Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury

Huang, Hung Chang; Fu, Chih-Yuan; Hsieh, Chi-Hsun; Wu, Shih Chi; Chen, R. J.; Huang, Jui Chien

doi:10.1007/s00068-012-0176-z

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…This indicates that false-positive fracture detection is uncommon using all modalities. Specificities are similar to those reported for adults in previous studies, (33,34,36,39,41) and similar to those reported for skull fractures in piglets (97.7% - 100.0%). (44) PPVs are high for all modalities and all regions (all above 80.0%) which indicates that a fracture detected by any modality is highly likely to indeed be a true-positive identification.…”

Section: Discussionsupporting

confidence: 90%

“…However, sensitivities for X-rays and Lodox in the present study are lower than those previously reported (70.0% for X-rays (57) and 100.0% for Lodox). (41) Sensitivities are, however, higher than those reported for piglets using all modalities (43.0% -58.0%), (23) except for the posterior limbs using X-rays. The moderate to high sensitivities for detecting limb fractures using all modalities is important since long bone fractures are common in instances of violent crime.…”

Section: Limb Fracturesmentioning

confidence: 65%

“…Many studies have assessed the sensitivities of CTs, X-rays and Lodox in the detection of skeletal BFT, (33)(34)(35)(36)(37)(38)(39)(40)(41) finding CTs to be the most sensitive modality for identifying BFT fractures, and finding comparable sensitivities for X-rays and Lodox. However, most studies have evaluated the diagnostic accuracies of imaging modalities by comparing them to results from autopsy or CT examinations, methods which frequently miss skeletal fractures.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

2021

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The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.

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Section: Discussionsupporting

confidence: 90%

Section: Limb Fracturesmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

2021

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“…Wei et al [ 22 ] reported that the rate of missed distal bone fracture when using plain X-ray films is up to 7.6% in TBI. In an attempting to lower this incidence of missed injuries, Huang et al [ 10 ] conducted a clinical study with whole body X-rays with Lodox/ Statscan for early detection of commonly missed trauma in TBI. Their institutional data showed that the missed extracranial injuries in TBI were up to 39.1% while the whole body X-rays reduced this rate of missed bone fractures down to 1.6% with low cost and low radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Missed Skeletal Trauma Detected by Whole Body Bone Scan in Patients with Traumatic Brain Injury

Seo

Whang

Pyen

et al. 2020

J Korean Neurosurg Soc

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Objective Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS ( p =0.000). Conclusion WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

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“…The technology was developed to scan the entire body of mineworkers with sufficient resolution and speed but with a low X-ray dosage to prevent harm during daily screenings (2). In recent years, acute care settings such as emergency departments have begun implementing Lodox imaging to triage trauma patients (3–15). Additional applications in the emergency room have included arteriography (16), ventriculoperitoneal shunt visualization (17, 18), detection of urinary stones (19) or foreign bodies (20, 21), and pediatric imaging (22–24).…”

Section: Discussionmentioning

confidence: 99%

Benefits of Utilizing Full-Body Lodox Digital Radiography in Forensic Pathology

Jorgenson

Lanter

Wiens

2015

Academic Forensic Pathology

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Introduction The purpose of this study was to measure the time spent by a single autopsy assistant in obtaining full-body radiographic imaging in a forensic pathology setting. The Lodox digital radiography (DR) system was compared with a traditional cassette-based portable computed radiography (CR) system to quantify time saved by the implementation of the Lodox imaging system. Methods Decedents were examined with the Lodox DR and portable CR systems to provide full-body coverage with each system. Timing was divided into preparation, acquisition, and postacquisition stages, with an additional transfer stage being required for the Lodox DR system. A neutral observer timed each stage for each decedent examined with both systems. Results The Lodox DR system provided an 87% time savings (p < 0.001) over the portable CR system to complete full-body radiographic scanning. While the portable CR system was faster at image acquisition (p < 0.001), the Lodox DR system was faster during the preparation (p < 0.001) and postacquisition (p < 0.001) stages. Conclusions The time required for a full-body radiographic examination is markedly shortened with utilization of the Lodox DR system. Seven full-body examinations can be completed with the Lodox DR system in the time that a single full-body examination is completed with the portable CR system. In a forensic pathology setting, the Lodox DR system is therefore more time-efficient than the portable CR system studied, as it provides the same scope in a shorter time period, allowing for streamlining of radiographic imaging studies.

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Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury

Cited by 5 publications

References 32 publications

Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

Missed Skeletal Trauma Detected by Whole Body Bone Scan in Patients with Traumatic Brain Injury

Benefits of Utilizing Full-Body Lodox Digital Radiography in Forensic Pathology

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