Inter-observer reliability of radiologist reports in scaphoid and carpal Computed Tomography (CT).

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This project is related to our local research projects 1.Does early Computerised Tomography exclude fracture in ‘clinical scaphoid fracture’? (complete) 2.Introducing CT scans into a clinical pathway to manage “clinical fractured scaphoid”, using meditutes and patient specific reminders to implement the evidence. (in progress) The scaphoid is one of the wrist bones. A fall on the outstretched hand is the usual mechanism of injury, and there is usually tenderness in a site known as the “anatomical snuff box”. Diagnosis of scaphoid fracture is difficult. Patients expect that we will use the newest technology available to ensure accurate diagnosis and appropriate management. Bone scans have been used, but they cannot be used too early, so the patient will need a plaster anyway. Magnetic Resonance Imagin (MRI) is probably the international gold standard, but it is expensive and difficult to access in Australia CT scans are relatively cheap and accessible in Australia. The technology is improving rapidly, and this study should help us answer the question: “Does early CT exclude fracture in ‘clinical scaphoid fracture’?” In addition to establishing whether the result obtained from CT is positive or negative, we need to ask whether the CT is precise. Precision, or reproducibility, implies that results are nearly identical when repeated under the same conditions. Reproducibility is sometimes called reliability because when it is present, we can rely on the result from having one person report the test result. This study is designed to determine if we can rely on this test. This study will test the reproducibility of CT reports using (n=9*15=135) a sample of 9 specialist radiologists working in our region reporting on a representative sample of 15 CTs from participants** in our first two studies. ** These participants have already consented to participating in research to determine the role of CT in this clinical situation. This study is related but needed to be conducted separately, as radiologists are now participants. It is possible that our local research projects will contribute to CT becoming the gold standard for this clinical problem. It will at least contribute to a comparison of the evidence for CT and MRI, because for the “gold standard MRI” there is little published evidence regarding its precision and reliability.

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