Toward an Improved Wrist View: Qualitative and Quantitative Investigation of the 20° Axial Lateral Wrist X-Ray

Gasheva, Anastasia; McHugh, Colleen; Scharfenberger, Angela; Jaremko, Jacob L.

doi:10.1016/j.jmir.2020.01.006

Cited by 2 publications

(7 citation statements)

References 8 publications

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“…Textbooks almost entirely focus on technical critique for the lateral wrist on the rotation of radius and ulna, 26–29 without consideration of adequate demonstration of the radio‐carpal joint space. This result is consistent with positioning techniques that describe the use of a radial tilt 23–25,30–34 …”

Section: Discussionsupporting

confidence: 88%

“…The ineffective demonstration of the radio‐carpal joint space proved an interesting observation not considered by any of the radiographers. This is well documented in literature, where the suggestion of a 15–20° tilt is to be utilised to better demonstrate the radio‐carpal joint line and the joint space 23–25 . A good example of the importance of the demonstration of the joint space is shown in Figures 2 and 3.…”

Section: Discussionmentioning

confidence: 67%

“…This result is consistent with positioning techniques that describe the use of a radial tilt. [23][24][25][30][31][32][33][34] Comparison of the radiographer assessments of the rejected images yielded a fascinating result for acceptability of imaging. Our results support the notion that large discrepancies exist between radiologists and radiographers on acceptance of imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Anecdotally, the lateral wrist projection is one of the more commonly rejected projections by radiographers. Furthermore, positioning inaccuracies due to rotation and lack of adequate projection through the radio‐carpal joint space can impact diagnosis and management of wrist joint injuries 21–24 . Hence, for this study we chose the lateral wrist to review for the appropriateness of reject imaging and change in practice due to the advent of DR.…”

Section: Introductionmentioning

confidence: 99%

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The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Steward,

Semsem,

Currie

et al. 2023

J of Medical Radiation Sci

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IntroductionThis study illustrates image rejection rates of the lateral wrist x‐ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image‐repeat decision‐making skills existing between radiologists, experienced radiographers and junior radiographers.MethodsA retrospective review was conducted of all rejected lateral wrist x‐ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study.ResultsThe review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers.ConclusionsThis review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision‐making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Steward,

Semsem,

Currie

et al. 2023

J of Medical Radiation Sci

View full text Add to dashboard Cite

show abstract

“…It has previously been reported though, that angulating the tube between 15 and 20° in the proximal direction improves visualization of the articular surface and therefore improves measurement consistency. 17 , 21 Angulating the central ray away from perpendicular will however introduce a degree of geometric distortion in the radiograph and depict the carpal bones with more overlap as opposed to in the perpendicular view. More research is needed to explore the impact of tube angulation on various measurements obtained from the lateral wrist radiograph not only in relation to DRF but also carpal measurements.…”

Section: Discussionmentioning

confidence: 99%

Observer agreement of volar tilt of the wrist is influenced by forearm rotation

Kirkeby

Jensen

Benjamin

et al. 2023

Acta Radiologica Open

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Background Dorsal/volar tilt is an important radiographic measurement commonly included in the treatment decision of distal radius fractures (DRFs). However, studies have shown that forearm positioning relative to rotation (i.e., supination and pronation) can affect the measured tilt value but with substantial interobserver variance. Purpose To examine whether interobserver agreement on radiographic tilt measurement is influenced by forearm rotation. Material and Methods We radiographed 21 cadaveric forearms at 5° rotational intervals between 15° supination and 15° pronation on lateral radiographs. A radiologist and a hand surgeon measured tilt in a blinded and randomized fashion. Bland–Altman analyses with bias and limits of agreement (LoA) were used to estimate interobserver agreement for forearms in all degrees of rotation, non-rotated forearms, supinated forearms, and pronated forearms. Results Interobserver agreement varied with forearm rotation. Bias (95% confidence interval [CI]; LoA) was −1.54° (95% CI: −2.53, −0.55; LoA: −13.46, 10.38) when measuring tilt on radiographs with all degrees of forearm rotation, and −1.48° (95% CI: −4.13, 1.17; LoA: −12.88, 9.92) when measuring tilt on true lateral 0° radiographs. When measuring on supinated and pronated radiographs, bias was −0.03° (95% CI: −1.35, 1.29; LoA: −8.34, 8.28) and −3.23° (95% CI: −5.41, −1.06; LoA: −16.90, 10.44), respectively. Conclusion Interobserver agreement on tilt was similar when comparing measurements made on true lateral radiographs to those made on the group with all degrees of forearm rotation. However, interobserver agreement improved with supination and worsened with pronation.

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Toward an Improved Wrist View: Qualitative and Quantitative Investigation of the 20° Axial Lateral Wrist X-Ray

Cited by 2 publications

References 8 publications

The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Observer agreement of volar tilt of the wrist is influenced by forearm rotation

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