The high noon view: The value of an additional radiographic projection along the path of penetrating foreign bodies.

OBJECTIVE

To determine whether an additional 'high noon' radiograph along the plane of penetrating foreign bodies improves accuracy and confidence in assessing cortical involvement of foreign bodies, whilst also remaining feasible for routine acquisition by medical radiation technologists.

MATERIALS AND

METHODS

Consecutive patients presenting with a penetrating foreign body at four participating sites were assessed. Routine radiographs, including standard views, were acquired. All patients also received a 'high noon' view aligned along the long axis of the partly penetrating foreign body. Two blinded musculoskeletal radiologists reviewed the images. Confidence in cortical involvement was assessed using a 5-point Likert scale, with and without the 'high noon' view. Subjective utility of the view was recorded. Accuracy was defined as the correct identification of the presence or absence of cortical bone involvement.

RESULTS

Twenty-one cases (19 males, 2 females; mean age 36 ± 19 years) were analyzed. Only a single attempt at 'high noon' view was needed in 17 of 21 (81%) of cases. The 'high noon' view improved accuracy for Reviewer 1 from 15/20 (71%) to 21/21 (100%) and for Reviewer 2 from 11/20 (52%) to 17/20 (81%). Likert confidence scores were significantly improved for both reviewers (Wilcoxon Signed rank test Z-value = -3.41, p < 0.001 for reviewer 1, and Z-value = -1.83, p = 0.033 for reviewer 2). Subjective beneficial utility was reported by reviewers in 12/21 (57%) and 13/21 (62%) cases, respectively.

CONCLUSION

Adding a 'high noon' view markedly improved diagnostic accuracy and radiologist confidence for cortical involvement of penetrating foreign bodies. The 'high noon' view was subjectively rated as helpful in over half of the cases. Operationally, the projection was easy for technologists to acquire as part of the routine workflow. This low-cost modification warrants further evaluation in larger studies, including cases with confirmed cortical involvement.

PLAIN LANGUAGE SUMMARY: Penetrating injuries can be hard to assess on regular X-ray images. This study explored whether adding a special view called the high noon view could help radiologists see if a foreign object had reached the hard outer layer of bone. This study found that this extra view made readings more accurate and helped radiologists feel more confident in their assessments. This matters because better imaging can support safer care and quicker decisions for people with these injuries.