Journal Reading

“Identification of Nasal Bone Fractures on

Conventional Radiography and Facial CT:
Comparison of the Diagnostic Accuracy in
Different Imaging Modalities and Analysis of
Interobserver Reliability “

Nendi Feby Valentina

406162066
Pembimbing : Dr. Musdalifah Sp.Rad
 Background
Nasal bone fractures have increased in prevalence and severity
concurrently with the increase in traumas and traffic accidents.
A nasal bone fracture is usually diagnosed by clinical examination and
conventional radiography as the standard procedure. However, some
investigators have reported the limitations of conventional radiography
for the evaluation of nasal bone fractures
Computed tomography (CT) has been shown to be a more accurate
diagnostic tool than conventional radiography for evaluating nasal bone
fractures and combined facial injuries
 However, it is currently unknown if CT can accurately diagnose nasal
bone fractures better than conventional radiography when they are
directly compared, and whether these results would differ between a
trained radiographer and a lesser experienced trainee
 Objectives
 Therefore, one aim of our study was to directly
compare the usefulness of conventional radiography
and CT for the identification of nasal bone
fractures. Another aim was to evaluate whether
there are differences in the assessment between
two individual readers (a staff radiologist and a
trainee) in terms of their statistical interpretations
of each of the conventional radiography and CT
findings from nasal bone fractures.
Patient and methods
Study Population 378 patients (207 male and 171
female patients; age range, 5-88
years; mean age, 52.7 years) were
selected. We then selected 145 of
these 378 patients with the following
inclusion criteria: patients with acute
nasal trauma who had undergone both
facial CT and conventional
radiography (coronal and both lateral
views) of the nasal bone on the same
day by using electric medical chart
and picture archiving and
communication system (PACS)
Radiological Imaging The radiological examination
consisted of coronal and lateral views
of both nasal bones and a CT scan
with axial images and coronal and
sagittal reformatted images.
Image Analysis and Reference Standart Standard Short lucent lines that
reached the anterior cortex of the
nasal bone, with or without
displacement, were regarded as
fractures in both imaging modalities.
Statistical Analysis The McNemar test and κ statistics
were used to compare the results
between the two imaging modalities
and between the two readers
Result
a 28-year-old man with no fracture
 a 24-year-old man with depressed
fracture
 a 42-year-old man with non-depressed
fracture
A 36-year-old man with painful nasal
swelling and a simple non-depressed
transverse nasal fracture.

A, Coronal and lateral conventional

radiography images show a discrete simple
fracture in the mid-portion of the nasal
bone.
B, CT images show no discrete fracture on
axial, sagittal, and coronal reformatted
images (arrow indicates nasal bone
fracture).
Discussion

 503 cases by analyzing nasal bone fractures by conventional radiography in

both lateral and Waters views, as well as by CT. Only 82% of nasal bone
fractures were identified by conventional radiography vs. 100% by CT
 In this study, diagnostic accuracy of facial CT was superior to that of
conventional radiography in the detection of nasal bone fracture
 In our study, conventional radiography showed limited diagnostic accuracy of
nasal bone fractures because of the presence of several pseudolesions, such
as prior nasal bone fracture, angulation deformity, anatomical variation,
fracture of ossified cartilage, midline nasal suture or nasomaxillary suture, a
thin nasal wall, and Mach band artifact
 However, for nine (10.2%) patients, including 3 patients with simple depressed
fracture and 6 with non-depressed fracture, the fracture was identified only on a
conventional radiograph
 In summary, CT is superior to conventional radiography for the detection of nasal
bone fractures, assessment of the type of nasal bone fracture, for combined
injuries, and for decision-making in therapeutic planning. However, although
conventional radiography is not the first choice as a diagnostic tool, it may be
useful for the detection of transverse and non-depressed nasal bone fractures
 Moreover, the identification of nasal bone fractures by a radiologist and a
trainee were not significantly different using conventional radiographs and CT
for diagnosis, whereas a staff radiologist showed better values in the
identification of nasal bone fracture and differentiation between depressed and
nondepressed fractures than a trainee.
CRITICAL APPRAISAL
ANALISA PICO

P Pasien dengan fraktur tulang hidung

I 108 pasien yang menjalani radiografi konvensional dan CT setelah mengalami

trauma nasal

C Membandingkan keakauratan diagnostic antara radiografi konvensional dengan CT

scan wajah untuk mengindentifikasi fraktur tulang hidung

O
CT secara signifikan lebih unggul daripada radiografi konvensional. Meskipun seorang
ahli radiologi menunjukkan nilai yang lebih baik dalam identifikasi fraktur tulang
hidung dan diferensiasi antara fraktur depresi dan non-depresi dibandingkan residen
 V I A analysis
VALIDITY
Apakah alokasi pasien pada penelitian ini Ya
dilakukan secara acak?
Apakah pengamatan pasien dilakukan secara Ya
cukup panjang dan lengkap?

Apakah semua populasi dalam kelompok yang Ya

diacak, dianalisis?

Apakah pasien dan dokter tetap blind dalam Ya

melakukan penelitian?
 V I A analysis
APPLICABLE
Apakah pada pasien kita terdapat perbedaan bila Tidak
dibandingkan dengan yang terdapat pada
penelitian sblmnya sehingga hasil tersebut tidak
dapat diterapkan pada pasien kita?
Apakah pemberian intervensi tersebut mungkin Ya
dapat diterapkan pada pasien kita?
Apakah pasien memiliki potensi yang Ya
menguntungkan bila intervensi diatas diberikan?
the therapy study is
VALID

the therapy study is

IMPORTANT

the therapy study is

APPLICABLE
JUDUL & PENGARANG
No. Kriteria Ya( +) / Tidak (-)
1 Jumlah kata dalam judul ,< 12 Tidak (25 kata)
kata
2. Deskripsi Judul Menggambarkan isi
judul

3. Daftar penulis sesuai aturan +

jurnal
4. Korespondensi penulis +

5. Tempat & waktu penelitian TIDAK

dalam judul
 ABSTRAK
No. Kriteria Ya (+) / Tidak
(-)
1. Abstrak 1 paragraf +

2. Mencakup IMRC +

3. Secara keseluruhan Informatif +

4. Tanpa singkatan selain yang baku +

5. Kurang dari 250 kata Tidak (282 kata)

 PENDAHULUAN
No. Kriteria Ya (+) /
Tidak (-)
1. Terdiri dari 2 bagian atau 2 paragraf YA (2)

2. Paragraf pertama mengemukakan alasan YA

dilakukan penelitian
3. Paragraf kedua menyatakan hipotesis YA
atau tujuan penelitian
4. Didukung oleh pustaka yang relevan +

5. Kurang dari 1 halaman +

BAHAN & METODE PENELITIAN
No. Kriteria Ya (+), tidak (-)
1 Jenis dan rancangan penelitian Case report
2 Waktu dan tempat penelitian Waktu +, tempat +
3 Populasi sumber +
4 Teknik sampling +
5 Kriteria inklusi +
6 Kriteria eksklusi +
7 Perkiraan dan perhitungan besar sampel -
8 Perincian cara penelitian +
9 Blind +
10 Uji statistik +
11 Program komputer +
12 Persetujuan subjektif +
 HASIL
No. Kriteria Ya (+),tidak
(-)
1 Jumlah subjek +

2 Tabel karakteristik subjek +

3 Tabel hasil penelitian +

4 Komentar dan pendapat penulis ttg +

hasil
5 Tabel analisis data dengan uji +
 PEMBAHASAN, KESIMPULAN, DAFTAR
PUSTAKA
No. Kriteria Ya (+) / Tidak (-
)
1 Pembahasan dan kesimpulan terpisah +
2 Pembahasan & kesimpulan dipaparkan dengan jelas +
3 Pembahasan mengacu dari penelitian sebelumnya +
4 Pembahasan sesuai landasan teori +
5 Keterbatasan penelitian +
6 Simpulan utama +
7 Simpulan berdasarkan penelitian +
8 Saran penelitian -

9 Penulisan daftar pustaka sesuai aturan +

 RESUME PENELITIAN
 Penelitian ini valid, penting dan dapat diterapkan pada kasus
fraktur tulang hidung.
 CT secara signifikan lebih unggul daripada radiografi
konvensional. Meskipun seorang ahli radiologi menunjukkan nilai
yang lebih baik dalam identifikasi fraktur tulang hidung dan
diferensiasi antara fraktur depresi dan non-depresi dibandingkan
residen