Digitally Enhanced Plaster of Paris Imaging of Distal Radial Fractures Is Preferred by Orthopaedic Surgeons and Radiologists: A Single Site Survey.

Abstract

Introduction: X-rays of bone fractures immobilised with Plaster of Paris (POP) produce images of reduced diagnostic quality due to the increased density and irregular pattern of the POP overlying the anatomy of interest. Post-processing parameters in digital radiography (DR) can be applied to POP images to increase diagnostic quality without increasing radiation dose. The aim of this study was to evaluate the preferred image quality of POP immobilised distal radius fractures using optimised digital image manipulation algorithms.

Methods: A cross-sectional, quantitative survey study was conducted between November 2021 and December 2023 at a large metropolitan health network. The manufacturer standard algorithm and three new image post-processing algorithms were applied to pre-selected image sets. Orthopaedic surgeons (n = 34) and radiologists (n = 35) were surveyed to rank image quality of 10 random image sets (80 images in total). Data were described and analysed using median rankings, Mann-Whitney U tests and Friedman rank tests with post hoc Wilcoxin rank tests.

Results: A total of 13 orthopaedic surgeons and 14 radiologists participated. A highly enhanced algorithm using contrast boost (Algorithm D) was the most preferred set (n = 18/27) due to better visibility of bony detail and fracture sites. There was no difference in rankings between clinician groups.

Conclusion: In this single site survey, both orthopaedic surgeons and radiologists preferred the highly enhanced post-processing algorithm (D) indicating that image quality can be improved using optimised digital manipulation. POP post-processing parameters with contrast boosting could be implemented to potentially increase diagnostic accuracy without increasing radiation dose for x-ray imaging of the wrist with POP.