Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Abstract

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of full-body linear X-ray scanning (LS) in multiple trauma patients in comparison to 128-multislice computed tomography (MSCT).

Materials and Methods: 106 multiple trauma patients (female: 33; male: 73) were retrospectively included in this study. All patients underwent LS of the whole body, including extremities, and MSCT covering the neck, thorax, abdomen, and pelvis. The diagnostic accuracy of LS for the detection of fractures of the truncal skeleton and pneumothoraces was evaluated in comparison to MSCT by two observers in consensus. Extremity fractures detected by LS were documented.

Results: The overall sensitivity of LS was 49.2 %, the specificity was 93.3 %, the positive predictive value was 91 %, and the negative predictive value was 57.5 %. The overall sensitivity for vertebral fractures was 16.7 %, and the specificity was 100 %. The sensitivity was 48.7 % and the specificity 98.2 % for all other fractures. Pneumothoraces were detected in 12 patients by CT, but not by LS. 40 extremity fractures were detected by LS, of which 4 fractures were dislocated, and 2 were fully covered by MSCT.

Conclusion: The diagnostic accuracy of LS is limited in the evaluation of acute trauma of the truncal skeleton. LS allows fast whole-body X-ray imaging, and may be valuable for detecting extremity fractures in trauma patients in addition to MSCT.

Key Points:

• The overall sensitivity of LS for truncal skeleton injuries in multiple-trauma patients was < 50 %.

• The diagnostic reference standard MSCT is the preferred and reliable imaging modality.

• LS may be valuable for quick detection of extremity fractures.

Citation Format:

• Jöres APW., Heverhagen JT, Bonél H et al. Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography. Fortschr Röntgenstr 2016; 188: 163 – 171

Zusammenfassung

Ziel: Ziel dieser Studie war die Evaluation der diagnostischen Genauigkeit eines Ganzkörper-Linearröntgenscanners (LS) bei Polytraumapatienten im Vergleich zur 128-Zeilen-Mehrschicht-Computertomografie.

Material und Methoden: 106 Polytraumapatienten (33 Frauen; 73 Männer) wurden retrospektiv in diese Studie eingeschlossen. Alle Patienten erhielten eine LS-Untersuchung des gesamten Körpers sowie ein MSCT, welches Hals, Thorax, Abdomen und Becken einschloss. Die diagnostische Genauigkeit von LS hinsichtlich der Detektion von Frakturen des Stammskeletts sowie der Detektion von Pneumothoraces wurde im Vergleich zum MSCT durch zwei Untersucher evaluiert. Extremitätenfrakturen welche durch LS detektiert wurden, wurden dokumentiert.

Ergebnisse: Insgesamt lag die Sensitivität von LS bei 49,2 %, die Spezifität bei 93,3 %, der positive Vorhersagewert 91 % und der negative Vorhersagewert 57,5 %. Die Sensitivität hinsichtlich Wirbelkörperfrakturen war 16,7 % sowie die Spezifität 100 %. Für alle anderen Frakturen betrug die Sensitivität 48,7 % und die Spezifität 98,2 %. Pneumothoraces wurden bei insgesamt 12 Patienten mittels CT detektiert – nicht jedoch durch LS. 40 Extremitätenfrakturen konnten mittels LS erkannt werden, von denen 4 Frakturen disloziert waren und lediglich 2 Frakturen vollständig durch die MSCT Untersuchung erfasst worden sind.

Schlussfolgerung: Die diagnostische Genauigkeit von LS ist in der Evaluation von Traumapatienten hinsichtlich des Stammskelettes limitiert. LS erlaubt eine zügige Ganzkörperröntgenuntersuchung und kann nützlich sein, um Extremitätenfrakturen in Ergänzung zum CT zu detektieren.

Kernaussagen:

• Die Gesamtsensitivität von LS für Verletzungen des Stammskelettes bei Polytraumapatienten beträgt < 50 %.

• Daher ist der diagnostische Referenzstandard MSCT als verlässlicheres bildgebendes Verfahren vorzuziehen.

• LS kann ergänzend für die schnelle Detektion von Extremitätenfrakturen sinnvoll sein.

Key words

multiple trauma - ATLS - full-body X-ray - Lodox

• References

• 1 Evangelopoulos DS, Deyle S, Zimmermann H et al. Personal experience with whole-body, low-dosage, digital X-ray scanning (LODOX-Statscan) in trauma. Scandinavian journal of trauma, resuscitation and emergency medicine 2009; 17: 41
• 2 Exadaktylos AK, Benneker LM, Jeger V et al. Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS. Injury 2008; 39: 525-529
• 3 McKenney KL, Nunez Jr DB, McKenney MG et al. Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients. American journal of roentgenology 1998; 170: 979-985
• 4 Deyle S, Wagner A, Benneker LM et al. Could full-body digital X-ray (LODOX-Statscan) screening in trauma challenge conventional radiography?. The Journal of trauma 2009; 66: 418-422
• 5 Pitcher RD, Wilde JC, Douglas TS et al. The use of the Statscan digital X-ray unit in paediatric polytrauma. Pediatric radiology 2009; 39: 433-437
• 6 Boffard KD, Goosen J, Plani F et al. The use of low dosage X-ray (Lodox/Statscan) in major trauma: comparison between low dose X-ray and conventional x-ray techniques. The Journal of trauma 2006; 60: 1175-1181 ; discussion 81–3
• 7 Mulligan ME, Flye CW. Initial experience with Lodox Statscan imaging system for detecting injuries of the pelvis and appendicular skeleton. Emergency radiology 2006; 13: 129-133
• 8 Pitcher RD, van As AB, Sanders V et al. A pilot study evaluating the "STATSCAN" digital X-ray machine in paediatric polytrauma. Emergency radiology 2008; 15: 35-42
• 9 Flach PM, Ross SG, Ampanozi G et al. "Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox. European journal of radiology 2012; 81: 2518-2526
• 10 Stull KE, L'Abbe EN, Steiner S. Measuring distortion of skeletal elements in Lodox Statscan-generated images. Clinical anatomy 2013; 26: 780-786
• 11 Schaller BB, Exadaktylos AK, Andres RH et al. A new full body low-dose x-ray technique is an alternative to conventional "shunt series" in patients with ventriculoperitoneal shunt dysfunction. The American journal of emergency medicine 2007; 25: 702-703
• 12 Knobel GJ, Flash G, Bowie GF. Lodox Statscan proves to be invaluable in forensic medicine. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2006; 96: 593-594, 596
• 13 Irving BJ, Maree GJ, Hering ER et al. Radiation dose from a linear slit scanning X-ray machine with full-body imaging capabilities. Radiation protection dosimetry 2008; 130: 482-489
• 14 Lodox Systems – Statscan critical imaging system -Product Specifications and Physical Dimensions. 2006 Lodox, technical report.
• 15 Loupatatzis C, Schindera S, Gralla J et al. Whole-body computed tomography for multiple traumas using a triphasic injection protocol. European radiology 2008; 18: 1206-1214
• 16 Yang L, Ye L, Ding J et al. Use of a full-body digital X-ray imaging system in acute medical emergencies: a systematic review. Emergency medicine journal: EMJ 2014;
• 17 Evangelopoulos DS, von Tobel M, Cholewa D et al. Impact of Lodox Statscan on radiation dose and screening time in paediatric trauma patients. European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery [et al] = Zeitschrift fur Kinderchirurgie 2010; 20: 382-386
• 18 Whiley SP, Alves H, Grace S. Full-body x-ray imaging to facilitate triage: a potential aid in high-volume emergency departments. Emergency medicine international 2013; 2013: 437078
• 19 Chen RJ, Fu CY, Wu SC et al. Diagnostic accuracy, biohazard safety, and cost effectiveness-the Lodox/Statscan provides a beneficial alternative for the primary evaluation of patients with multiple injuries. The Journal of trauma 2010; 69: 826-830
• 20 Lamb AD, Qadan M, Gray AJ. Detection of occult pneumothoraces in the significantly injured adult with blunt trauma. Eur J Emerg Med 2007; 14: 65-67
• 21 Omar HR, Abdelmalak H, Mangar D et al. Occult pneumothorax, revisited. Journal of trauma management & outcomes 2010; 4: 12
• 22 Ianniello S, Di Giacomo V, Sessa B et al. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. La Radiologia medica 2014;
• 23 Samelson EJ, Christiansen BA, Demissie S et al. Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2011; 22: 1123-1131
• 24 Huber-Wagner S, Lefering R, Qvick LM et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 2009; 373: 1455-1461
• 25 Fabian T. Whole-body CT in multiple trauma. Lancet 2009; 373: 1408-1409 Epub 2009 Mar 25
• 26 Wedegartner U, Lorenzen M, Nagel HD et al. Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT. Fortschr Röntgenstr 2004; 176: 1039-1044
• 27 Frellesen C, Stock W, Kerl JM et al. Topogram-based automated selection of the tube potential and current in thoraco-abdominal trauma CT – a comparison to fixed kV with mAs modulation alone. European radiology 2014; 24: 1725-1734