Tuesday, December 2 | 10:20 a.m.-10:30 a.m. | T3-SSMK05-6 | Room E351
In this session, researchers will describe how reviewing clinical photographs of skin ulcerations alongside foot x-rays can enhance early osteomyelitis diagnosis.
The method could help bridge gaps in experience among radiologists and potentially reduce delays in diagnosis and treatment, according to presenter Asad Khawaja, a medical student at the University of Texas Southwestern Medical Center in Dallas, and colleagues.
Osteomyelitis of the foot often develops from unhealed foot ulcers, particularly in people with diabetes. X-rays are often the first-line imaging study, with findings suggestive of osteomyelitis, including loss of bone cortex, for instance. Yet x-rays are limited for detecting early osteomyelitis, especially when radiologists have no knowledge of the location and depth of skin ulceration, according to the researchers.
Thus, they aimed to determine whether reviewing a photograph of the ulceration in the electronic medical record could improve radiologists’ diagnostic accuracy.
First, three radiologists with varying levels of musculoskeletal radiology experience (15 years, 5 years, and 1 year) reviewed and scored x-rays from 69 patients by consensus. They assessed the probability of osteomyelitis (OM) using a 5-point scale (1: definitely no OM, 2: probably no OM, 3: indeterminate, 4: probably OM, 5: definitely OM). Next, after a week, the x-rays were reevaluated alongside photographs of skin ulceration, using the same grading system.
Based on the combined readings of the three radiologists, the area under the curve (AUC) significantly improved from 0.69 (without photographs) to 0.74 (with photographs) (p < 0.05). However, the improvement was not statistically significant after excluding the least experienced radiologist, according to the results.
“Integrating clinical photographs into radiographic workflows may improve diagnostic accuracy of osteomyelitis in the foot, particularly among trainees,” the researchers suggest.
Fill out your midmorning and learn the details in this session, which covers image-guided interventions and infection.