Automatic rib unfolding in postmortem computed tomography: diagnostic evaluation of the OpenRib software compared with the autopsy in the detection of rib fractures
The main objective of this study was to evaluate the diagnostic performance of the OpenRib software against the gold standard of autopsy in the detection of rib fractures. The secondary objective was to measure inter-rater agreement between each radiological reader.
Materials and methods
Thirty-six subjects who underwent postmortem CT and autopsy were included in this study. Rib fractures were first assessed during the autopsy by carefully dissecting and examining each rib. They were also independently evaluated by three readers using OpenRib software. This software produces from postmortem CT images a reformat of the rib cage and a display of all ribs in a single plane. Each reader was asked to determine if the rib was fractured and, if so, whether the fracture was single or multiple.
After exclusions, 649 ribs were included in the statistical analysis. The two readers with a similar level of experience showed a satisfactory inter-rater agreement and a sensitivity of 0.73 and 0.83 with a specificity of 0.95 and 0.91. However, the experienced reader diagnosed significantly more fractures than the autopsy and the other two readers (p < 0.001).
The use of automatic rib unfolding software in postmortem CT allows an efficient and accurate assessment of rib fractures and enables the diagnosis of fractures that cannot be detected during a standard autopsy. For now, this method seems to be the simplest that can be routinely performed; however, it requires training time in order to be sufficiently effective.
KeywordsRib fractures Postmortem computed tomography Image processing Diagnostic performance
Compliance with ethical standards
Subjects of this study are deceased; the assessment of rib fractures is routinely performed at an autopsy and radiological post-processing was performed using standard PMCT images. Therefore, the approval of the ethics committee was not necessary.
Conflict of interest
One of the authors involved in this work participates in a non-remunerated research contract with Canon Medical systems, the developer of the software used for rib cage unfolding. The rest of the authors declare that they have no conflict of interest and state that this work has not received any funding.
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