Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-Space model in the Diagnosis of Occult Scaphoid Fractures

Abstract

<br /><strong><span style="font-size: xx-small;">Background: </span></strong><br /><span style="font-size: xx-small; font-family: Arial,Arial;">The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. </span><br /> <br />Methods: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. </span></span></span></strong><br />Results: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;"><0.001), and observer 3 from 0.11 to 0.24 (95% CI 0.0-0.77, </span></span><em><span style="font-size: xx-small; font-family: Arial,Arial;"><em><span style="font-size: xx-small; font-family: Arial,Arial;">P</span></em></span></em><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">=0.24). </span></span></span></strong><br />Conclusion: <br /><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">modalities for suspected scaphoid fractures. </span></span></span></strong>