Inverting Grayscale Improves Detection of Proximal Femur Fracture

Study Overview
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Brief Summary
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Proximal femur fractures (PFF) are a worldwide public health concern. A delay in the diagnosis and treatment worsens the prognosis. Inversion of grayscale is a tool available on most X-rays visualization software, and its use has been suggested to improve radiological diagnosis. The study aims to determine if using inverted grayscale radiography results in better diagnoses of PFF among medical students. Material and Methods. The investigators evaluated the detection of PFF by fifth-year medical students on a series of 30 pelvis X-rays. The series was composed of 20 X-rays with PFF and 10 X-rays without fracture. A first reading session was set up where X-rays were presented separately in conventional and inverted grayscale. A second session one month later showed both grayscale visualizations together (BIcontrast X-rays Analysis Method - BIXAM). X-rays' order of appearance was randomized. The investigators performed the same evaluation on senior orthopedic surgeons as a control. Finally, sensitivity, specificity, and accuracy were assessed for each method (conventional, inverted, and BIXAM) with the McNemar test. Subgroup analyses were performed on the fracture localization (femoral neck, trochanteric).

Official Title
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Inverting Grayscale in Conventional Orthopedics X-rays Improves Detection of Proximal Femur Fracture Among Undergraduate Medical Students

Conditions
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Diagnoses Disease

Intervention / Treatment
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* Diagnostic Test: BIXAM


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: fifth-year medical students Exclusion Criteria: other medical students

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: student<br>Twenty fifth-year medical students were asked to participate in the study | Diagnostic Test: BIXAM<br>* Series two consisted of inverted and conventional X-rays of the same subject (BIXAM) shown together<br>|
| Active Comparator: senior surgeon<br>As controls, we asked 3 independent board-certified orthopedic surgeons to participate in the study following the same conditions as described previously. | Diagnostic Test: BIXAM<br>* Series two consisted of inverted and conventional X-rays of the same subject (BIXAM) shown together<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| accuracy | accuracy was compared between conventional and inverted grayscales or both images shown together (BIXAM series) with non-parametric McNemar test | one month | 
| Sensibility, specificity, | Sensibility, specificity were compared between conventional and inverted grayscales or both images shown together (BIXAM series) with non-parametric McNemar test | one month |