Khaled Hamed Salem1,2, Andreas Ladenburger3, Felix Schoth4, Jörg Axel Ohnsorge2. 1. Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Egypt. 2. Department of Orthopaedic Surgery, RWTH Aachen University, Germany. 3. Department of Orthopaedic Surgery, Sana Klinikum Offenbach, Germany. 4. Department of Diagnostic Radiology, Marienhaus Klinikum, Bad Neuenahr, Germany.
Abstract
BACKGROUND: Digital radiographs of the whole spine are made using marginally superimposed imaging plates exposed simultaneously to be combined by interpolation of the overlapping area. Post-processing artefacts in these radiographs leading to the misdiagnosis of implant breakage have not yet been described in the literature. METHODS: An erroneous fusion of a digital spine x-ray after scoliosis surgery created an image showing two broken rods, whereas both rods proved complete continuity intraoperatively. Following an interdisciplinary error analysis, the chain of errors was systematically reconstructed. Using the digital imaging material of patients operatively treated the same way; the reproducibility of the error was analyzed. Erroneous image fusions were produced by slight displacement of existing, not yet combined x-ray images of these patients. RESULTS: Under certain requirements, the false impression of implant breakage could be reproduced. Especially in the case of missing or malpositioned radiopaque markers, the hazard to overlook an erroneous image fusion is present. Within the post-processing step performed by qualified staff, control is indispensable and manual correction can be crucial. CONCLUSIONS: This experimental study and causal analysis show the clinical relevance of post-processing artefacts in digital radiography. To prevent false diagnosis and maltreatment, the knowledge of possible sources of error is indispensable.
BACKGROUND: Digital radiographs of the whole spine are made using marginally superimposed imaging plates exposed simultaneously to be combined by interpolation of the overlapping area. Post-processing artefacts in these radiographs leading to the misdiagnosis of implant breakage have not yet been described in the literature. METHODS: An erroneous fusion of a digital spine x-ray after scoliosis surgery created an image showing two broken rods, whereas both rods proved complete continuity intraoperatively. Following an interdisciplinary error analysis, the chain of errors was systematically reconstructed. Using the digital imaging material of patients operatively treated the same way; the reproducibility of the error was analyzed. Erroneous image fusions were produced by slight displacement of existing, not yet combined x-ray images of these patients. RESULTS: Under certain requirements, the false impression of implant breakage could be reproduced. Especially in the case of missing or malpositioned radiopaque markers, the hazard to overlook an erroneous image fusion is present. Within the post-processing step performed by qualified staff, control is indispensable and manual correction can be crucial. CONCLUSIONS: This experimental study and causal analysis show the clinical relevance of post-processing artefacts in digital radiography. To prevent false diagnosis and maltreatment, the knowledge of possible sources of error is indispensable.
Entities:
Keywords:
Computed radiography; Digital image fusion; Post-processing artefacts; Rod failure; Spine
Authors: Timothy R Kuklo; Benjamin K Potter; Teresa M Schroeder; Michael F O'Brien Journal: Spine (Phila Pa 1976) Date: 2006-05-15 Impact factor: 3.468
Authors: James M Mok; Sigurd H Berven; Mohammad Diab; Melissa Hackbarth; Serena S Hu; Vedat Deviren Journal: Spine (Phila Pa 1976) Date: 2008-03-15 Impact factor: 3.468