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Mason K, Iball G, Hinchcliffe D, Snaith B. A systematic review comparing the effective radiation dose of musculoskeletal cone beam computed tomography to other diagnostic imaging modalities. Eur J Radiol 2024; 177:111558. [PMID: 38964225 DOI: 10.1016/j.ejrad.2024.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Cone-Beam CT (CBCT) is well established in orofacial diagnostic imaging and is currently expanding into musculoskeletal applications. This systematic review sought to update the knowledge base on radiation dose comparisons between imaging modalities in MSK imaging and consider how research studies have reported dose measures. METHODS This review utilised a database search and an online literature tool. Studies with potential relevance were screened then before full text review, each performed by two independent reviewers, with a third independent reviewer available for conflicts. Data was extracted using a bespoke tool created within the literature tool. RESULTS 21 studies were included in the review which compared CBCT with MSCT (13), conventional radiography (1), or both (7). 19 studies concluded that CBCT provided a reduced radiation dose when compared with MSCT: the factor of reduction ranging from 1.71 to 50 with an average of 12. Studies comparing CBCT to DR found DR to have an average dose reduction of 4.55. CONCLUSIONS The claims that CBCT produces a lower radiation dose than MSCT is borne out with most studies confirming doses less than half that of MSCT. Fewer studies include DR as a comparator but confirm that CBCT results in a higher effective dose on average, with scope for CBCT to provide an equivalent radiation dose. This review highlighted a need for consistency in methodology when conducting studies which compare radiation dose across different technologies. Potential solutions lie outside the scope of this review, likely requiring multi-discipline approach to ensure a cohesive outcome.
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Affiliation(s)
- K Mason
- Mid Yorkshire Teaching Hospitals NHS Trust, Aberford Rd, Wakefield, WY WF1 4DG, UK.
| | - G Iball
- University of Bradford, Bradford, WY BD7 1DB, UK.
| | - D Hinchcliffe
- Mid Yorkshire Teaching Hospitals NHS Trust, Aberford Rd, Wakefield, WY WF1 4DG, UK
| | - B Snaith
- Mid Yorkshire Teaching Hospitals NHS Trust, Aberford Rd, Wakefield, WY WF1 4DG, UK; University of Bradford, Bradford, WY BD7 1DB, UK
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Molanes-López EM, Ferrer JM, Dougnon AO, Gado AA, Sanoussi A, Ousmane N, Lazoumar RH, Charle-Cuéllar P. Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger. HUMAN RESOURCES FOR HEALTH 2024; 22:22. [PMID: 38553707 PMCID: PMC10979590 DOI: 10.1186/s12960-024-00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND A non-randomized controlled trial, conducted from June 2018 to March 2019 in two rural communes in the health district of Mayahi in Niger, showed that including community health workers (CHWs) in the treatment of severe acute malnutrition (SAM) resulted in a better recovery rate (77.2% vs. 72.1%) compared with the standard treatment provided solely at the health centers. The present study aims to assess the cost and cost-effectiveness of the CHWs led treatment of uncomplicated SAM in children 6-59 months compared to the standard national protocol. METHODS To account for all relevant costs, the cost analysis included activity-based costing and bottom-up approaches from a societal perspective and on a within-trial time horizon. The cost-effectiveness analysis was conducted through a decision analysis network built with OpenMarkov and evaluated under two approaches: (1) with recovery rate and cost per child admitted for treatment as measures of effectiveness and cost, respectively; and (2) assessing the total number of children recovered and the total cost incurred. In addition, a multivariate probabilistic sensitivity analysis was carried out to evaluate the effect of uncertainty around the base case input data. RESULTS For the base case data, the average cost per child recovered was 116.52 USD in the standard treatment and 107.22 USD in the CHWs-led treatment. Based on the first approach, the CHWs-led treatment was more cost-effective than the standard treatment with an average cost per child admitted for treatment of 82.81 USD vs. 84.01 USD. Based on the second approach, the incremental cost-effectiveness ratio of the transition from the standard to the CHWs-led treatment amounted to 98.01 USD per additional SAM case recovered. CONCLUSIONS In the district of Mayahi in Niger, the CHWs-led SAM treatment was found to be cost-effective when compared to the standard protocol and provided additional advantages such as the reduction of costs for households. TRIAL REGISTRATION ISRCTN with ID 31143316. https://doi.org/10.1186/ISRCTN31143316.
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Affiliation(s)
- Elisa M Molanes-López
- Department of Statistics and Operational Research, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040, Madrid, Spain
| | - José M Ferrer
- Department of Statistics and Operational Research, Faculty of Medicine, Interdisciplinary Mathematics Institute, Universidad Complutense de Madrid (UCM), HUMLOG Research Group, 28040, Madrid, Spain
| | | | | | - Atté Sanoussi
- Nutrition Direction, Ministry of Health, 623, Niamey, Niger
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Czarnecki P, Siemionow M, Baek GH, Górecki M, Romanowski L. Hand and wrist - what the hand surgeon wants to know from the radiologist. Pol J Radiol 2024; 89:e70-e79. [PMID: 38510550 PMCID: PMC10953511 DOI: 10.5114/pjr.2024.135304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024] Open
Abstract
Hand surgeons, as unique specialists, appreciate the complexity of the anatomy of the hand. A hand is not merely a group of anatomic structures but a separate organ that works by feeling, sending information to the brain, and enabling a variety of movements, from precise skills to firm tasks. Acute and chronic problems interfere with complicated hand function and potentially influence work or daily life activities for a long time. Thus, the surgeon's role is to propose appropriate treatment with predictable results. This paper attempts to specify the preoperative considerations and their influence on the choice of surgical procedure and the assessment of results potentially influencing further treatment. We have divided the manuscript by anatomical structures, which is a natural surgical assessment and planning approach. The most common problems were highlighted to introduce the method of decision-making and surgical solutions.
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Affiliation(s)
- Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Maria Siemionow
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
- Department of Orthopaedics, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Michał Górecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Moshfeghi M, Safi Y, Różyło-Kalinowska I, Gandomi S. Does the size of an object containing dental implant affect the expression of artifacts in cone beam computed tomography imaging? Head Face Med 2022; 18:20. [PMID: 35765076 PMCID: PMC9241278 DOI: 10.1186/s13005-022-00326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Artifacts fault image quality but handling several factors can affect it. This study was conducted to investigate the effect of object size on artifacts in cone-beam computed tomography systems. Methods Five phantoms, each containing a titanium implant in a sheep bone block, were fabricated of various sizes ranging from XS to XL: The M phantom was the same size as the device’s field of view (FOV). The L and XL phantoms were 20 and 40% larger than the FOV while the S and XS phantoms were 20 and 40% smaller than FOV, respectively. Ballistic gelatin was used to fill the phantoms. Phantoms were scanned by NewTom VGI and HDXWill Q-FACE. The mean and standard deviation (SD) of gray values in each 120 ROI was obtained by OnDemand software. The contrast to noise ratio (CNR) was also calculated. Results The gray value in S and M phantoms were more homogenous. The lowest SD value (10.20) was found in S phantom. The highest value for SD (125.16) was observed in XL phantom. The lowest (4.47) and highest (9.92) CNR were obtained in XL and S phantoms, respectively. HDXWill Q-FACE recorded a higher SD and a lower CNR than NewTom VGI (P < 0.05). Conclusion Object dimensions of the FOV size or up to 20% smaller provided better image quality. Since the dimensions of soft tissue in most patients are larger than the selective FOV, it is recommended that in CBCT artifacts studies, an object with dimensions closer to the patient’s dimensions be used to better relate the results with the clinical condition, because the sample dimensions affect the amount of artifacts.
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Affiliation(s)
- Mahkameh Moshfeghi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ingrid Różyło-Kalinowska
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland
| | - Shiva Gandomi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Fitzpatrick E, Sharma V, Rojoa D, Raheman F, Singh H. The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis. Skeletal Radiol 2022; 51:923-934. [PMID: 34542681 PMCID: PMC8930799 DOI: 10.1007/s00256-021-03883-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity. MATERIALS AND METHODS We conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC). RESULTS We identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6-93.6) sensitive and 99.2% (95% CI 92.6-99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7-97.2) and 100% (95% CI 99-100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67-98) and specificity was 100% (95% CI 10-100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82-0.96), which is deemed to be almost perfect. CONCLUSION CBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.
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Affiliation(s)
- Emma Fitzpatrick
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Vivek Sharma
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Djamila Rojoa
- Department of Plastics Surgery, Leicester Royal Infirmary, University Hospital of Leicester, Leicester, UK
| | - Firas Raheman
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Harvinder Singh
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Murphy MC, Gibney B, Walsh J, Orpen G, Kenny E, Bolster F, MacMahon PJ. Ultra-low-dose cone-beam CT compared to standard dose in the assessment for acute fractures. Skeletal Radiol 2022; 51:153-159. [PMID: 34132888 DOI: 10.1007/s00256-021-03825-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Multi-detector computed tomography (MDCT) is superior in fracture detection than conventional radiography; however, dose is increased. Cone-beam computed tomography (CBCT) offers higher spatial resolution and lower dose than MDCT. Manufacturers offer an ultra-low-dose algorithm. This study compares the diagnostic accuracy of the ultra-low-dose CBCT (ULDCBCT) with that of the standard-dose CBCT (SDCBCT). MATERIALS AND METHODS In total, 64 patients were scanned with both the SDCBCT and the ULDCBCT protocols. Both studies were reported by two consultant radiologists with fellowship training in emergency radiology separated in time. The reporter recorded a diagnosis of fracture or normal and diagnostic confidence using a 5-point Likert scale. The gold standard was taken as the SDCBCT. Reporters were blinded to the indication and the SDCBCT report. Cases of discrepancy were resolved by consensus. RESULTS There were 34 fractures and 30 cases had no fracture. Several fractures were missed using the UDCBCT, and there were also several cases of overdiagnosis. ULD was inferior to SD for fracture diagnosis (p < 0.00001). The diagnostic accuracy of ULDCBCT was 82.8% (75.1-88.9 CI). The diagnostic accuracy of plain radiograph was 64% (55.1-75.7% CI). Diagnostic confidence was reduced; the mean confidence for SDCBCT was 4.68 vs 4.12 for ULDCBCT (p < 0.001). The Kappa for interobserver agreement was 0.6. CONCLUSION ULDCBCT is inferior to SDCBCT in fracture detection and confidence is reduced. For diagnostic studies, the standard dose should be used.
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Affiliation(s)
- M C Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | - B Gibney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J Walsh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - G Orpen
- Department of Radiography, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - E Kenny
- Department of Medical Physics, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - P J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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