).
Main Results:
- 31 pediatric patients were included; 24 fractures were confirmed.
- The Span and Level IRT image correctly identified injuries in 91.67% of fracture cases compared to X-rays (P < 0.0002).
- High diagnostic accuracy: sensitivity 0.92, specificity 0.86, PPV 0.96, NPV 0.75; AUC 0.89.
Conclusions:
- Smart device IRT camera attachments are feasible for pediatric fracture localization.
- Promising results suggest potential to decrease reliance on radiographs.
- This technology could be particularly beneficial in resource-limited settings.
Background:
Musculoskeletal injuries are one of the top 10 reasons children present to the emergency department (ED). Infrared thermal imaging (IRT) is a noninvasive and nonradiating imaging modality that can detect subtle temperature differences. IRT may be used to detect the presence of musculoskeletal injury.
Objective:
This study aimed to assess the utility of a smart device infrared camera attachment's ability to localize acute pediatric long bone fractures in patients less than 5 years of age.
Methods:
This was a prospective pilot study comparing thermal imagery on an injured extremity to radiographs. All IRT images were obtained via an iPad with an infrared camera attachment. Using two different IRT images (Hi/Lo and Span and Level), the area of maximum temperature ( Tmax ) was identified and compared to radiographs.
Results:
A total of 31 patients were enrolled in the study. Twenty-four (77.50%) were identified as having fractures, and 7 (22.50%) did not have any fractures. IRT correctly identified an injury in the fracture group 91.67% of the time when using the Span and Level IRT image compared to standard x-rays ( P < 0.0002). When using the Span and Level image to identify Tmax to localize a fracture on x-ray, sensitivity is 0.92, specificity is 0.86, positive predictive value is 0.96, and negative predictive value is 0.75. A receiver operating characteristic (ROC) curve was completed with area under the curve (AUC) being 0.89.
Conclusions:
This pilot study shows that the use of smart device infrared camera attachments is feasible and has promising results in fracture localization. This could allow for a decrease in radiographs and be particularly useful in resource-limited areas.
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