通过还是不通过？确定膝关节前后位和侧位X光片的可接受性

IF 2.5 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography Pub Date : 2024-10-01 DOI:10.1016/j.radi.2024.09.067

C.J.H. Gan , X. Zhuang , D.T.F.B. Mahmood , E.C.-P. Chua

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引用次数: 0

摘要

导言：在目前的临床实践中，确定全膝关节置换术（TKR）X 光片可接受性的标准尚未确立。在 TKR 患者中，植入部件取代了解剖标志，这使得放射技师更难确定旋转程度。本研究旨在为 TKR X 光片确定一个可接受的膝关节旋转范围。方法回顾性地分析了被拒绝的 TKR X 光片（199 张 AP 和 186 张 lateral）。放射技师对X光片上的旋转进行了客观测量。骨科医生对 46 张正侧位和 46 张侧位放射照片的旋转度和诊断价值进行评分。分别使用布兰德-阿尔特曼（Bland-Altman）和科恩卡帕（Cohen's kappa）分析了X光片测量和外科医生评分的同行间可靠性（IRR）。斯皮尔曼秩相关分析和受体运算特性分析用于确定放射线测量结果与外科医生评分之间的相关性和诊断性能。外科医生对射线照片的旋转和诊断价值评级仅有轻微到一般的一致性。放射线测量结果与外科医生的评分之间存在中度到高度的相关性。放射线测量结果可对可接受和不可接受的放射线照片进行可接受到极好的区分。可用性方面可接受的测量旋转范围为正侧：0-5.29 毫米，侧向：0-5.29 毫米：结论建议的测量方法和确定的旋转范围可用于放射技师在临床实践中确定 TKR 放射照片的可接受性。后续研究可以对不常见的膝关节植入物进行调查，并寻求不同机构对可接受的旋转度达成共识。对实践的意义所提出的方法表明，接受阈值（正侧：5.29 毫米，侧向：6.01 毫米）内的射线照片可以减少重复检查和辐射暴露，并提高成像效率。

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To pass or not to pass? Determining the acceptability of anteroposterior and lateral knee radiographs

Introduction

The criteria for determining the acceptability of total knee replacement (TKR) radiographs are not established in current clinical practice. In TKR patients, the implant components replaced the anatomical landmarks, making it more difficult for radiographers to determine the degree of rotation. This study aims to establish an acceptable range of knee rotation for TKR radiographs.

Methods

Rejected TKR radiographs (199 AP and 186 lateral) were analysed retrospectively. Radiographers objectively measured rotation on the radiographs. A subset of 46 AP and 46 lateral radiographs were rated by orthopaedic surgeons for rotation and diagnostic value. Inter-rater reliability (IRR) of radiographic measurements and surgeons' ratings were analysed using Bland–Altman and Cohen's kappa, respectively. Spearman's rank-order correlation and Receiver Operator Characteristic analyses were used to determine the correlation and diagnostic performance of the radiographic measurements against the surgeon's ratings.

Results

Strong IRR was observed for the radiographic measurements. Only slight to fair agreement was observed for the surgeons' rotation and diagnostic value ratings of the radiographs. Moderate to strong correlation was observed between the radiographic measurements and the surgeons’ ratings. The radiographic measurements provided acceptable to excellent discrimination of acceptable and unacceptable radiographs. The acceptable range of measured rotation for usability was AP: 0–5.29 mm and lateral: 0–6.01 mm.

Conclusion

The proposed measurement methods and the established rotation range could potentially be used by radiographers in clinical practice to determine the acceptability of TKR radiographs. Follow-up studies could investigate uncommon knee implants and seek consensus across different institutions on the acceptable degree of rotation.

Implications for practice

The proposed method suggests that accepting radiographs within the threshold (AP: 5.29 mm, lateral: 6.01 mm) reduces repeated examination and radiation exposure and improves imaging efficiency.

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来源期刊

Radiography RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.70

自引率

34.60%

发文量

169

审稿时长

63 days

期刊介绍： Radiography is an International, English language, peer-reviewed journal of diagnostic imaging and radiation therapy. Radiography is the official professional journal of the College of Radiographers and is published quarterly. Radiography aims to publish the highest quality material, both clinical and scientific, on all aspects of diagnostic imaging and radiation therapy and oncology.