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PubMed1992

Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study.

OBJECTIVES: The aim of this study was to determine the relation between coronary artery calcification detected by ultrafast computed tomographic scanning and histopathologic coronary artery disease. BACKGROUND: Recent studies suggest that discrete coronary artery calcification as visualized by ultrafast computed tomographic scanning may facilitate the noninvasive detection or estimation, or both, of the in situ extent of coronary disease. Such quantitative relations have not been established. METHODS: Thirteen consecutive perfusion-fixed autopsy hearts (from eight male and five female patients aged 17 to 83 years) were scanned by ultrafast computed tomographic scanning in contiguous 3-mm tomographic sections. The major epicardial arteries were dissected free, positioned longitudinally and scanned again in cross section. Coronary artery calcification in a coronary segment was defined as the presence of one or more voxels with a computed tomographic density > 130 Hounsfield units. Each epicardial artery was sectioned longitudinally, stained and measured with a planimeter for quantification of cross-sectional and atherosclerotic plaque areas at 3-mm intervals, corresponding to the computed tomographic scans. A total of 522 paired coronary computed tomographic and histologic sections were studied. RESULTS: Direct relations were found between ultrafast computed tomographic scanning coronary artery calcium burden and atherosclerotic plaque area and percent lumen area stenosis. However, the range for plaque area or percent lumen stenosis, or both, associated with a given calcium burden was broad. Three hundred thirty-one coronary segments showed no calcification by computed tomography. Although atherosclerotic disease was found in several corresponding pathologic specimens, > 97% of these noncalcified segments were associated with nonobstructive disease (< 75% area stenosis); if no calcification was determined in an entire coronary vessel, all corresponding coronary disease was found to be nonobstructive. To determine the relation between arterial calcification and any atheromatous disease, computed tomographic calcium burden for each segment was paired with the histologic absence or presence of disease. Ultrafast computed tomographic scanning had a sensitivity and specificity of 59% and 90% and a negative and positive predictive value of 65% and 87%, respectively. A direct correlation was found (r = 0.99) between total calcium burden calculated from tomographic scans of the heart as a whole and scans of the arteries obtained in cross section. CONCLUSIONS: The detection of coronary calcification by ultrafast computed tomographic scanning is highly predictive of the presence of histopathologic coronary disease, but the use of this technique to define the extent of coronary disease may be limited. However, the absence of coronary calcification at any site is highly specific for the absence of obstructive disease.

Adolescent↗
PubMed2004

Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder.

BACKGROUND: The demand for time-consuming psychotherapy of phobia/panic exceeds the supply of trained therapists. Delegating routine therapy aspects to a computer might ease this problem. METHOD: Ninety-three out-patients with phobia or panic disorder were randomized in a 2: 2 : 1 ratio to have self-exposure therapy guided either mainly by a stand-alone computer system (FearFighter) or entirely face-to-face by a clinician, or to have mainly computer-guided self-relaxation as a placebo. Both computer groups (FearFighter and relaxation) had brief back-up advice from a clinician. Primary outcome measures were self- and blind-assessor ratings of Main Problem and Goals, and Global Phobia. RESULTS: Drop-outs occurred significantly more often in the two self-exposure groups (43% if mainly computer-guided, 24% if entirely clinician-guided) than with self-relaxation (6%); the difference between the two self-exposure groups was not significant. Even with all drop-outs included, the mainly computer-guided exposure group and the relaxation group had 73% less clinician time per patient than did the entirely clinician-guided exposure group. The two self-exposure groups had comparable improvement and satisfaction at post-treatment and at 1-month follow-up, while relaxation was ineffective. Mean improvement on the primary outcome measures (self- and assessor-rated) was 46% computer, 49% clinician, 9% relaxation at post-treatment (week 10) and 58% computer, 53% clinician and -4% relaxation at 1-month follow-up (week 14). Mean effect sizes on the primary outcome measures were 2.9 computer, 3.5 clinician and 0.5 relaxation at post-treatment; and 3.7 computer, 3.5 clinician and 0.5 relaxation at 1-month follow-up. The assessor did not rate patients at follow-up. CONCLUSIONS: Despite its (non-significantly) higher dropout rate, self-exposure therapy for panic/ phobia cut clinician time per patient by 73% without losing efficacy when guided mainly by a computer rather than entirely by a clinician. The finding needs confirmation at a follow-up that is longer and includes a blind assessor. Self-relaxation had the highest rate of completers but was ineffective.

Analysis of Variance↗
PubMed2003

A data mining technique for discovering distinct patterns of hand signs: implications in user training and computer interface design.

Hand signs are considered as one of the important ways to enter information into computers for certain tasks. Computers receive sensor data of hand signs for recognition. When using hand signs as computer inputs, we need to (1) train computer users in the sign language so that their hand signs can be easily recognized by computers, and (2) design the computer interface to avoid the use of confusing signs for improving user input performance and user satisfaction. For user training and computer interface design, it is important to have a knowledge of which signs can be easily recognized by computers and which signs are not distinguishable by computers. This paper presents a data mining technique to discover distinct patterns of hand signs from sensor data. Based on these patterns, we derive a group of indistinguishable signs by computers. Such information can in turn assist in user training and computer interface design.

Algorithms↗
PubMed1998

Age differences in attitudes toward computers.

It is commonly believed that older adults hold more negative attitudes toward computer technology than younger people. This study examined age differences in attitudes toward computers as a function of experience with computers and computer task characteristics. A sample of 384 community-dwelling adults ranging in age from 20 to 75 years performed one of three real-world computer tasks (data entry, database inquiry, accounts balancing) for a 3-day period. A multidimensional computer attitude scale was used to assess attitudes toward computers pretask and posttask. Although there were no age differences in overall attitudes, there were age effects for the dimensions of comfort, efficacy, dehumanization, and control. In general, older people perceived less comfort, efficacy, and control over computers than did the other participants. The results also indicated that experience with computers resulted in more positive attitudes for all participants across most attitude dimensions. These effects were moderated by task and gender. Overall, the findings indicated that computer attitudes are modifiable for people of all age groups. However, the nature of computer experience has an impact on attitude change.

Adult↗
PubMed1991

Computer literacy among medical, nursing, dental and veterinary undergraduates.

Universities need to ensure that clinical undergraduates are educated in the use of computers in medical, nursing, dental and veterinary practice. We surveyed 875 students at Glasgow University to determine their computer literacy and attitudes to the use of computers. One in five students had not used a computer during the last year and 16% thought themselves to be a complete novice with computers. Medical students were more likely to have used a computer recently compared to dental and nursing students. For one in four students, the idea of working with a computer makes them anxious. Seventy per cent of students wanted more use of computers in the curriculum and 30% applied to attend an optional computing course in the summer. Although a third of students had not used a computer at school, the proportion had increased a little in recent years. At Glasgow University, changes need to be made to the undergraduate curriculum to teach students the use of computers in clinical practice. With a few exceptions, there is no reason to believe that this does not apply to other British universities.

Attitude of Health Personnel↗
PubMed2004

Fast and robust computation of colon centerline in CT colonography.

Although several methods for generating the centerline of a colon from CT colonographic scans have been proposed, in general they are time-consuming and do not take into account that the images of the colon may be of nonoptimal quality, with collapsed regions, and stool within the colon. Furthermore, the colonic lumen or wall, which is often used as a basis for computation of a centerline, is not always precisely segmented. In this study, we have developed an algorithm for computation of a colon centerline that is fast compared to the centerline algorithms presented in the reviewed literature, and that relies little on a complete colon segments identification. The proposed algorithm first extracts local maxima in a distance map of a segmented colonic lumen. The maxima are considered to be nodes in a set of graphs, and are iteratively linked together, based on a set of connection criteria, giving a minimum distance spanning tree. The connection criteria are computed from the distance from object boundary, the Euclidean distance between nodes and the voxel values on the pathway between pairs of nodes. After the last iteration, redundant branches are removed and end segments are recovered for each remaining graph. A subset of the initial maxima is used for distinguishing between the colon and noncolonic centerline segments among the set of graphs, giving the final centerline representation. A phantom study showed that, with respect to phantom variations, the algorithm achieved nearly constant computation time (2.3-2.9 s) except for the most extreme setting (20.2 s). The algorithm successfully found all, or most of, the centerline (93% - 100%). Displacement from optimum varied with colon diameter (1.2-6.6 mm). By use of 40 CT colonographic scans, the computer-generated centerlines were compared with the centerlines generated by three radiologists. The similarity was measured based on percent coverage and average displacement. The computer-generated centerlines, when compared with human-generated centerlines, had approximately the same displacement as when the human-generated centerlines were compared among each other (3.8 mm versus 4.0 mm). The coverage of the computer-generated centerlines was slightly less than that of the human-generated centerlines (92% versus 94%). The 40 centerlines were, on average, computed in 10.5 seconds, including computation time for the distance transform, with an Intel Pentium-based 800 MHz computer, as compared with 12-17 seconds or more (excluding computation time for the distance transform needed) per centerline as reported in other studies.

Algorithms↗
PubMed2005

A stylized computational model of the head for the reference Japanese male.

Computational models of human anatomy, along with Monte Carlo radiation transport simulations, have been used by Snyder et al. [MIRD Pamphlet No. 5, revised (The Society of Nuclear Medicine, New York, 1978)], Cristy and Eckerman [ORNL/TM-8381/VI, Oak Ridge National Laboratory, Oak Ridge, TN (1987)] and Zubal et al. [Med. Phys. 21, 299-302 (1994)] to estimate internal organ doses from internal and external radiation sources. These were created using physiological data from Caucasoid subjects but not from other races. There is a need for research to determine whether the obvious differences from the Caucasoid anatomy make these models unsuitable for estimating the absorbed dose in other races such as the Mongoloid. We used the cranial region of the adult Japanese male to represent the Mongoloid race. This region contains organs that are highly sensitive to radiation. The cranial region of a physical phantom produced by KYOTO KAGAKU Co., LTD. using numerical data from a Japanese Reference Man [Tanaka, Nippon Acta. Radiol. 48, 509-513 (1988)] was used to supply the data for the geometry of a stylized computational model. Our computational model was constructed with equations rather than voxel-based, in order to deal with as small a number of parameters as possible in the computer simulation experiment. The accuracy of our computational model was checked by comparing simulated experimental results obtained with MCNP4C with actual doses measured with thermoluminescence dosimeters (TLDs) inside the physical phantom from which our computational model was constructed. The TLDs, whose margin of error is less than +/-10%, were arranged at six positions. Co-60 was used as the radiation source. The irradiated dose was 2 Gy in terms of air kerma. In the computer simulation experiments, we used our computational model and Cristy's computational model, whose component data are those of the tissue substitute materials and of the human body as published in ICRU Report 46. The observed absorbed dose values (Gy) at all six points were calculated as the percentage difference between MCNP4C simulation and the TLDs. In our computational model, the average values of all the percentage differences were 6.0+/-4.0% (tissue substitute materials) and 7.6+/-6.6% (ICRU Report 46), respectively. In Cristy's model, the corresponding values were 20.4+/-3.8% (tissue substitute materials) and 21.0+/-4.1% (ICRU Report 46), respectively. Considering the margin of error in the radiation sensitivity of the TLDs, this study validates our computational model as a test object for radiation dosimetry studies.

Asian People↗
PubMed2005

Comparisons of Physicians' and Nurses' Attitudes towards Computers.

Before starting the implementation of integrated hospital information systems, the physicians' and nurses' attitudes towards computers were measured by means of a questionnaire. The study was conducted in Dubrava University Hospital, Zagreb in Croatia. Out of 194 respondents, 141 were nurses and 53 physicians, randomly selected. They surveyed by an anonymous questionnaire consisting of 8 closed questions about demographic data, computer science education and computer usage, and 30 statements on attitudes towards computers. The statements were adapted to a Likert type scale. Differences in attitudes towards computers between groups were compared using Kruskal-Wallis and Mann Whitney test for post-hoc analysis. The total score presented attitudes toward computers. Physicians' total score was 130 (97-144), while nurses' total score was 123 (88-141). It points that the average answer to all statements was between "agree" and "strongly agree", and these high total scores indicated their positive attitudes. Age, computer science education and computer usage were important factors witch enhances the total score. Younger physicians and nurses with computer science education and with previous computer experience had more positive attitudes towards computers than others. Our results are important for planning and implementation of integrated hospital information systems in Croatia.

Attitude of Health Personnel↗
PubMedDate not supplied

The computer-literate nurse.

This study investigated the perceptions of nursing educators concerning the amount and kinds of computer training that should occur in the nursing degree program. Data were collected in two phases: a semi-structured interview of experts in the application of the computer to nursing and a random sample of nursing educators in 2-year and 4-year nursing degree programs. The panel of experts identified objectives within each of seven domains: programming and algorithms, skills in computer usage, major uses and applications, limitations of computers, personal and social aspects, and relevant values and attitudes. The responses of this panel were used to generate an universe of computer literacy objectives. The sample of nursing educators then identified a subset of objectives within the universe that they felt nursing students should master in order to be computer literate. The survey found that nursing educators desire graduates of nursing degree programs to understand how a computer works and to develop skills in using application programs. They do not expect nursing graduates to acquire programming skills, however, they do expect the graduates to acquire skills in using the computer as a tool in nursing. These skills include using a word processor for writing nursing care plans, using computer-aided instruction as a learning tool, using a hospital computer information system, using a computerized library database, and using software for statistical computations.

Computer Literacy↗
PubMed1990

Application of computers in clinics in Singapore: status and doctors' perceptions.

A survey of 67 private clinics in Singapore indicates a positive trend towards use of computer-based information systems for administrative and medical applications. The computerised clinics are generally large in terms of number of staff and number of patients, and have been in operation for 3 to 15 years. Specialist clinics have a greater tendency to use computers. The widely used applications in clinics with computers are word processing, accounting, database, medical billing, drugs inventory, laboratory billing and reporting, medical records tracking, and prescription processing. Clinics with computers find: (1) software are generally suitable, (2) objectives of computerisation have been generally achieved, (3) a slight increase in operating costs, (4) a slight increase in staff productivity, and (5) satisfactory vendor support. The responding doctors rate their knowledge of computers from average to poor. Doctors with computers in their clinics hold the perception that: (1) computers can adequately support clinic operations, (2) computer systems are reliable, (3) a genuine need exists for computers in clinics, (4) computers are useful as research tools, and (5) legal and ethical constraints may inhibit use of computers in medical applications. Further analysis of the data has identified some interesting correlations among clinic variables and among doctors' perception variables.

Attitude to Computers↗
PubMed2000

Computers and the pediatric surgeon: a primer.

Computers have become an integral part of surgical practice. To use and maintain computers effectively, the surgeon must have a basic knowledge of the inner workings of the computer. It also is helpful to understand how the systems have evolved. Medical computing started in the financial department of large hospitals. From there it expanded to clinical data systems. Coincident with the development of clinical data systems was the introduction of the IBM personal computer in 1981 and the development of the Internet. All these events led to the use of the personal computer as a communication tool. This will shape much of how we use computers in the coming millennium. The computer is made up of several component parts. The brain of the computer is the central processing unit (CPU), which performs all of the calculations in the computer. The CPU works in concert with the random access memory (RAM) and hardware peripherals to perform tasks as directed by a program. To use this increasingly complex tool effectively, the pediatric surgeon must have a basic knowledge of information systems. It is through this knowledge that information systems may be used to enhance the efficiency of pediatric surgical practice.

Child↗
PubMed2004

Cluster computing for digital microscopy.

Microscopy is becoming increasingly digital and dependent on computation. Some of the computational tasks in microscopy are computationally intense, such as image restoration (deconvolution), some optical calculations, image segmentation, and image analysis. Several modern microscope technologies enable the acquisition of very large data sets. 3D imaging of live cells over time, multispectral imaging, very large tiled 3D images of thick samples, or images from high throughput biology all can produce extremely large images. These large data sets place a very large burden on laboratory computer resources. This combination of computationally intensive tasks and larger data sizes can easily exceed the capability of single personal computers. The large multiprocessor computers that are the traditional technology for larger tasks are too expensive for most laboratories. An alternative approach is to use a number of inexpensive personal computers as a cluster; that is, use multiple networked computers programmed to run the problem in parallel on all the computers in the cluster. By the use of relatively inexpensive over-the-counter hardware and open source software, this approach can be much more cost effective for many tasks. We discuss the different computer architectures available, and their advantages and disadvantages.

Cells↗
PubMed1994

Accuracy of subcutaneous fat measurement: comparison of skinfold calipers, ultrasound, and computed tomography.

OBJECTIVE: The purpose of this study was to compare skinfold caliper and ultrasound measurement of subcutaneous body fat at three abdominal sites with computed tomography, which is considered to be the gold standard. DESIGN: This was a cross-sectional study in which computed-tomography, ultrasound, and skinfold caliper measurements were made at three distinct abdominal sites. All body composition and anthropometric measurements were performed on each subject on one occasion. SUBJECTS: Twenty-two subjects were recruited (13 men and 9 women). Mean ages (+/- standard deviation) were 43 +/- 4 years for the women and 51 +/- 18 years for the men. All subjects had been previously scheduled for an abdominal or pelvic computed-tomography scan at the Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada, and participated in the study on a volunteer basis. MAIN OUTCOME MEASURES: A better agreement was found between the skinfold calipers and computed-tomography methods than between the ultrasound and computed-tomography method for the measurement of subcutaneous body fat. This was observed when the data were analyzed for both correlational agreement and for graphical interpretation. STATISTICAL ANALYSES PERFORMED: The relationships among skinfold, ultrasound, and computed-tomography measurements were analyzed by determining Pearson correlation coefficients. A graphical method described by Bland and Altman was also used to assess agreement among the three methods. RESULTS: Significant correlation coefficients were observed between skinfold calipers and computed tomography at all three abdominal sites (site 1, r = .60, P = .003; site 2, r = .70, P = .0001; site 3, r = .73, P = .0001). Ultrasound and computed-tomography methods only showed a significant correlation at site 3 (r = .54; P = .009). The graphical method revealed that the variation in the ultrasound measurements was much greater than that of the skinfold measurements when compared to computed-tomography values. APPLICATIONS/CONCLUSIONS: The results of this study indicated that relative agreement in the measurement of subcutaneous body fat between skinfold and computed-tomography measurements was superior to that exhibited between ultrasound and computed-tomography measurements. This finding enhances the potential use of skinfold calipers in the clinical setting, particularly in view of the fact that measurement of subcutaneous body fat at different body sites is becoming increasingly important for the characterization of risk of certain disease states.

Abdomen↗
PubMed1976

Computer recognition of generalized spike-wave discharges.

Twelve 12h daytime telemetered EEGs were read for generalized spike-wave (S-W) bursts by a computer and independently by three experienced electroencephalographers. The computer system was a hybrid of analog devices (tape-recorder, voltage summator, and high-pass filters) and a multipurpose laboratory digital device (PDP-12). The computer was programmed to identify only the location on the record and the duration of the generalized S-W paroxysms. From 1,462 discharges identified by both the readers and the computer, a consensus list of 609 was derived by selecting only those bursts identified by all three readers. The computer recognized 516 (85%) of those bursts on the consensus list; the computer's accuracy, as compared with the consensus, rose to 92% when portions of the EEG containing sleep were discounted. The computer also recognized as generalized S-W paroxysms 15 high-voltage transients, which none of the three readers selected. Ten of these, however, occurred during sleep. When the computer results were added to those of the three readers to permit a four-way inter-reader comparison, the computer was found to have had about as many isolated decisions as any of the three readers. In the number of bursts recognized, the computer tended to be about as conservative as the reader under whose guidance it was originally programmed. The computer's accuracy in measuring burst duration was not evaluated statistically.

Computers, Hybrid↗
PubMed2000

Management of scrap computer recycling in Taiwan.

It is estimated that approximately 300,000 scrap personal computers are generated each year in Taiwan [S.-L. Chang, A Study on the Scrap Computer Treatment Cost, Environment Protection Administration of Taiwan, December 1998 (in Chinese)]. The disposal of such a huge number of scrap computers presents a difficult task for the island due to the scarcity of landfills and incineration facilities available locally. Also, the hazardous materials contained (i.e., phosphor coatings of cathode ray tubes (CRTs), batteries, polychlorinated biphenyl capacitors, mercury-containing parts, liquid crystal display, high-lead content CRT funnel glass, and plastic containing flame-retardant bromine, etc.) in the scrap computers may seriously pollute the environment if they are not properly disposed of. Therefore, the EPA of Taiwan declared scrap personal computers the producer's recycling responsibility as of July 1997. Under this decree, the manufacturers, importers and sellers of personal computers have to properly recover and recycle the scrapped computers which they originally sell. On June 1, 1998, a producer responsibility recycling program for scrap computers was officially implemented in Taiwan. Under this program, consumers can bring their unwanted personal computers to the designated collection points and receive reward money. Currently, only six computer items are mandated to be recycled in this recycling program. They are notebooks, monitors, hard disks, power supplies, printed circuit boards and main frame shells. This article outlines the current scrap computer recycling system in Taiwan.

Bromine↗
PubMed2005

Computer and internet use among urban African Americans with type 2 diabetes.

Previous studies have identified a "digital divide" between African Americans and whites, with African Americans having substantially lower rates of Internet use. However, use of the Internet to access health information has not been sufficiently evaluated in this population. Therefore, we conducted a telephone survey to determine the prevalence of computer and Internet use among 457 African American adults with type 2 diabetes. Participants were 78% female, with a mean age of 57 +/- 11 years, and about one-third had a yearly income % $7,500. Forty percent of the participants reported having a computer at home and 46% reported knowing how to use a computer. Most participants (58%) reported that they had, at some point, used a computer, and of those, 40% reported that they used the computer to find health information. In a stratified analysis, participants with lower education levels (<high school) were less likely to have a computer; older participants, men, and individuals with lower education levels were less likely to know how to use a computer and to use it to search for health information (all P < .05). Nonetheless, of the participants who did not know how to use a computer, 66% reported that they would be willing to learn. In addition, 82% reported that they had friends or family in the neighborhood who would let them use a computer. Furthermore, 89% of participants reported that they would use a computer program to manage their diabetes if it were offered free of charge. These data show promise for the willingness of this under-served population to use computers and access health information using the Internet. New programs are needed to explore Internet-based interventions to improve self-management and diabetes care among African Americans.

Adult↗
PubMed2003

Integrating Web-based computer cases into a required clerkship: development and evaluation.

PURPOSE: To evaluate a five-year experience (1995-2000) developing and integrating computer cases into a required clerkship. METHOD: In Study 1, 54 volunteer students were randomly assigned to study articles, a paper case, or a computer case on low back pain/kidney stones. Students were given an exam immediately after the exercise and one week later. In Study 2, 325 clerkship students were asked to select and complete two computer cases or to prepare assignments on unrelated topics. Among the cases offered were two test cases on low back pain/kidney stones and pneumonia. Questions specific to the computer test cases (CC) and other noncomputer cases (NCC) were in the final exam. Exam scores related to CC questions and NCC questions were compared between the groups of students who did and did not complete the computer cases. Students also rated the computer cases on a questionnaire. RESULTS: In Study 1, reading articles required the most time and received the most negative comments. The students who completed the computer case scored the best on the exam one week later. In Study 2, the students who completed the two computer cases scored significantly higher on the CC questions than did students who studied only one or none of the computer cases (p <.001). There was no difference among groups for the NCC scores (p =.76). Students rated the computer cases with a mean of 6 on a seven-point scale (7 = strongly agree). CONCLUSION: Computer cases are effective learning tools, are well-received by students, and can be successfully integrated into existing clerkships.

Clinical Clerkship↗
PubMed2002

The role of plain films and computed tomography in the evaluation of scapular neck fractures.

OBJECTIVE: To assess the ability of plain films and computed tomography scans to show the pattern, displacement, and angulation of scapular neck fractures. To assess the ability of computed tomography to identify concomitant occult shoulder injuries. DESIGN: Masked retrospective radiographic review. SETTING: Level I trauma center. PARTICIPANTS: Three orthopaedic surgeons (two attending physicians and one senior resident) and one musculoskeletal radiology attending physician reviewed the imaging studies of scapula neck fractures in twenty patients treated at our institution. MAIN OUTCOME MEASURES: Kappa analysis of agreement of fracture characteristics and benefits of computed tomography for scapular neck fractures. RESULTS: The mean weighted kappa coefficient for interobserver reliability of fracture displacement was 0.49 when the fractures were assessed by plain films alone, 0.15 when they were assessed by computed tomography scans alone, and 0.35 when they were assessed by plain films and computed tomography scans. The mean weighted kappa coefficients for fracture angulation were 0.30, 0.23, and 0.16, respectively. The mean simple kappa coefficients for fracture classification were 0.81, 0.20, and 0.33, respectively. Concomitant injury to the superior shoulder suspensory complex was seen in 57 percent of cases, including nine clavicle fractures, one coracoid fracture, and three acromion process fractures. The coracoid fracture and two of the acromion process fractures were minimally displaced and seen on computed tomography scans only. CONCLUSION: Scapular neck fracture displacement, angulation, and anatomic classification showed moderate interobserver reliability by plain films but were not enhanced by computed tomography. Computed tomography confused, rather than clarified, the assessment of these characteristics. Computed tomography may be useful to identify associated injuries to the superior shoulder suspensory complex, which can be missed by plain films alone. Routine computed tomography in patients with scapular neck fractures cannot be recommended based on this study. Computed tomography of scapular neck fractures may be useful in selected cases in which intraarticular extension is noted on plain films.

Female↗