Detection of rib fractures in an abused infant using digital radiography: A laboratory study

Paul K. Kleinman, Brian O'Connor, Katherine Nimkin, Shawn M. Rayder, Melissa R. Spevak, Patricia L. Belanger, David J. Getty, Andrew Karellas

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Purpose: To assess the diagnostic performance of digital radiography using charge-coupled device (CCD) technology in the detection of rib fracture in infant abuse. Materials and methods: Four fractured posterior rib arcs and eight normal ribs removed at autopsy from a 10-month-old abused infant were radiographed using a CCD prototype, four clinical film-screen systems, and direct-exposure film. Each rib was viewed with these six systems in nine different projections. The resultant 648 images were assessed for probability of fracture (0-100%) by four pediatric radiologists. The calculated area under the resultant ROC curves (Az) for the CCD was compared with those obtained with direct-exposure, high-detail, medium and fast film-screen radiographic systems. Results: The mean Az for the CCD (0.937) fell within the range of the high-detail systems (0.934-0.940) and was significantly higher (p < 0.05) than the medium and fast system (0.861 and 0.858, respectively). Despite a lower spatial resolution than direct-exposure film (7 line pairs per millimeter vs. > 20 line pairs per millimeter) the CCD performance was comparable (Az = 0.944 vs. 0.937). The similar performance can be explained by the higher contrast resolution of the digital technology. Conclusion: This study indicates that in the ex vivo setting, digital radiology can perform comparably to high-detail filmscreen imaging. The findings suggest that digital radiography has the potential to replace film-screen imaging in the evaluation of inflicted skeletal injury in infants.

Original languageEnglish (US)
Pages (from-to)896-901
Number of pages6
JournalPediatric radiology
Issue number12
StatePublished - 2002


  • Child abuse
  • Digital radiography
  • Fractures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging


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