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Journal of Personalized Medicine Feb 2022This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast...
This study aimed to investigate the effects of tumor-rib distance and dose-dependent rib volume on radiation-induced rib fractures (RIRFs) in patients with breast cancer. We retrospectively included 510 women with breast cancer who underwent surgical resection with adjuvant radiotherapy. The tumor-rib distance was measured using preoperative computed tomography (CT) images. Postoperative chest wall thickness and dose-dependent rib volumes, which are absolute rib volumes receiving >20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 45 Gy (V45), and 50 Gy (V50), were measured from the stimulation CT images for radiation treatment planning. We assessed the relationship of RIRF with tumor-rib distance, postoperative chest wall thickness, and dose-dependent rib volumes. Patients with high values of tumor-rib distance and postoperative chest wall thickness had significantly lower risks of RIRF than those with low values. Patients with high values of V20, V30, V40, V45, and V50 had significantly higher risks of RIRF than those with low values. In a multivariate analysis, tumor-rib distance and all five dose-dependent rib volumes, as well as osteoporosis and radiation field, were independent risk factors for RIRF. Tumor-rib distance and dose-dependent rib volume were independent risk factors for RIRF in patients with breast cancer.
PubMed: 35207728
DOI: 10.3390/jpm12020240 -
The British Journal of Radiology Jun 2023To evaluate the performance and robustness of a deep learning-based automatic fresh rib fracture detection and positioning system (FRF-DPS).
OBJECTIVE
To evaluate the performance and robustness of a deep learning-based automatic fresh rib fracture detection and positioning system (FRF-DPS).
METHODS
CT scans of 18,172 participants admitted to eight hospitals from June 2009 to March 2019 were retrospectively collected. Patients were divided into development set (14,241), multicenter internal test set (1612), and external test set (2319). In internal test set, sensitivity, false positives (FPs) and specificity were used to assess fresh rib fracture detection performance at the lesion- and examination-levels. In external test set, the performance of detecting fresh rib fractures by radiologist and FRF-DPS were evaluated at lesion, rib, and examination levels. Additionally, the accuracy of FRF-DPS in rib positioning was investigated by the ground-truth labeling.
RESULTS
In multicenter internal test set, FRF-DPS showed excellent performance at the lesion- (sensitivity: 0.933 [95%CI, 0.916-0.949], FPs: 0.50 [95%CI, 0.397-0.583]) and examination-level. In external test set, the sensitivity and FPs at the lesion-level of FRF-DPS (0.909 [95%CI, 0.883-0.926], < 0.001; 0.379 [95%CI, 0.303-0.422], = 0.001) were better than the radiologist (0.789 [95%CI, 0.766-0.807]; 0.496 [95%CI, 0.383-0.571]), so were the rib- and patient-levels. In subgroup analysis of CT parameters, FRF-DPS were robust (0.894-0.927). Finally, FRF-DPS(0.997 [95%CI, 0.992-1.000], < 0.001) is more accurate than radiologist (0.981 [95%CI, 0.969-0.996]) in rib positioning and takes 20 times less time.
CONCLUSION
FRF-DPS achieved high detection rate of fresh rib fractures with low FP values, and precise positioning of ribs, thus can be used in clinical practice to improve the detection rate and work efficiency.
ADVANCES IN KNOWLEDGE
We developed the FRF-DPS system which can detect fresh rib fractures and rib position, and evaluated by a large amount of multicenter data.
Topics: Humans; Rib Fractures; Deep Learning; Retrospective Studies; Sensitivity and Specificity; Ribs
PubMed: 36972072
DOI: 10.1259/bjr.20221006 -
BMC Cancer Apr 2023The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated...
BACKGROUND
The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures.
METHODS
We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location).
RESULTS
A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients.
CONCLUSIONS
Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.
Topics: Humans; Rib Fractures; Radiosurgery; Retrospective Studies; Lung Neoplasms; Thoracic Wall
PubMed: 37046249
DOI: 10.1186/s12885-023-10776-8 -
The American Journal of Emergency... Oct 2023This study compares the results of Artificial Intelligence (AI) diagnosis of rib fractures using initial CT and follow-up CT as the final diagnostic criteria, and...
PURPOSE
This study compares the results of Artificial Intelligence (AI) diagnosis of rib fractures using initial CT and follow-up CT as the final diagnostic criteria, and studies AI-assisted diagnosis in improving the detection rate of rib fractures.
METHODS
A retrospective study was conducted on 113 patients who underwent initial and follow-up CT scans due to trauma. The initial and follow-up CT were used as diagnostic criteria, respectively. All images were transmitted to the AI software (V2.1.0, Huiying Medical Technology Co., Beijing, China) for rib fracture detection. The radiologist group (Group 1), AI group (Group 2), and Radiologist with AI group (Group 3) reviewed CT images at an interval of one month, recorded and compared the differences in the sensitivity and specificity for diagnosing rib fractures.
RESULTS
589 and 712 rib fractures were diagnosed by the initial and follow-up CT, respectively. The initial CT diagnosis failed to detect 127 rib fractures, resulting in a missed rate of 17.84%. In addition, four normal ribs were mistakenly identified as being fractured. The follow-up CT was regarded as the diagnostic standard for rib fractures. The sensitivity and specificity were 82.16% and 99.80% for Group 1, 79.35% and 84.90% for Group 2, and 91.57% and 99.70% for Group 3. The sensitivity of Group 3 was higher than that of Group 1 and Group 2 (p < 0.05). The specificity was lower for Group 2 compared with Group 1 and Group 3 (p < 0.05).
CONCLUSION
AI-assisted diagnosis improved the detection rate of rib fractures, the follow-up CT should be used for the diagnosis standard of rib fractures, and AI misdiagnoses can be greatly reduced when a radiologist reviews the diagnosis.
Topics: Humans; Rib Fractures; Artificial Intelligence; Retrospective Studies; Follow-Up Studies; Tomography, X-Ray Computed; Sensitivity and Specificity
PubMed: 37478635
DOI: 10.1016/j.ajem.2023.07.018 -
Age and Ageing Feb 2020Adults aged ≥60 years now represent the majority of patients presenting with major trauma. Falls are the most common cause of injury, accounting for nearly... (Review)
Review
Adults aged ≥60 years now represent the majority of patients presenting with major trauma. Falls are the most common cause of injury, accounting for nearly three-quarters of all traumas in this population. Trauma to the thorax represents the second most common site of injury in this population, and is often associated with other serious injuries. Mortality rates are 2-5 times higher in older adults compared to their younger counterparts, often despite equivalent injury severity scores. Risk scoring systems have been developed to identify rib fracture patients at high risk of deterioration. Overall mortality from rib fractures is high, at approximately 10% for all ages. Mortality and morbidity from rib fractures primarily derive from pain-induced hypoventilation, pneumonia and respiratory failure. The main goal of care is therefore to provide sufficient analgesia to allow respiratory rehabilitation and prevent pulmonary complications. The provision of analgesia has evolved to incorporate novel regional anaesthesia techniques into conventional multimodal analgesia. Analgesia algorithms may aid early aggressive management and escalation of pain control. The current role for surgical fixation of rib fractures remains unclear for older adults who have been underrepresented in the research literature. Older adults with rib fractures often have multi-morbidity and frailty which complicate their injuries. Trauma services are evolving, and increasingly geriatricians will be embedded into trauma services to deliver comprehensive geriatric assessment. This review aims to provide an evidence-based overview of the management of rib fractures for the physician treating older patients who have sustained trauma.
Topics: Age Factors; Aged; Humans; Pain Management; Rib Fractures; Risk Assessment
PubMed: 31858117
DOI: 10.1093/ageing/afz157 -
Healthcare (Basel, Switzerland) Apr 2023Rib fractures occur in almost half of blunt chest wall trauma victims in Australia. They are associated with a high rate of pulmonary complications, and consequently,...
Rib fractures occur in almost half of blunt chest wall trauma victims in Australia. They are associated with a high rate of pulmonary complications, and consequently, with increased discomfort, disability, morbidity, and mortality. This article summarises thoracic cage anatomy and physiology, and chest wall trauma pathophysiology. Institutional clinical strategies and clinical pathway "bundles of care" are usually available to reduce mortality and morbidity in patients with chest wall injury. This article analyses multimodal clinical pathways and intervention strategies that include surgical stabilisation of rib fractures (SSRF) in thoracic cage trauma patients with severe rib fractures, including flail chest and simple multiple rib fractures. The management of thoracic cage injury should include a multidisciplinary team approach with proper consideration of all potential avenues and treatment modalities (including SSRF) to obtain the best patient outcomes. There is good evidence for the positive prognostic role of SSRF as part of a "bundle of care" in the setting of severe rib fractures such as ventilator-dependent patients and patients with flail chest. However, the use of SSRF in flail chest treatment is uncommon worldwide, although early SSRF is standard practice at our hospital for patients presenting with multiple rib fractures, flail chest, and/or severe sternal fractures. Several studies report that SSRF in patients with multiple simple rib fractures lead to positive patient outcomes, but these studies are mostly retrospective studies or small case-control trials. Therefore, prospective studies and well-designed RCTs are needed to confirm the benefits of SSRF in patients with multiple simple rib fractures, as well as in elderly chest trauma patients where there is scant evidence for the clinical outcomes of SSRF intervention. When initial interventions for severe chest trauma are unsatisfactory, SSRF must be considered taking into account the patient's individual circumstances, clinical background, and prognostic projections.
PubMed: 37107898
DOI: 10.3390/healthcare11081064 -
The American Journal of Emergency... Mar 2020Pneumonia is a known complication following rib fractures. This study was undertaken to identify clinical and demographic factors associated with the development of...
INTRODUCTION
Pneumonia is a known complication following rib fractures. This study was undertaken to identify clinical and demographic factors associated with the development of pneumonia among trauma patients with rib fractures.
METHODS
This retrospective study examined trauma patients with one or more rib fractures, who were admitted for inpatient management during the time period 2012 through 2017. Variables studied included age, gender, injury severity score (ISS), mechanism of injury, smoking status, alcohol use, administration of influenza and pneumococcal vaccine, number and side of rib fracture(s), pulmonary contusion, pneumothorax, flail chest, spirometer use, blood transfusion, and intravenous fluid administration.
RESULTS
Among 78 cases and 74 controls (matched for age and ISS), patients who developed pneumonia were more likely to be male, have higher number of rib fractures, alcohol consumption of 1-5 drinks per day, and a higher initial volume of intravenous fluids during first 24 h. Patients with pneumonia were more likely to be treated with incentive spirometry. There were no difference in age, ISS, smoking status, side of rib fractures, pulmonary contusion, pneumothorax, flail chest, influenza vaccination, pneumonia vaccination, or mechanism of injury between the two groups.
CONCLUSION
Risk factors for the development of pneumonia following rib fractures include male gender, higher number of rib fractures, alcohol consumption, and higher rates of intravenous fluid administration during the initial 24 h following trauma.
Topics: Female; Humans; Incidence; Male; Middle Aged; Pneumonia; Registries; Retrospective Studies; Rib Fractures; Risk Assessment; Risk Factors; Thoracic Injuries; United States; Wounds, Nonpenetrating
PubMed: 31831351
DOI: 10.1016/j.ajem.2019.10.021 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2018
Topics: Aged; Chest Pain; Diagnosis, Differential; Dyspnea; Hernia; Herniorrhaphy; Humans; Lung Diseases; Male; Pleural Effusion; Rib Fractures; Thoracotomy; Tomography, X-Ray Computed
PubMed: 29874694
DOI: 10.1055/a-0630-6075 -
Injury Dec 2015Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and... (Review)
Review
Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and the probability of death increases further with age. Treatment is centered on pain control and early mobilization to provide adequate pulmonary hygiene. Multimodality interventions, such as incentive spirometry, postural changes, and coughing, are pivotal in minimizing the risk of pneumonia and death. Recently, many studies have found mortality benefit to operation fixation (ORIF) of ribs in select patients. However, this procedure remains underutilized partly due to lack of familiarity with its technique and pitfalls by trauma surgeons, in particular. Whereas there are publications on operative technique, there are no studies describing pitfalls associated with this procedure. The purpose of this paper is to describe pitfalls on the technical aspects of ORIF of the ribs based on the medical literature where possible and based on our experience in instances where peer reviewed evidence is lacking. The paper is not meant to serve as a protocol for managing rib fractures.
Topics: Age Factors; Cough; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Rib Fractures; Thoracic Injuries
PubMed: 26521992
DOI: 10.1016/j.injury.2015.10.022 -
Journal of Cardiothoracic Surgery Apr 2023Multiple rib fractures (≥ 3 displaced rib fractures and/or flail chest) are severe chest trauma with high morbidity and mortality. Rib fixation has become the first... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Multiple rib fractures (≥ 3 displaced rib fractures and/or flail chest) are severe chest trauma with high morbidity and mortality. Rib fixation has become the first choice for multiple rib fracture treatment. However, the timing of surgical rib fixation is unclear.
MATERIALS AND METHODS
The present study explored whether early rib fracture fixation can improve the outcome of multiple rib fractures. The present research included patients who were hospitalized in three Jiangsu hospitals following diagnosis with multiple rib fractures. Patients received early rib fracture fixation (≤ 48 h) or delayed rib fracture fixation (> 48 h) utilizing computer-based random sequencing (in a 1:1 ratio). The primary outcome measures included hospital length of stay, intensive care unit (ICU) stay, mechanical ventilation, inflammatory cytokine levels, infection marker levels, infection, and mortality.
RESULTS
A total of 403 individuals were classified into two groups, namely, the early group (n = 201) and the delayed group (n = 202). Patients belonging to the two groups had similar baseline clinical data, and there were no statistically significant differences between them. Early rib fracture fixation greatly decreased the length of stay in the ICU (4.63 days vs. 6.72 days, p < 0.001), overall hospital stay (10.15 days vs. 12.43 days, p < 0.001), ventilation days (3.67 days vs. 4.55 days, p < 0.001), and hospitalization cost (6900 USD vs. 7600 USD, p = 0.008). Early rib fracture fixation can decrease inflammatory cytokine levels and infection marker levels, prevent hyperinflammation and improve infection in patients with multiple rib fractures. The timing of rib fracture fixation does not influence the surgical procedure time, operative blood loss, 30-day all-cause mortality, or surgical site infection.
CONCLUSION
The findings from the present research indicated that early rib fracture fixation (≤ 48 h) is a safe, rational, effective and economical strategy and worth clinical promotion.
Topics: Humans; Rib Fractures; Fracture Fixation, Internal; Flail Chest; Thoracic Injuries; Hospitalization; Length of Stay; Retrospective Studies
PubMed: 37038166
DOI: 10.1186/s13019-023-02203-7