RibAssist 3D: Biplanar Rib-Fracture Detection, Addressing, and Selective 3D Localization from CT-Derived Projections

Rib fractures are common, clinically significant, and time-consuming to localize on computed tomography (CT). We ask whether fractures detected in two orthogonal projections (anteroposterior, AP, and lateral) can be paired across views and triangulated into reliable 3D fracture points at a controlled rate of false 3D outputs. We answer this with a staged diagnostic study. Biplanar geometry is exact: detector-predicted centers reconstruct to median 4.0 mm 3D error when correspondence is correct. On the sealed cohort, dual-view availability reaches 61.1% and the candidate graph contains a correct pair for 58.4% of fractures. The binding limitation is not geometry or localization but confidence-limited cross-view correspondence. Lateral-detector retraining lifts dual-view availability (0.52 to 0.76 in development) and moves the frontier from 0% to 2.44% recall at 10 mm. When the policy commits a correct pair, the emitted point is geometrically accurate (sealed median 1.49 mm, rib-exact 93%). A pre-specified pass on the untouched 55-case cohort promotes 15 of 601 fractures to correct 3D localizations at 0.436 false 3D points per case, yielding 2.50% end-to-end commitment yield. The contribution is validated biplanar reconstruction geometry with high conditional localization fidelity, a staged identification of cross-view correspondence confidence as the effective bottleneck, and a selective assistive workflow that preserves uncertain findings rather than a standalone automatic reconstructor.