Impact of specific training in detecting osteoporotic vertebral fractures on routine chest radiographs

Purpose: Vertebral fractures are the most common complication of osteoporosis. Routine chest radiographs are a potential screening method, but a significant under-reporting has been described previously. The purpose of this study was to evaluate the effect of a specific training on the detection rate of vertebral fractures of a radiology resident. Materials and Methods: 936 routine lateral chest radiographs of postmenopausal women were evaluated by a radiology resident (R1) during clinical routine. After the evaluation of 470 radiographs (pre-training group), R1 underwent a specific training based on the teaching initiative of the IOF/ESSR. Afterwards the remaining 466 radiographs were evaluated (post-training group). As a standard of reference, all radiographs were reviewed by two radiologists in consensus (R2 + 3). A semi-quantitative method (spinal fracture index, SFI) was used to assess vertebral fractures. Results: Kappa-values as statistical measure of agreement between R1 and R2 + 3 for the detection of vertebral fractures (Genant Severity > 0) increased from κ = 0.311 (95 % CI: 0.217 - 0.405; "fair agreemento") in the pre-training group to κ = 0,882 (95 % CI: 0,835 - 0,929; "almost perfect agreemento") in the post-training group. Similar results were observed for severe fractures (Genant Severity > 1). Especially fractures with Genant Severity 1 were not detected by R1 before training. Conclusion: A brief training is essential to increase the awareness of radiologists to correctly report osteoporotic vertebral fractures and may help to initiate appropriate therapy in patients with vertebral fractures. Key Points: The awareness of radiologists regarding the correct reporting of vertebral fractures is in need of improvement. The detection of vertebral fractures improves with targeted training. The teaching initiative of the IOF/ESSR is suitable for this. Citation Format: Gruber M., Dinges J., Müller D. et al. Impact of Specific Training in Detecting Osteoporotic Vertebral Fractures on Routine Chest Radiographs. Fortschr Röntgenstr 2013; 185: 1074 1080.