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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.

52. age range. 5-88 years.Patient and methods Study Population 378 patients (207 male and 171 female patients. mean age. 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) .7 years) were selected.

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. with or without displacement.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. were regarded as fractures in both imaging modalities. Image Analysis and Reference Standart Standard Short lucent lines that reached the anterior cortex of the nasal bone.

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 .

CT images show no discrete fracture on axial.A 36-year-old man with painful nasal swelling and a simple non-depressed transverse nasal fracture. Coronal and lateral conventional radiography images show a discrete simple fracture in the mid-portion of the nasal bone. A. sagittal. and coronal reformatted images (arrow indicates nasal bone fracture). B. .

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angulation deformity. a thin nasal wall. as well as by CT. Only 82% of nasal bone fractures were identified by conventional radiography vs. fracture of ossified cartilage. 100% by CT  In this study. conventional radiography showed limited diagnostic accuracy of nasal bone fractures because of the presence of several pseudolesions.Discussion  503 cases by analyzing nasal bone fractures by conventional radiography in both lateral and Waters views. and Mach band artifact . such as prior nasal bone fracture. midline nasal suture or nasomaxillary suture. anatomical variation. diagnostic accuracy of facial CT was superior to that of conventional radiography in the detection of nasal bone fracture  In our study.

including 3 patients with simple depressed fracture and 6 with non-depressed fracture. the fracture was identified only on a conventional radiograph  In summary. assessment of the type of nasal bone fracture. CT is superior to conventional radiography for the detection of nasal bone fractures. . for nine (10.2%) patients. and for decision-making in therapeutic planning. whereas a staff radiologist showed better values in the identification of nasal bone fracture and differentiation between depressed and nondepressed fractures than a trainee. However. it may be useful for the detection of transverse and non-depressed nasal bone fractures  Moreover. for combined injuries. although conventional radiography is not the first choice as a diagnostic tool. However. the identification of nasal bone fractures by a radiologist and a trainee were not significantly different using conventional radiographs and CT for diagnosis.

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 .

dianalisis? Apakah pasien dan dokter tetap blind dalam Ya melakukan penelitian? . 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.

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 .

Kriteria Ya( +) / Tidak (-) 1 Jumlah kata dalam judul . Daftar penulis sesuai aturan + jurnal 4. Tempat & waktu penelitian TIDAK dalam judul .< 12 Tidak (25 kata) kata 2.JUDUL & PENGARANG No. Deskripsi Judul Menggambarkan isi judul 3. Korespondensi penulis + 5.

Tanpa singkatan selain yang baku + 5. ABSTRAK No. Abstrak 1 paragraf + 2. Kriteria Ya (+) / Tidak (-) 1. Secara keseluruhan Informatif + 4. Mencakup IMRC + 3. Kurang dari 250 kata Tidak (282 kata) .

Paragraf kedua menyatakan hipotesis YA atau tujuan penelitian 4. PENDAHULUAN No. Kriteria Ya (+) / Tidak (-) 1. Terdiri dari 2 bagian atau 2 paragraf YA (2) 2. Paragraf pertama mengemukakan alasan YA dilakukan penelitian 3. Didukung oleh pustaka yang relevan + 5. Kurang dari 1 halaman + .

BAHAN & METODE PENELITIAN No. 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 + . tidak (-) 1 Jenis dan rancangan penelitian Case report 2 Waktu dan tempat penelitian Waktu +. Kriteria Ya (+).

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. DAFTAR PUSTAKA No. KESIMPULAN. 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 + .

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