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Its assessors found 22 studies, most of them retrospective, and three more arrived during consultation. Thirteen studies compared the tools with standard care, mostly the original radiology report, and most were done outside the UK. The committee concluded that the tools can detect additional moderate to severe fractures that the original reports missed, generally with a specificity above 90%. It was uncertain how much detection would improve in the NHS. NICE allowed BriefCase-Triage, CINA-VCF Quantix, HealthVCF, HealthOST and IB Lab FLAMINGO during a three-year evidence generation period. The algorithms are fixed and work in addition to standard radiology review. 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