Tessa Drijkoningen - Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, USA
Robert Knotter - Emergency Department, Reinier de Graaf Gasthuis, Delft, The Netherlands
Frank J. Beeres - Surgery Department, Medisch Centrum Haaglanden, Den Haag, The Netherlands
Emile G. Coerkamp - Radiology Department, Medisch Centrum Haaglanden, Den Haag, The Netherlands
Anton H.J. Koning - Department of Bioinformatics, Erasmus MC University Medical Center, Rotterdam, Netherlands
Steven J. Rhemrev - Surgery Department, Medisch Centrum Haaglanden, Den Haag, The Netherlands

  Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures.   Methods: A convenient cohort of ۲۴ patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by ۷ observers of which ۳ observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. Results: The Kappa value varied from ۰.۱۱ to ۰.۳۳ for the first assessment. For the three observers who assessed the CT-scans twice; observer ۱ improved from a kappa of ۰.۳۳ to ۰.۵۰ (۹۵% CI ۰.۲۶-۰.۷۴, P=۰.۰۱), observer ۲ from ۰.۱۷ to ۰.۷۸ (۹۵% CI ۰.۳۶-۱.۰, P<۰.۰۰۱), and observer ۳ from ۰.۱۱ to ۰.۲۴ (۹۵% CI ۰.۰-۰.۷۷, P=۰.۲۴). Conclusion: Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic modalities for suspected scaphoid fractures.

۳D Imaging, Occult fracture, Scaphoid, Virtual Reality