PDF(Pubmed)
Abstract：
Iatrogenic worsening of spinal injury can result in significant harm to American football players and complicate management when equipment is removed in the acute setting by inexperienced personnel. Spine imaging before removal of protective equipment mitigates this risk. There is no consensus regarding the ideal timing of equipment removal or whether current diagnostic imaging modalities are effective to detect such injuries without equipment removal. Prior data suggest that CT is a diagnostic modality for this purpose; however, radiologists\' accuracy in detecting fractures in the presence of protective equipment requires additional study.
(1) Does the introduction of American football equipment result in a significant reduction in sensitivity for cervical spine fracture detection? (2) Absent specific guidance as to parameters needed to establish diagnostic quality, can a radiologist determine whether such CTs are of diagnostic quality by subjectively relying on the ability to identify anatomic landmarks?
A pendulum device was engineered to deliver a measured axial load to the crown of cadavers to produce a variety of cervical spine fractures in 13 cadaver specimens. The cadavers were then imaged using a standardized CT protocol first without and then with protective football equipment. The images were presented to three board-certified, fellowship-trained radiologists to (1) identify all fractures from the occiput to T1 and (2) subjectively assess the diagnostic quality of the resulting CTs. A sensitivity analysis was performed against a reference standard of fractures produced by the consensus of all radiologists in this study to determine whether there was any reduction in radiologists\' ability to detect fractures once football equipment was in place.
We found that CT scans obtained with football protective equipment in place resulted in lower sensitivity in diagnosing cervical spine injuries than CT scans obtained without pads. A total of 42 fractures were identified in the reference standard, allowing for a combined 126 possible fracture identifications between the three interpreters. Without football equipment, a combined 98 fractures were identified, whereas a combined 65 fractures were identified once the equipment was introduced. Overall, the sensitivity was reduced by 26% (52% [65 of 126] versus 78% [98 of 126] [95% CI 14.8% to 37.5%]; p < 0.001). Of the 78 total CT series imaged with football equipment, 92% (72 of 78) were considered to be of diagnostic quality. However, the study radiologists failed to identify 50% (53 of 105) of fractures present in those CT images.
The sensitivity of cervical spine fracture detection using CT is diminished in the setting of protective American football equipment. Future studies in live subjects with cervical spine fracture may be warranted to support these conclusions.
These findings contradict previous studies that determined CT to be a diagnostic imaging modality to image the cervical spine through equipment. Although the interpreting radiologists consistently deemed CTs performed in the presence of helmets and shoulder pads to have subjectively diagnostic quality, numerous fractures that had been detected in the absence of equipment were missed in their presence. Furthermore, this study established that subjective approval of the appearance of an imaging study based on the ability to recognize anatomic landmarks is insufficient to reliably determine the diagnostic quality of a CT study.
(1) Does the introduction of American football equipment result in a significant reduction in sensitivity for cervical spine fracture detection? (2) Absent specific guidance as to parameters needed to establish diagnostic quality, can a radiologist determine whether such CTs are of diagnostic quality by subjectively relying on the ability to identify anatomic landmarks?
A pendulum device was engineered to deliver a measured axial load to the crown of cadavers to produce a variety of cervical spine fractures in 13 cadaver specimens. The cadavers were then imaged using a standardized CT protocol first without and then with protective football equipment. The images were presented to three board-certified, fellowship-trained radiologists to (1) identify all fractures from the occiput to T1 and (2) subjectively assess the diagnostic quality of the resulting CTs. A sensitivity analysis was performed against a reference standard of fractures produced by the consensus of all radiologists in this study to determine whether there was any reduction in radiologists\' ability to detect fractures once football equipment was in place.
We found that CT scans obtained with football protective equipment in place resulted in lower sensitivity in diagnosing cervical spine injuries than CT scans obtained without pads. A total of 42 fractures were identified in the reference standard, allowing for a combined 126 possible fracture identifications between the three interpreters. Without football equipment, a combined 98 fractures were identified, whereas a combined 65 fractures were identified once the equipment was introduced. Overall, the sensitivity was reduced by 26% (52% [65 of 126] versus 78% [98 of 126] [95% CI 14.8% to 37.5%]; p < 0.001). Of the 78 total CT series imaged with football equipment, 92% (72 of 78) were considered to be of diagnostic quality. However, the study radiologists failed to identify 50% (53 of 105) of fractures present in those CT images.
The sensitivity of cervical spine fracture detection using CT is diminished in the setting of protective American football equipment. Future studies in live subjects with cervical spine fracture may be warranted to support these conclusions.
These findings contradict previous studies that determined CT to be a diagnostic imaging modality to image the cervical spine through equipment. Although the interpreting radiologists consistently deemed CTs performed in the presence of helmets and shoulder pads to have subjectively diagnostic quality, numerous fractures that had been detected in the absence of equipment were missed in their presence. Furthermore, this study established that subjective approval of the appearance of an imaging study based on the ability to recognize anatomic landmarks is insufficient to reliably determine the diagnostic quality of a CT study.
摘要：
脊柱损伤的医源性恶化可能会对美式足球运动员造成重大伤害，并且在缺乏经验的人员在急性环境中移除设备时会使管理复杂化。在移除防护设备之前的脊柱成像减轻了这种风险。关于设备拆除的理想时机或当前的诊断成像方式是否可以在不拆除设备的情况下有效检测此类伤害，尚无共识。先前的数据表明，CT是用于此目的的诊断方式；然而，放射科医师在防护设备存在的情况下检测骨折的准确性需要额外的研究。
（1）引入美式足球设备是否会导致颈椎骨折检测的敏感性显着降低？（2）对于建立诊断质量所需的参数缺乏特定的指导，放射科医师是否可以通过主观地依靠识别解剖标志的能力来确定此类CT是否具有诊断质量？
设计了一种摆锤装置，将测量的轴向载荷传递到尸体的冠部，以在13具尸体标本中产生各种颈椎骨折。然后首先使用标准化的CT协议对尸体进行成像，然后使用保护性足球设备。这些图像被提交给三个董事会认证，经过研究培训的放射科医师（1）确定从枕骨到T1的所有骨折，（2）主观评估所得CT的诊断质量。针对本研究中所有放射科医师的共识所产生的骨折参考标准进行敏感性分析，以确定一旦足球设备到位，放射科医师检测骨折的能力是否有任何降低。
我们发现，使用足球防护装备获得的CT扫描在诊断颈椎损伤方面的灵敏度低于不使用垫获得的CT扫描。在参考标准中总共确定了42处骨折，允许在三个口译员之间组合126个可能的断裂识别。没有足球装备，共确认了98处骨折,而一旦引入设备，就发现了65处骨折。总的来说,敏感性降低了26%(52%[126例中的65]对78%[126例中的98][95%CI14.8%~37.5%];p<0.001).在用足球设备成像的78个CT系列中，92％（78个中的72个）被认为具有诊断质量。然而,这项研究的放射科医师未能识别出这些CT图像中存在的50%(105个中的53个)的骨折.
在美式足球防护装置的设置中，使用CT检测颈椎骨折的灵敏度降低。未来对颈椎骨折患者的研究可能有必要支持这些结论。
这些发现与以前的研究相矛盾，以前的研究确定CT是一种通过设备对颈椎成像的诊断成像方式。尽管解释放射科医生一致认为在头盔和肩垫的情况下进行的CT具有主观诊断质量，在没有设备的情况下发现的许多骨折在他们的存在下被遗漏。此外，这项研究确定,基于识别解剖标志的能力对影像学研究外观的主观认可不足以可靠地确定CT研究的诊断质量.
（1）引入美式足球设备是否会导致颈椎骨折检测的敏感性显着降低？（2）对于建立诊断质量所需的参数缺乏特定的指导，放射科医师是否可以通过主观地依靠识别解剖标志的能力来确定此类CT是否具有诊断质量？
设计了一种摆锤装置，将测量的轴向载荷传递到尸体的冠部，以在13具尸体标本中产生各种颈椎骨折。然后首先使用标准化的CT协议对尸体进行成像，然后使用保护性足球设备。这些图像被提交给三个董事会认证，经过研究培训的放射科医师（1）确定从枕骨到T1的所有骨折，（2）主观评估所得CT的诊断质量。针对本研究中所有放射科医师的共识所产生的骨折参考标准进行敏感性分析，以确定一旦足球设备到位，放射科医师检测骨折的能力是否有任何降低。
我们发现，使用足球防护装备获得的CT扫描在诊断颈椎损伤方面的灵敏度低于不使用垫获得的CT扫描。在参考标准中总共确定了42处骨折，允许在三个口译员之间组合126个可能的断裂识别。没有足球装备，共确认了98处骨折,而一旦引入设备，就发现了65处骨折。总的来说,敏感性降低了26%(52%[126例中的65]对78%[126例中的98][95%CI14.8%~37.5%];p<0.001).在用足球设备成像的78个CT系列中，92％（78个中的72个）被认为具有诊断质量。然而,这项研究的放射科医师未能识别出这些CT图像中存在的50%(105个中的53个)的骨折.
在美式足球防护装置的设置中，使用CT检测颈椎骨折的灵敏度降低。未来对颈椎骨折患者的研究可能有必要支持这些结论。
这些发现与以前的研究相矛盾，以前的研究确定CT是一种通过设备对颈椎成像的诊断成像方式。尽管解释放射科医生一致认为在头盔和肩垫的情况下进行的CT具有主观诊断质量，在没有设备的情况下发现的许多骨折在他们的存在下被遗漏。此外，这项研究确定,基于识别解剖标志的能力对影像学研究外观的主观认可不足以可靠地确定CT研究的诊断质量.
