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Tang K, Wu F, Mao Y, Shen J, Li Y, Wang B, Zhang A. Clinical value of low-dose three-dimensional reconstruction by multi-slice spiral computed tomography and by traditional X-ray in the diagnosis of distal radius epiphyseal injury in children. Am J Transl Res 2024; 16:3376-3384. [PMID: 39114688 PMCID: PMC11301459 DOI: 10.62347/luzj4979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/30/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To compare the clinical value of multi-slice spiral computed tomography (MSCT) low-dose three-dimensional reconstruction and traditional X-ray in the auxiliary diagnosis of distal radius epiphyseal injury in children. METHODS A retrospective analysis was performed on 105 children with distal radius bone scale injury (classified by Salter-Harris classification) admitted from March 2020 to June 2022. All children underwent MSCT three-dimensional reconstruction examination and traditional X-ray examination. The detection rate of epiphyseal injury of the distal radius was compared, along with the resolution, sensitivity and specificity. The image clarity and display degree of bone structure were analyzed. The radiation dose-related indicators and the time required for diagnosis were compared. RESULTS The detection rate and diagnostic accuracy of MSCT (100%, 92.38%) was significantly higher than that of X-ray (76.19%, 64.76%). In terms of radiation dose index, the volume dose index CTDI of MSCT ranged from 1-5 mGy while the X-ray group ranged from 5-10 mGy. The dose length product (DLP) value of the MSCT group was lower than in the X-ray group (20-100 mGy·cm vs. 50-150 mGy·cm). The diagnostic scan time for MSCT was shorter than that of conventional X-ray. The acceptance rate with MSCT was 99%, significantly higher than that with conventional X-ray (85%). CONCLUSIONS Low-dose three-dimensional reconstruction of MSCT in the diagnosis of epiphyseal injury of distal radius in children shows significant advantages over traditional CT in the detection rate, diagnostic accuracy, postoperative reduction quality evaluation, and radiation dose.
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Affiliation(s)
- Kai Tang
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Fang Wu
- Department of Gastroenterology, Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxi 214000, Jiangsu, China
| | - Yongmin Mao
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Jun Shen
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Yi Li
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Bang Wang
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Aiguo Zhang
- Department of Orthopedics, Affiliated Children’s Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
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Croci E, Hess H, Warmuth F, Künzler M, Börlin S, Baumgartner D, Müller AM, Gerber K, Mündermann A. Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence. Eur Radiol 2024; 34:270-278. [PMID: 37566272 PMCID: PMC10791975 DOI: 10.1007/s00330-023-10082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Patients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head. MATERIALS AND METHODS Fluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere. RESULTS The nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°. CONCLUSION The proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane. CLINICAL RELEVANCE STATEMENT This nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders. KEY POINTS • Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears. • Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements. • The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Hanspeter Hess
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Fabian Warmuth
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Marina Künzler
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Sean Börlin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Kate Gerber
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Nishiyama N, Masuda T, Nakagawa J, Terami K, Nakaura T. Optimization of wrist tendon detection in virtual monochromatic images using dual energy-computed tomography. Jpn J Radiol 2023; 41:1397-1404. [PMID: 37460747 DOI: 10.1007/s11604-023-01467-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/05/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To evaluate the depiction of wrist tendons in virtual monochromatic images (VMIs) during a dual-energy CT (DE-CT) with the VMI image of conventional equivalent to 120 kVp. MATERIALS AND METHODS Using Catphan600 and phantom analysis software for CT evaluation, measurements of VMI in a DE-CT were performed corresponding to the tube voltages of single-energy CT at 120 kVp. Using a Discovery CT750 HD CT scanner (GE Healthcare) with DE-CT technology, 73 patients were scanned. We calculated the CT number, image noise, visual score, and contrast noise ratio (CNR) at the extensor pollicis tendon, extensor digitorum tendon, and flexor tendon in 11 VMIs from the DE-CT and VMI image of conventional equivalent to 120 kVp. The results from the optimal VMIs were then compared with that of the VMI image of the conventional equivalent to 120 kVp. RESULTS The highest CT number and CNR for the tendon were for the 140 keV VMI in the DE-CT compared to the other energy levels. There were significantly higher CT numbers, CNR values, and visual scores for each tendon at 140 keV VMI with the DE-CT (p < 0.01) compared with a VMI image of conventional equivalent to 120 kVp. CONCLUSION Energy level of the VMIs during DE-CT for the best wrist tendon delineation was 140 keV. This value of 140 keV for the DE-CT was significantly higher than the CT number and CNR for the extensor pollicis, extensor digitorum, and flexor tendon compared with a VMI image of conventional equivalent to 120 kVp.
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Affiliation(s)
- Norimi Nishiyama
- Department of Radiological Technologist, Okayama Saiseikai General Hospital, 2-25, Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Takanori Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan.
| | - Junnichi Nakagawa
- Department of Radiological Technologist, Okayama Saiseikai General Hospital, 2-25, Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Keisuke Terami
- Department of Radiological Technologist, Okayama Saiseikai General Hospital, 2-25, Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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Kunz AS, Schmalzl J, Huflage H, Luetkens KS, Patzer TS, Kuhl PJ, Gruschwitz P, Petritsch B, Schmitt R, Bley TA, Grunz JP. Twin Robotic Gantry-Free Cone-Beam CT in Acute Elbow Trauma. Radiology 2023; 306:e221200. [PMID: 36346312 DOI: 10.1148/radiol.221200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Posttraumatic CT imaging of the elbow can be challenging when patient mobility is limited. Gantry-free cone-beam CT (CBCT) with a twin robotic radiography system offers greater degrees of positioning freedom for three-dimensional elbow scans over gantry-based multidetector CT (MDCT), but studies analyzing their clinical value remain lacking. Purpose To investigate the diagnostic performance of gantry-free CBCT versus two-dimensional radiography in adults and children with acute elbow trauma. Materials and Methods In a retrospective study, consecutive patients with elbow trauma and positioning difficulty in a gantry-based MDCT who underwent three-dimensional elbow imaging with a gantry-free CBCT after radiography were enrolled between January 2021 and April 2022 at a tertiary care university hospital. Imaging data sets were independently analyzed for fracture presence, articular involvement, and multi-fragment injuries by three radiologists. Diagnostic performance was calculated individually with surgical reports serving as the reference standard. Differences between radiography and CBCT were compared with the McNemar test. Diagnostic confidence was estimated subjectively by each reader, and results were compared with the Wilcoxon signed-rank test. Results Elbow examinations of 23 adults and children (mean age ± SD, 49 years ± 23; seven women) were included with individual assessment of humerus, radius, and ulna (69 bones; 36 fractured). Multi-fragmentary fracture patterns and involvement of articular surfaces were ascertained in 28 and 30 bones, respectively. CBCT allowed for similar or higher sensitivity compared with radiography in the assessment of fractures (range for three readers, 94%-100% vs 72%-81%; respectively, P ≤ .06-.008), articular surface involvement (90%-97% vs 73%-87%; P ≤ .25), and multi-fragmentary patterns (96%-96% vs 68%-75%; P ≤ .03). Readers' diagnostic confidence improved considerably with access to CBCT data sets versus radiographs (all P ≤ .001). For CBCT, the median dose-length product was 70.9 mGy · cm, and the volume CT dose index was 4.4 mGy. Conclusion In acute elbow injuries, gantry-free cone-beam CT enabled improved detection of fractures, articular involvement, and multi-fragmentary patterns compared with two-dimensional radiography. Published under a CC BY 4.0 license Online supplemental material is available for this article.
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Affiliation(s)
- Andreas Steven Kunz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Jonas Schmalzl
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Henner Huflage
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Karsten Sebastian Luetkens
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Theresa Sophie Patzer
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Philipp Josef Kuhl
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Philipp Gruschwitz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Bernhard Petritsch
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Rainer Schmitt
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Thorsten Alexander Bley
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
| | - Jan-Peter Grunz
- From the Department of Diagnostic and Interventional Radiology (A.S.K., H.H., K.S.L., T.S.P., P.J.K., P.G., B.P., R.S., T.A.B., J.P.G.) and Department of Trauma, Hand, Plastic and Reconstructive Surgery (J.S.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and the Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany (R.S.)
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Low-Dose CT Imaging of the Pelvis in Follow-up Examinations-Significant Dose Reduction and Impact of Tin Filtration: Evaluation by Phantom Studies and First Systematic Retrospective Patient Analyses. Invest Radiol 2022; 57:789-801. [PMID: 35776429 DOI: 10.1097/rli.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Low-dose (LD) computed tomography (CT) is still rarely used in musculoskeletal (MSK) radiology. This study evaluates the potentials of LD CT for follow-up pelvic imaging with special focus on tin filtration (Sn) technology for normal and obese patients with and without metal implants. MATERIALS AND METHODS In a phantom study, 5 different LD and normal-dose (ND) CT protocols with and without tin filtration were tested using a normal and an obese phantom. Iterative reconstruction (IR) and filtered back projection (FBP) were used for CT image reconstruction. In a subsequent retrospective patient study, ND CT images of 45 patients were compared with follow-up tin-filtered LD CT images with a 90% dose reduction. Sixty-four percent of patients contained metal implants at the follow-up examination. Computed tomography images were objectively (image noise, contrast-to-noise ratio [CNR], dose-normalized contrast-to-noise ratio [CNRD]) and subjectively, using a 6-point Likert score, evaluated. In addition, the figure of merit was calculated. For group comparisons, paired t tests, Wilcoxon signed rank test, analysis of variance, or Kruskal-Wallis tests were used, where applicable. RESULTS The LD Sn protocol with 67% dose reduction resulted in equal values in qualitative (Likert score) and quantitative image analysis (image noise) compared with the ND protocol in the phantom study. For follow-up examinations, dose could be reduced up to 90% by using Sn LD CT scans without impairment in the clinical study. However, metal implants resulted in a mild impairment of Sn LD as well as ND CT images. Cancellous bone ( P < 0.001) was assessed worse and cortical bone ( P = 0.063) equally in Sn LD CT images compared with ND CT images. Figure of merit values were significant ( P ≤ 0.02) lower and hence better in Sn LD as in ND protocols. Obese patients benefited in particular from tin filtration in LD MSK imaging in terms of image noise and CNR ( P ≤ 0.05). CONCLUSIONS Low-dose CT scans with tin filtration allow maximum dose reduction while maintaining high image quality for certain clinical purposes, for example, follow-up examinations, especially metal implant position, material loosening, and consolidation controls. Overweight patients benefit particularly from tin filter technology. Although metal implants decrease image quality in ND as well as in Sn LD CT images, this is not a relevant limitation for assessability.
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Lei M, Zhang M, Luo N, Ye J, Lin F, Chen Y, Chen J, Xiao M. The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models. PLoS One 2022; 17:e0275297. [PMID: 36155982 PMCID: PMC9512178 DOI: 10.1371/journal.pone.0275297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Evaluation of the clinical performance of ultra-low-dose computed tomography (CT) images of the shoulder joint on image-based diagnosis and three-dimensional (3D) printing surgical planning. Materials and methods A total of 93 patients with displaced shoulder fractures were randomly divided into standard-dose, low-dose, and ultra-low-dose groups. Three-dimensional printing models of all patients’ shoulder joints were fabricated. The subjective image quality and 3D-printing model were evaluated by two senior orthopedic surgeons who were blinded to any scanning setting. A 3-point scale system was used to quantitatively assess the image quality and 3D printing model, where more than 2 points meant adequate level for clinical application. Results Compared with the standard dose protocol, ultra-low-dose technique reduced the radiation dose by 99.29% without loss of key image quality of fracture pattern. Regarding the subjective image quality, the assessment scores for groups of standard, low, and ultra-low doses were 3.00, 2.76, 2.00 points on scapula and humerus, and 3.00, 2.73, 2.44 points on clavicle. Scores of the three groups for the assessment of 3D printing models were 3.00, 2.80, 1.34 on scapula and humerus, and 3.00, 2.90, 2.06 on clavicle. In the ultra-low-dose group, 24 out of 33 (72.7%) 3D printing models of scapula and humerus received lower than 2 points of the evaluation score, while nearly 94% of the clavicle models reached the adequate level. Conclusion An ultra-low-dose protocol is adequate for the diagnosis of either displaced or non-displaced fractures of the shoulder joint even though minor flaws of images are present. Three-dimensional printing models of shoulder joints created from ultra-low-dose CT scans can be used for surgical planning at specific bone like the clavicle but perform insufficiently in the overall surgical planning for shoulder injuries due to the significant geometric flaws.
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Affiliation(s)
- Ming Lei
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Meng Zhang
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Niyuan Luo
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jingzhi Ye
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Fenghuan Lin
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yanxia Chen
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jun Chen
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Mengqiang Xiao
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
- * E-mail:
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Lee MH, Park HJ, Kim JN, Kim MS, Hong SW, Park JH, Kang CH. Virtual non-contrast images from dual-energy CT angiography of the abdominal aorta and femoral arteries: comparison with true non-contrast CT images. Br J Radiol 2022; 95:20220378. [PMID: 36039820 PMCID: PMC9815733 DOI: 10.1259/bjr.20220378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/01/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess whether virtual non-contrast (VNC) computed tomography (CT) images acquired from dual-energy CT (DECT) have sufficient image quality to replace true non-contrast (TNC) CT images in CT angiography (CTAG). METHODS This study enrolled 63 consecutive patients who underwent a CTAG that included a single-energy non-contrast scan, followed by a post-contrast DECT scan. Comparison of attenuation and noise between TNC and VNC images was made by drawing circular regions of interest (ROI) on a picture archiving and communication system (PACS) workstation within the aortic lumen at the levels of the renal arteries, the aortic bifurcation and right femoral artery. Mean attenuation and image noise (one standard deviation) were registered in Hounsfield units (HU). The VNC images were subjectively evaluated for artifacts such as subtraction of calcifications or architectural distortion based on TNC image as a standard of reference. RESULTS Most attenuations of the VNCs were higher than TNC, except right femoral artery of reader 2. Most image noises of TNC were higher than VNC, except abdominal aorta in reader 1. In qualitative image analysis, mean scores of VNC according to the 5-point scale were 3.68 and 3.63 (reader 1 and reader 2, respectively) which mean good to excellent to diagnose. CONCLUSION HUs and VNC image noises are different from TNC images in CTAG. VNC images have sufficient image quality to replace TNC images in the diagnosis of calcific lesions. ADVANCES IN KNOWLEDGE VNC images acquired from DECT have image quality adequate to replace TNC images in the diagnosis of the calcific lesion on the CTAG. VNC images based on DECT can avoid excessive and unnecessary patient exposure to radiation during CTAG.
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Affiliation(s)
- Min Hee Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Woo Hong
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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Addala TE, Greffier J, Hamard A, Snene F, Bobbia X, Bastide S, Belaouni A, de Forges H, Larbi A, de la Coussaye JE, Beregi JP, Claret PG, Frandon J. Early results of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg 2022; 12:4248-4258. [PMID: 35919065 PMCID: PMC9338366 DOI: 10.21037/qims-21-848] [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: 09/08/2021] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Background Ultra-low dose computed tomography (ULD-CT) was shown to be a good alternative to digital radiographs in various locations. This study aimed to assess the diagnostic sensitivity and specificity of ULD-CT versus digital radiographs in patients consulting for extremity traumas in emergency room. Methods Digital radiography and ULD-CT scan were performed in patients consulting at the emergency department (February-August 2018) for extremity traumas. Fracture detection was evaluated retrospectively by two blinded independent radiologists. Sensitivity and specificity were evaluated using best value comparator (BVC) and a Bayesian latent class model (LCM) approaches and clinical follow-up. Image quality, quality diagnostic and diagnostic confidence level were evaluated (Likert scale). The effective dose received was calculated. Results Seventy-six consecutive patients (41 men, mean age: 35.2±13.2 years), with 31 wrists/hands and 45 ankles/feet traumas were managed by emergency physicians. According to clinical data, radiography had 3 false positive and 10 false negative examinations, and ULD-CT, 2 of each. Radiography and ULD-CT specificities were similar; sensitivities were lower for radiography, with BVC and Bayesian. With Bayesian, ULD-CT and radiography sensitivities were 90% (95% CI: 87-93%) and 76% (95% CI: 71-81%, P<0.0001) and specificities 96% (95% CI: 93-98%) and 93% (95% CI: 87-97%, P=0.84). The inter-observer agreement was higher for ULD-CT for all subjective indexes. The effective dose for ULD-CT and radiography was 0.84±0.14 and 0.58±0.27 µSv (P=0.002) for hand/wrist, and 1.50±0.32 and 1.44±0.78 µSv (P=NS) for foot/ankle. Conclusions With an effective dose level close to radiography, ULD-CT showed better detection of extremities fractures in the emergency room and may allow treatment adaptation. Further studies need to be performed to assess impact of such examination in everyday practice. Trial Registration ClinicalTrials.gov Identifier: NCT04832490.
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Affiliation(s)
- Taki Eddine Addala
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Joël Greffier
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Aymeric Hamard
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Fehmi Snene
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Xavier Bobbia
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sophie Bastide
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, Univ Montpellier, Nîmes, France
| | - Asmaa Belaouni
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Hélène de Forges
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Ahmed Larbi
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Jean-Emmanuel de la Coussaye
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Jean-Paul Beregi
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Pierre-Géraud Claret
- IMAGINE Research Unit 103, Emergency Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Julien Frandon
- IMAGINE Research Unit 103, Department of Medical Imaging, Nîmes University Hospital, Montpellier University, Nîmes, France
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9
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Lei M, Zhang M, Li H, Liu J, Chen J, Xu R, Xiao M. The diagnostic performance of ultra-low-dose 320-row detector CT with different reconstruction algorithms on limb joint fractures in the emergency department. Jpn J Radiol 2022; 40:1079-1086. [PMID: 35588348 DOI: 10.1007/s11604-022-01290-1] [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: 01/12/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to evaluate whether ultra-low-dose computed tomography (ULD-CT) could replace conventional-dose CT (CD-CT) for diagnosis of acute wrist, ankle, knee, and shoulder fractures in emergency departments (ED). METHODS We developed CD-CT and ULD-CT scanning schemes for the various joints of the four limbs and scanned emergency patients prospectively. When performing CD-CT, a conventional bone reconstruction algorithm was used, while ULD-CT used both soft tissue and bone algorithms. A five-point scale was used to evaluate whether ULD-CT image quality affected surgical planning. The image quality and diagnostic performance of different types of scanned and reconstructed images for diagnosing fractures were evaluated and compared. Effective radiation dose of each group was calculated. RESULTS Our study included 56 normal cases and 185 fracture cases. The combination of bone and soft tissue algorithms on ULD-CT can improve diagnostic performance, such that on ULD-CT, the sensitivity improved from 96.7% to 98.9%, specificity from 98.2% to 100%, positive predictive value from 99.4% to 100%, negative predictive value from 90.2% to 96.6% and diagnostic accuracy ranged from 97.5% to 99.1%. There were no statistically significant differences between ULD-CT and CD-CT on diagnostic performance (p values, 0.40-1.00). The radiation doses for ULD-CT protocols were only 3.0-7.7% of those for CD-CT protocols (all p < 0.01). CONCLUSIONS In the emergency department, the 320-row detector ULD-CT could replace CD-CT in the diagnosis of limb joint fractures. The combination of bone algorithm with soft tissue algorithm reconstruction can further improve the image quality and diagnostic performance.
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Affiliation(s)
- Ming Lei
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Meng Zhang
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Hongyi Li
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Jingfeng Liu
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Jun Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Rulin Xu
- Research Collaboration, Canon Medical Systems Co., Ltd, Rm 2906, R&F Centre, No.10 Huaxia Road, Guangzhou, Guangdong, China
| | - Mengqiang Xiao
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China.
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10
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Smith EB, Patel LD, Dreizin D. Postoperative Computed Tomography for Facial Fractures. Neuroimaging Clin N Am 2021; 32:231-254. [PMID: 34809841 DOI: 10.1016/j.nic.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and the hardware employed is imperative. This article is intended to promote efficient and salient reporting by illustrating surgical approaches and rationale. Hardware selection can be inferred and a defined set of potential complications anticipated when assessing the adequacy of surgical reconstruction on postoperative computed tomography for midface, internal orbital, and mandible fractures.
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Affiliation(s)
- Elana B Smith
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Lakir D Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - David Dreizin
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA.
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11
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Feng B, Yu L, Mo E, Chen L, Zhao J, Wang J, Hu W. Evaluation of Daily CT for EPID-Based Transit In Vivo Dosimetry. Front Oncol 2021; 11:782263. [PMID: 34796120 PMCID: PMC8592931 DOI: 10.3389/fonc.2021.782263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The difference in anatomical structure and positioning between planning and treatment may lead to bias in electronic portal image device (EPID)-based in vivo dosimetry calculations. The purpose of this study was to use daily CT instead of planning CT as a reference for EPID-based in vivo dosimetry calculations and to analyze the necessity of using daily CT for EPID-based in vivo dosimetry calculations in terms of patient quality assurance. Materials and Methods Twenty patients were enrolled in this study. The study design included eight different sites (the cervical, nasopharyngeal, and oral cavities, rectum, prostate, bladder, lung, and esophagus). All treatments were delivered with a CT-linac 506c (UIH, Shanghai) using 6 MV photon beams. This machine is equipped with diagnosis-level fan-beam CT and an amorphous silicon EPID XRD1642 (Varex Imaging Corporation, UT, USA). A Monte Carlo algorithm was developed to calculate the transmit EPID image. A pretreatment measurement was performed to assess system accuracy by delivering based on a homogeneous phantom (RW3 slab, PTW, Freiburg). During treatment, each patient underwent CT scanning before delivery either once or twice for a total of 268 fractions obtained daily CT images. Patients may have had a position correction that followed our image-guided radiation therapy (IGRT) procedure. Meanwhile, transmit EPID images were acquired for each field during delivery. After treatment, all patient CTs were reviewed to ensure that there was no large anatomical change between planning and treatment. The reference of transmit EPID images was calculated based on both planning and daily CTs, and the IGRT correction was corrected for the EPID calculation. The gamma passing rate (3 mm 3%, 2 mm 3%, and 2 mm 2%) was calculated and compared between the planning CT and daily CT. Mechanical errors [ ± 1 mm, ± 2 mm, ± 5 mm multileaf collimator (MLC) systematic shift and 3%, 5% monitor unit (MU) scaling] were also introduced in this study for comparing detectability between both types of CT. Result The average (standard deviation) gamma passing rate (3 mm 3%, 2 mm 3%, and 2 mm 2%) in the RW3 slab phantom was 99.6% ± 1.0%, 98.9% ± 2.1%, and 97.2% ± 3.9%. For patient measurement, the average (standard deviation) gamma passing rates were 87.8% ± 14.0%, 82.2% ± 16.9%, and 74.2% ± 18.9% for using planning CTs as reference and 93.6% ± 8.2%, 89.7% ± 11.0%, and 82.8% ± 14.7% for using daily CTs as reference. There were significant differences between the planning CT and daily CT results. All p-values (Mann–Whitney test) were less than 0.001. In terms of error simulation, nonparametric test shows that there were significant differences between practical daily results and error simulation results (p < 0.001). The receiver operating characteristic (ROC) analysis indicated that the detectability of mechanical delivery error using daily CT was better than that of planning CT. AUCDaily CT = 0.63–0.96 and AUCPlanning CT = 0.49–0.93 in MLC systematic shift and AUCDaily CT = 0.56–0.82 and AUCPlanning CT = 0.45–0.73 in MU scaling. Conclusion This study shows the feasibility and effectiveness of using two-dimensional (2D) EPID portal image and daily CT-based in vivo dosimetry for intensity-modulated radiation therapy (IMRT) verification during treatment. The daily CT-based in vivo dosimetry has better sensitivity and specificity to identify the variation of IMRT in MLC-related and dose-related errors than planning CT-based.
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Affiliation(s)
- Bin Feng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Lei Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Enwei Mo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Liyuan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Jun Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
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12
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Evaluation of Ultra-High-Resolution Cone-Beam CT Prototype of Twin Robotic Radiography System for Cadaveric Wrist Imaging. Acad Radiol 2021; 28:e314-e322. [PMID: 32654956 DOI: 10.1016/j.acra.2020.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES Cone-beam CT (CBCT) applications possess potential for dose reduction in musculoskeletal imaging. This study evaluates the ultra-high-resolution CBCT prototype of a twin robotic X-ray system in wrist examinations compared to high-resolution multidetector CT (MDCT). MATERIALS AND METHODS Sixteen wrists of body donors were examined with the CBCT scan mode and a 384 slice MDCT system. Radiation-equivalent low-dose (CTDIvol(16cm) = 3.3 mGy) and full-dose protocols (CTDIvol(16cm) = 13.8 mGy) were used for both systems. Two observers assessed image quality on a seven-point Likert scale. In addition, software-assisted quantification of signal intensity fractions in cancellous bone was performed. Fewer pixels with intermediate signal intensity were considered to indicate superior depiction of bone microarchitecture. RESULTS Subjective image quality in CBCT was superior to dose equivalent MDCT with p ≤ 0.03 for full-dose and p < 0.001 for low-dose scans, respectively. Median Likert values were 7/7 (reader 1 / reader 2) in full-dose CBCT, 6/6 in full-dose MDCT, 5/6 in low-dose CBCT and 3/3 in low-dose MDCT. Intraclass correlation coefficient was 0.936 (95% confidence interval, 0.897-0.961; p < 0.001), indicating excellent reliability. Objective analysis displayed smaller fractions of "indecisive" pixels with intermediate signal intensity for full-dose CBCT (0.57 [interquartile range 0.13]) compared to full-dose MDCT (0.68 [0.21]), low-dose CBCT (0.72 [0.19]), and low-dose MDCT (0.80 [0.15]) studies. No significant difference was observed between low-dose CBCT and full-dose MDCT. CONCLUSION The new CBCT prototype provides superior image quality for trabecula and bone marrow in cadaveric wrist studies and enables dose reduction up to 75% compared to high-resolution MDCT.
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13
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Zak L, Tiefenboeck TM, Wozasek GE. Computed Tomography in Limb Salvage and Deformity Correction-3D Assessment, Indications, Radiation Exposure, and Safety Considerations. J Clin Med 2021; 10:3781. [PMID: 34501227 PMCID: PMC8432111 DOI: 10.3390/jcm10173781] [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: 05/19/2021] [Revised: 07/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Computed tomography (CT) is an essential tool in orthopedic surgery but is known to be a method with that entails radiation exposure. CT increases the risk of developing fatal cancer, which should not be underestimated. However, patients with bone defects and/or deformities must frequently undergo numerous investigations during their treatment. CT is used for surgical planning, evaluating callus maturation, alignment measurement, length measurement, torsion measurement, and angiography. This study explores the indications in CT scans for limb lengthening and deformity correction and estimates the effective radiation dose. These results should help avoid unnecessary radiation exposure by narrowing the examination field and by providing explicit scanning indications. For this study, 19 posttraumatic patients were included after the bone reconstruction of 21 lower limbs. All patients underwent CT examinations during or after treatment with an external ring fixator. The mean effective dose was 3.27 mSv, with a mean cancer risk of 1:117,014. The effective dose depended on the location and indication of measurement, with a mean dose of 0.04 mSv at the ankle up to 6.8 mSv (or higher) for vascular depictions. CT evaluation, with or without 3D reconstruction, is a crucial tool in complex bone reconstruction and deformity treatments. Therefore, strict indications are necessary to reduce radiation exposure-especially in young patients-without compromising the management of their patients.
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Affiliation(s)
- Lukas Zak
- Department of Orthopedics and Trauma-Surgery, Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (T.M.T.); (G.E.W.)
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14
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Keller G, Götz S, Kraus MS, Grünwald L, Springer F, Afat S. Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol. Diagnostics (Basel) 2021; 11:diagnostics11071209. [PMID: 34359292 PMCID: PMC8304839 DOI: 10.3390/diagnostics11071209] [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: 05/29/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022] Open
Abstract
This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344–0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality.
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Affiliation(s)
- Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (S.G.); (M.S.K.); (S.A.)
- Correspondence: (G.K.); (F.S.)
| | - Simon Götz
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (S.G.); (M.S.K.); (S.A.)
| | - Mareen Sarah Kraus
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (S.G.); (M.S.K.); (S.A.)
| | - Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (S.G.); (M.S.K.); (S.A.)
- Department of Diagnostic Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
- Correspondence: (G.K.); (F.S.)
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (S.G.); (M.S.K.); (S.A.)
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15
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Duarte ML, dos Santos LR, Oliveira ASB, Iared W, Peccin MS. Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis. SAO PAULO MED J 2021; 139:388-397. [PMID: 34346965 PMCID: PMC9615584 DOI: 10.1590/1516-3180.2020.0374.r3.1902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER CRD42019148491 at the PROSPERO database.
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Affiliation(s)
- Márcio Luís Duarte
- MD, MSc. Musculoskeletal Radiologist, WEBIMAGEM, São Paulo (SP), Brazil; and Doctoral Student in Evidence-based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Lucas Ribeiro dos Santos
- MD, MSc. Endocrinologist and Professor of Physiology and Medical Clinic, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil; and Doctoral Student in Evidence-based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Acary Souza Bulle Oliveira
- MD, PhD. Afliated Professor, Department of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Wagner Iared
- MD, PhD. Supervising Professor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Maria Stella Peccin
- PT, PhD. Associate Professor, Department of Human Movement Sciences, and Advisor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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Shim E, Ha T, Kim BH, Hong SJ, Kang CH, Jeon S, Cha J. Additive values of pelvic tomosynthesis in comparison to pelvic radiography alone for the diagnosis of sacroiliitis in patients with suspected axial spondyloarthritis. Skeletal Radiol 2021; 50:1197-1207. [PMID: 33188609 DOI: 10.1007/s00256-020-03626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare inter-reader agreement and diagnostic confidence in detecting sacroiliitis by the modified New York criteria (mNY) on digital radiography (DR) versus digital pelvic tomosynthesis assisted DR (DR+DPT), and to evaluate changes in the presence of axial spondyloarthritis (axSpA) according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. METHODS One hundred and thirty-eight patients who underwent both DR and DPT with suspicious axSpA in our rheumatologic clinic were included from February 2017 to February 2018. Three radiologists independently graded sacroiliitis and confidence level on DR first and then re-graded them on DPT in a paired manner. Agreement, confidence, and diagnostic accuracy were evaluated for readers. Changes in the presence of disease by mNY and ASAS criteria were assessed between DR alone and DR+DPT. RESULTS On DR alone, 73 patients were assessed with radiographic sacroiliitis, and 85 were classified into axSpA by the ASAS criteria; however, 78 and 85, respectively, were classified on DR+DPT. With the assistance of DPT, 17 and 12 patients changed to the disease positivity according to the mNY and ASAS criteria, respectively; the negative results changed to positive in 11 and six patients, respectively. For all readers, agreement improved with DPT (0.79 to 0.89). DR+DPT achieved higher diagnostic accuracy (AUC, P < 0.05). CONCLUSION The combination of DR and DPT achieved a higher diagnostic performance than that of DR alone, with better agreement. On DR+DPT, the diagnoses of 9.0% of patients with suspicious axSpA (12 of 134) were changed to the status of disease by the ASAS criteria.
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Affiliation(s)
- Euddeum Shim
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Taeho Ha
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Suk-Joo Hong
- Department of Radiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul, 02856, Republic of Korea
| | - Sookyung Jeon
- Mammogrpahy and Radiography Application Specialist, GE Healthcare Korea, 15F, Seoul Square, 416 Hangang-daero, Jung-gu, Seoul, 04637, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea Unversity Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
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Mah D, Chamoli U, Smith GCS. Usefulness of computed tomography based three-dimensional reconstructions to assess the critical shoulder angle. World J Orthop 2021; 12:301-309. [PMID: 34055587 PMCID: PMC8152441 DOI: 10.5312/wjo.v12.i5.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/28/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The critical shoulder angle (CSA) is a radiographic measurement that provides an assessment of both glenoid inclination and acromial length. Higher values may correlate with the presence of rotator cuff tears. However, it is difficult to obtain a high-quality true anteroposterior (AP) radiograph of the shoulder, with any excess scapular version or flexion/extension resulting in deviation from the true CSA value. Three-dimensional (3D) bony reconstructions of computed tomography (CT) shoulder scans may be able to be rotated to obtain a similar view to that of true AP radiographs.
AIM To compare CSA measurements performed on 3D bony CT reconstructions, with those on corresponding true AP radiographs.
METHODS CT shoulder scans were matched with true AP radiographs that were classified as either Suter-Henninger type A or C quality. 3D bony reconstructions were segmented from the CT scans, and rotated to replicate an ideal true AP view. Two observers performed CSA measurements using both CT and radiographic images. Measurements were repeated after a one week interval. Reliability was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots [bias, limits of agreement (LOA)].
RESULTS Twenty CT shoulder scans were matched. The mean CSA values were 32.55° (± 4.26°) with radiographs and 29.82° (± 3.49°) with the CT-based method [mean difference 2.73° (± 2.86°); P < 0.001; bias +2.73°; LOA -2.17° to +7.63°]. There was a strong correlation between the two methods (r = 0.748; P < 0.001). Intra-observer reliability was similar, but the best intra-observer values were achieved by the most experienced observer using the CT-based method [ICC: 0.983 (0.958-0.993); bias +0.03°, LOA -1.28° to +1.34°]. Inter-observer reliability was better with the CT-based method [ICC: 0.897 (0.758-0.958), bias +0.24°, LOA -2.93° to +3.41°].
CONCLUSION The described CT-based method may be a suitable alternative for critical shoulder angle measurement, as it overcomes the difficulty in obtaining a true AP radiographic view.
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Affiliation(s)
- Dominic Mah
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Uphar Chamoli
- Spine Service Research Group, St. George and Sutherland Clinical School, University of New South Wales, Sydney 2052, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney 2007, New South Wales, Australia
| | - Geoffrey CS Smith
- St. George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney 2217, New South Wales, Australia
- Department of Orthopaedics, St. George Hospital, Sydney 2217, New South Wales, Australia
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18
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Nicholson JA, Fox B, Dhir R, Simpson AHRW, Robinson CM. The accuracy of computed tomography for clavicle non-union evaluation. Shoulder Elbow 2021; 13:195-204. [PMID: 33897851 PMCID: PMC8039767 DOI: 10.1177/1758573219884067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/06/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The primary aim of this study is to determine the accuracy of CT scanning when evaluating non-union of the clavicle. METHODS A retrospective review was performed of all CT scans undertaken for suspected nonunion of midshaft clavicle fractures over a 10-year period. The influence of scan timing, callus and patient characteristics was evaluated. RESULTS One hundred eighty-four CT scans were analysed. No patient was incorrectly diagnosed with union (n = 85). Ninety-nine scans were reported as non-union with inadequate bridging callus, 19 of which were united at operation or on repeat CT imaging and represented delayed unions. Atrophic callus was found in 57 patients and all of which had a confirmed non-union (positive predictive value 100%). A hypertrophic callus was found in 42 patients, all of the delayed unions were found in this group (positive predictive value for non-union 55%, p < 0.001). CT compared to radiographs showed greater inter-observer agreement for union (weighted kappa 0.75 vs. 0.50 respectively). Overall, CT is 100% sensitive and 81.7% specific for non-union diagnosis. DISCUSSION CT has excellent accuracy to determine clavicle union but approximately one in five suspected non-unions went onto unite. Hypertrophic callus finding resulted in a delayed union in approximately half of the cases in our study.
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Affiliation(s)
- Jamie A Nicholson
- Department of Orthopaedic Surgery, University of Edinburgh,
Edinburgh, UK
| | - B Fox
- Department of Orthopaedic Surgery, University of Edinburgh,
Edinburgh, UK
| | - R Dhir
- Department of Orthopaedic Surgery, University of Edinburgh,
Edinburgh, UK
| | - AHRW Simpson
- Department of Orthopaedic Surgery, University of Edinburgh,
Edinburgh, UK
| | - CM Robinson
- Department of Orthopaedic Surgery, University of Edinburgh,
Edinburgh, UK
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Tarallo L, Micheloni GM, Mazzi M, Rebeccato A, Novi M, Catani F. Advantages of preoperative planning using computed tomography scan for treatment of malleolar ankle fractures. World J Orthop 2021; 12:129-139. [PMID: 33816140 PMCID: PMC7995337 DOI: 10.5312/wjo.v12.i3.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Malleolar ankle fractures have been classified using plain radiographs, and there is no consensus regarding the role of computed tomography (CT) scans in preoperative planning. We analyzed critical aspects, such as limits of standard radiographs, types of injury, classification methods and cost/benefit evaluations. CT scans allow a 3D analysis of the fracture to be obtained and consequently assess the indication for surgical procedure, surgical access and the type of fixation devices required. This exam is useful for detecting lesions that may go unnoticed on radiographs and will help surgeons to clarify the pathoanatomy of ankle fractures. According to Arbeitsgemeinschaft fur Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification, CT scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures with posterior malleolar involvement and all type 44C fractures (according to AO/OTA). Also Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with CT scans.
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Affiliation(s)
- Luigi Tarallo
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Gian Mario Micheloni
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Michele Mazzi
- Dipartimento di Chirurgia, AULSS8 Berica-Ospedale San Bortolo-Vicenza, Vicenza 36100, Italy
| | - Arturo Rebeccato
- Dipartimento di Chirurgia, AULSS8 Berica-Ospedale San Bortolo-Vicenza, Vicenza 36100, Italy
| | - Michele Novi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Fabio Catani
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
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20
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Xiao M, Zhang M, Lei M, Hu X, Wang Q, Chen Y, Ye J, Xu R, Chen J. Application of ultra-low-dose CT in 3D printing of distal radial fractures. Eur J Radiol 2020; 135:109488. [PMID: 33385624 DOI: 10.1016/j.ejrad.2020.109488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore the effect of ultra-low-dose computed tomography (CT) on three-dimensional (3D) printing models and the diagnosis of wrist fractures. METHOD This study enrolled 76 patients with distal radial fractures (DRFs). All patients underwent 320-row detector CT and were divided randomly into two groups. In Group A, 38 patients were scanned with the standard-dose protocol using a tube voltage of 120 kV and current of 100 mA. In Group B, 38 patients were scanned with the ultra-low-dose protocol using a tube voltage of 80 kV and current of 10 mA. For objective image quality assessment, the noise, CT number, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. Subjectively, two experienced orthopaedic surgeons blinded to the scan parameters evaluated the clarity of the 3D printing model and fracture line using a 3-point scale (the diagnosis was considered acceptable with scores ≥2). The mean radiation dose was calculated. The diagnostic performances for the fractures between the two groups were compared. RESULTS The effective radiation dose was significantly reduced by 97.1 % in Group B, compared to Group A (0.28 ± 0.05vs. 9.75 ± 2.23 μSv, respectively). Quantitative objective image quality parameters (e.g., CNR, SNR, and CT numbers) were higher in the standard-dose group (p < 0.001). However, there was no difference in subjective scoring of the 3D printing model. Although the fracture line score was higher in Group A (2.92±0.27 vs. 2.16 ± 0.37; p < 0.001), the diagnostic performance of the two groups was consistent (all scores ≥2). There were no statistically significant differences in the sensitivity, specificity or accuracy between standard-dose group and ultra-low-dose group. CONCLUSIONS The ultra-low-dose protocol effectively reduced the radiation dose by 97.1 %, while maintaining the image quality for diagnosis of DRFs. Therefore, this protocol can meet the needs of 3D printing models for preoperative assessments.
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Affiliation(s)
- Mengqiang Xiao
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Meng Zhang
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Ming Lei
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Xiaolu Hu
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Qingshan Wang
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Yanxia Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Jingzhi Ye
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Rulin Xu
- Radiology Group, Canon Medical Systems(China) Co., LTD, Rm 2906, R&F Centre, No.10 Huaxia Road, Guangzhou City, Guangdong Province, China.
| | - Jun Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
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21
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Low-Dose CT in Pelvic Imaging: Comparing Dose and Image Quality in Relation to Clinical Value in a Phantom Study. AJR Am J Roentgenol 2020; 216:453-463. [PMID: 33325736 DOI: 10.2214/ajr.20.22907] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The aim of this phantom study was to determine whether low-dose CT of the pelvis can be performed using a dose similar to that used in a standard radio-graphic examination and to ascertain whether CT, with its better delineation of complex structures, has greater clinical value than radiography and therefore will result in improved patient care. Special consideration was given to CT performed using the tin filtration technique. MATERIALS AND METHODS. For dose comparison, an anthropomorphic phantom with 20 thermoluminescent dosimeters, two different CT scanners, and three conventional radiography devices were used. Seven CT protocols (including tin filtration) and four different radiographic examinations were performed. Dose calculations, objective and subjective evaluations of image quality, and figure-of-merit calculations were compared among the techniques. Furthermore, the images obtained were evaluated in a clinical context. Intraclass correlation was determined for the subjective results. RESULTS. The dose values of the tested low-dose CT protocols, in particular those using the tin filtration technique, corresponded to or were only slightly higher than the dose values of conventional pelvic radiographic images obtained in three views. Low-dose CT examinations were rated sufficient for consolidation control and had an informative value that was significantly higher than that of conventional radiography. Tin filtering showed the best results for low-dose CT in terms of combining dose and clinically relevant image quality. CONCLUSION. In this phantom study, low-dose CT was superior to radiography for visualizing and evaluating the dorsal pelvic ring, with only marginally higher radiation exposure occurring when the latest-generation CT systems were used. Tin filtration can improve image quality, create further dose reductions, or provide both benefits.
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22
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Grunz JP, Pennig L, Fieber T, Gietzen CH, Heidenreich JF, Huflage H, Gruschwitz P, Kuhl PJ, Petritsch B, Kosmala A, Bley TA, Gassenmaier T. Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions. Eur Radiol 2020; 31:3600-3609. [PMID: 33280057 PMCID: PMC8128787 DOI: 10.1007/s00330-020-07563-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tabea Fieber
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Julius Frederik Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Josef Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Diagnostic accuracy of ultra-low-dose CT for torsion measurement of the lower limb. Eur Radiol 2020; 31:3574-3581. [PMID: 33241518 PMCID: PMC8249276 DOI: 10.1007/s00330-020-07528-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023]
Abstract
Objectives The study aimed to investigate the diagnostic performance of simulated ultra-low-dose CT (ULD-CT) for torsion measurement of the lower limb. Methods Thirty retrospectively identified patients were included (32.3 ± 14.2 years; 14 women, 16 men). ULD-CT simulations were generated at dose levels of 100%, 10%, 5%, and 1% using two reconstruction methods: standard filtered back projection (FBP) and iterative reconstruction (ADMIRE). Two readers measured the lower limb torsion in all data sets. The readers also captured image noise in standardized anatomical landmarks. All data sets were evaluated regarding subjective diagnostic confidence (DC; 5-point Likert scale). Effective radiation dose of the original data sets and the simulated ULD-CT was compared. Results There was no significant difference of measured lower limb torsion in any simulated dose level compared to the original data sets in both readers. Dose length product (DLP) of the original examinations was 402.1 ± 4.3 mGy cm, which resulted in an effective radiation dose of 4.00 ± 2.12 mSv. Calculated effective radiation dose in ULD-CT at 1% of the original dose was 0.04 mSv. Image noise increased significantly with dose reduction (p < 0.0001) and was dependent on the reconstructional method (p < 0.0001) with less noise using ADMIRE compared to FBP. Both readers rated DC at doses 100%, 10%, and 5% with 5.0/5: there were no ratings worse than 3/5 at 1% dose level. Conclusions The results suggest that radiation dose reduction down to 1% of original CT dose levels may be achieved in CT torsion measurements of the lower limb without compromising diagnostic accuracy. Key Points • Modern CT delivers exceptional high image quality in musculoskeletal imaging, especially for evaluation of osseous structures. • Usually, this high image quality is accompanied by significant radiation exposure to the patient and may not always be required for the intended purpose, e.g., pure delineation of cortical bone of the lower limb. • This study shows the tremendous prospects of radiation dose reduction without compromising diagnostic confidence in CT torsion measurement of the lower limb.
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Kim JN, Park HJ, Kim MS, Kook SH, Ham SY, Kim E, Park SJ. Radiation dose reduction in extremity multi-detector CT: A comparison of image quality with a standard dose protocol. Eur J Radiol 2020; 135:109405. [PMID: 33441267 DOI: 10.1016/j.ejrad.2020.109405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the quantitative and qualitative image quality of computed tomography (CT) of the extremities (shoulder, wrist, pelvis, and ankle joints) with low-dose radiation and standard-dose radiation. MATERIALS AND METHODS In this study, we included 400 individuals who underwent CT of the extremities, comprising 50 cases of each joint (shoulder, wrist, pelvis, and ankle) at low and standard dose regimens. Low-dose CTs were performed using identical voltage and parameters with the exception of decreased (half of standard dose) tube current. Low-dose and standard-dose images were compared in terms of radiation dose, objective image quality according to the standard deviation (SD) of the Hounsfield unit value of the medulla, cortex, muscle, subcutaneous fat, and air, and subjective image quality according to noise, sharpness, diagnostic acceptability, and artifacts. RESULTS In the shoulder and pelvis, the mean value of the SD for all tissue on low dose CT images was significantly higher than that of standard dose CT, except for the SD of cortex in the shoulder joint and marrow in the pelvis. In the wrist, the mean value of the SD for all tissue was not significantly different between low dose and standard CT (p > 0.05). In the ankle, the mean value of the SD of the medulla and cortex was not different (p > 0.05), but the remaining measurements were significantly higher in low dose CT. Subjective image quality in the shoulder and pelvis were significantly reduced in low dose CT. In the wrist, all categories of subjective image quality except artifacts were similar. In the ankle, all categories of subjective image quality except for artifacts were degraded in low dose CT. CONCLUSIONS Objective image noise is more increased in low dose CT images of the shoulder and pelvis. Although diagnostic performance was acceptable, mean subjective image quality also decreased. In the wrist, objective image noise and subjective image quality were not degraded in low dose CT. In the ankle, some measurements of objective and subjective image quality were similar between low dose and standard dose CT.
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Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Jin Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abstract
EPIDEMIOLOGY Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy impact, a distinction is made between anteroposterior compression, lateral compression, and vertical shear (Young and Burgess classification), while the stability-related classification according to Tile distinguishes between type A (stable), type B (rotationally unstable) and type C (completely unstable). A comprehensive modern classification is given by the AO/OTA. RADIOLOGICAL FRACTURE DIAGNOSIS Plain pelvis x‑rays lack sufficient sensitivity but are still used to detect highly unstable pelvic fractures. CT has superior sensitivity and specificity. In addition to fracture classification, CT allows reliable assessment of associated vascular and bladder/urethral injuries and large soft tissue hemorrhage. MRI is unparalleled in showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage. MRI may also prove to be a valuable diagnostic tool for pelvic ring injuries in children, adolescents and young women, provided they are hemodynamically stable. Angiography, ultrasonography and bone scintigraphy are additional important diagnostic and therapeutic options. PRACTICAL RECOMMENDATIONS Knowledge of basic pelvic trauma mechanisms is important to understand the potential severity of traumatic pelvic fractures and to classify them correctly in terms of stability. Being familiar with typical concomitant injuries in pelvic ring fractures allows reliable diagnosis and their communication with the clinician. CT remains the "diagnostic workhorse". In fragile pelvic fractures, the often prolonged course with fracture progression must be taken into account, which is why MRI is of particular importance herein.
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Affiliation(s)
- Thomas Grieser
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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Low-Dose Computed Tomographic Scans for Postoperative Evaluation of Craniomaxillofacial Fractures: A Pilot Clinical Study. Plast Reconstr Surg 2020; 146:366-370. [PMID: 32740589 DOI: 10.1097/prs.0000000000007017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Computed tomographic scans are frequently obtained following craniomaxillofacial fracture reconstruction. The additive radiation from such scans is not trivial; cumulative radiation exposure poses stochastic health risks. In this article, the authors postulate that a low-dose computed tomography protocol provides adequate image quality for postoperative evaluation of reconstructed craniomaxillofacial fractures. This study included patients for whom a computed tomographic scan was indicated following craniomaxillofacial fracture repair at a Level I trauma center. Postoperative craniomaxillofacial computed tomography was performed using a low-dose protocol, rather than standard protocols. A craniomaxillofacial surgeon and a radiologist interpreted the images to determine whether they were of sufficient quality. It was decided a priori that any inadequate low-dose computed tomography would require repeated scanning using standard protocols. The primary endpoint was the need for repeated computed tomography. In addition, the clarity of clinically significant anatomical landmarks on the images was graded on a five-point Likert scale. Twenty patients were scanned postoperatively using the low-dose protocol. Mean radiation dose (total dose-length product) from the low-dose protocol was 71 mGy · cm versus 532 mGy · cm for the preoperative computed tomographic scans that were obtained using conventional protocols (p < 0.001). All 20 low-dose computed tomographic scans were determined to provide satisfactory image quality. No patients required repeated computed tomography secondary to poor image quality. Low-dose computed tomography received high image-quality scores. A low-dose computed tomography protocol that delivers approximately 7.5-fold less radiation than the standard protocols was found to be adequate for postoperative evaluation of craniomaxillofacial fractures. Larger prospective studies may be warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
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27
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Rayudu NM, Anitha DP, Mei K, Zoffl F, Kopp FK, Sollmann N, Löffler MT, Kirschke JS, Noël PB, Subburaj K, Baum T. Low-dose and sparse sampling MDCT-based femoral bone strength prediction using finite element analysis. Arch Osteoporos 2020; 15:17. [PMID: 32088769 DOI: 10.1007/s11657-020-0708-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/06/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study aims to evaluate the impact of dose reduction through tube current and sparse sampling on multi-detector computed tomography (MDCT)-based femoral bone strength prediction using finite element (FE) analysis. FE-predicted femoral failure load obtained from MDCT scan data was not significantly affected by 50% dose reductions through sparse sampling. Further decrease in dose through sparse sampling (25% of original projections) and virtually reduced tube current (50% and 25% of the original dose) showed significant effects on the FE-predicted failure load results. PURPOSE To investigate the effect of virtually reduced tube current and sparse sampling on multi-detector computed tomography (MDCT)-based femoral bone strength prediction using finite element (FE) analysis. METHODS Routine MDCT data covering the proximal femur of 21 subjects (17 males; 4 females; mean age, 71.0 ± 8.8 years) without any bone diseases aside from osteoporosis were included in this study. Fifty percent and 75% dose reductions were achieved by virtually reducing tube current and by applying a sparse sampling strategy from the raw image data. Images were then reconstructed with a statistically iterative reconstruction algorithm. FE analysis was performed on all reconstructed images and the failure load was calculated. The root mean square coefficient of variation (RMSCV) and coefficient of correlation (R2) were calculated to determine the variation in the FE-predicted failure load data for dose reductions, using original-dose MDCT scan as the standard of reference. RESULTS Fifty percent dose reduction through sparse sampling showed lower RMSCV and higher correlations when compared with virtually reduced tube current method (RMSCV = 5.70%, R2 = 0.96 vs. RMSCV = 20.78%, R2 = 0.79). Seventy-five percent dose reduction achieved through both methods (RMSCV = 22.38%, R2 = 0.80 for sparse sampling; RMSCV = 24.58%, R2 = 0.73 for reduced tube current) could not predict the failure load accurately. CONCLUSION Our simulations indicate that up to 50% reduction in radiation dose through sparse sampling can be used for FE-based prediction of femoral failure load. Sparse-sampled MDCT may allow fracture risk prediction and treatment monitoring in osteoporosis with less radiation exposure in the future.
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Affiliation(s)
- Nithin Manohar Rayudu
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - D Praveen Anitha
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Kai Mei
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Zoffl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix K Kopp
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian T Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore.
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Marx C, Schaser KD, Rammelt S. Early Corrections after Failed Ankle Fracture Fixation. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:323-331. [PMID: 32040967 DOI: 10.1055/a-1079-6476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Even minor residual fragment malpositioning after internal fixation of ankle fractures is associated with a worse prognosis. Frequent causes for non-anatomical reduction are fibular shortening due to comminuted fractures or poor bone quality, translational or rotational malpositioning of the distal fibula within the tibial incisura with unstable syndesmosis injuries, and inadequately addressed bony avulsions of the tibiofibular syndesmosis. After operative treatment of fracture dislocations with syndesmotic fixation, in case of complex fracture pathoanatomy, and with suspected non-anatomic reduction in postoperative radiographs, computed tomography imaging of both ankles should be performed. Correction of relevant malreductions should be performed as early as possible in order to speed up rehabilitation and to avoid late sequelae due to a load shift or instability in a weight-bearing joint.
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Affiliation(s)
- Christine Marx
- UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus, Dresden
| | - Klaus Dieter Schaser
- UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus, Dresden
| | - Stefan Rammelt
- UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus, Dresden
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Alagic Z, Bujila R, Enocson A, Srivastava S, Koskinen SK. Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects. Skeletal Radiol 2020; 49:531-539. [PMID: 31501959 PMCID: PMC7021773 DOI: 10.1007/s00256-019-03309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. MATERIALS AND METHODS An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. RESULTS In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. CONCLUSIONS Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.
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Affiliation(s)
- Zlatan Alagic
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Robert Bujila
- Functional Unit for Medical Radiation Physics and Nuclear Medicine, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden ,Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Subhash Srivastava
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden
| | - Seppo K. Koskinen
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Rammelt S, Boszczyk A. Computed Tomography in the Diagnosis and Treatment of Ankle Fractures: A Critical Analysis Review. JBJS Rev 2019; 6:e7. [PMID: 30562210 DOI: 10.2106/jbjs.rvw.17.00209] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Stefan Rammelt
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Andrzej Boszczyk
- Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Otwock, Poland
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31
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Precision of determining bone pose and marker position in the foot and lower leg from computed tomography scans: How low can we go in radiation dose? Med Eng Phys 2019; 69:147-152. [DOI: 10.1016/j.medengphy.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/29/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
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Sollmann N, Mei K, Schwaiger B, Gersing A, Kopp F, Bippus R, Maegerlein C, Zimmer C, Rummeny E, Kirschke J, Noël P, Baum T. Effects of virtual tube current reduction and sparse sampling on MDCT-based femoral BMD measurements. Osteoporos Int 2018; 29:2685-2692. [PMID: 30143850 PMCID: PMC6267136 DOI: 10.1007/s00198-018-4675-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/14/2018] [Indexed: 01/14/2023]
Abstract
UNLABELLED This study investigates the impact of tube current reduction and sparse sampling on femoral bone mineral density (BMD) measurements derived from multi-detector computed tomography (MDCT). The application of sparse sampling led to robust and clinically acceptable BMD measurements. In contrast, BMD measurements derived from MDCT with virtually reduced tube currents showed a considerable increase when compared to original data. INTRODUCTION The study aims to evaluate the effects of radiation dose reduction by using virtual reduction of tube current or sparse sampling combined with standard filtered back projection (FBP) and statistical iterative reconstruction (SIR) on femoral bone mineral density (BMD) measurements derived from multi-detector computed tomography (MDCT). METHODS In routine MDCT scans of 41 subjects (65.9% men; age 69.3 ± 10.1 years), reduced radiation doses were simulated by lowering tube currents and applying sparse sampling (50, 25, and 10% of the original tube current and projections, respectively). Images were reconstructed using FBP and SIR. BMD values were assessed in the femoral neck and compared between the different dose levels, numbers of projections, and image reconstruction approaches. RESULTS Compared to full-dose MDCT, virtual lowering of the tube current by applying our simulation algorithm resulted in increases in BMD values for both FBP (up to a relative change of 32.5%) and SIR (up to a relative change of 32.3%). In contrast, the application of sparse sampling with a reduction down to 10% of projections showed robust BMD values, with clinically acceptable relative changes of up to 0.5% (FBP) and 0.7% (SIR). CONCLUSIONS Our simulations, which still require clinical validation, indicate that reductions down to ultra-low tube currents have a significant impact on MDCT-based femoral BMD measurements. In contrast, the application of sparse-sampled MDCT seems a promising future clinical option that may enable a significant reduction of the radiation dose without considerable changes of BMD values.
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Affiliation(s)
- N. Sollmann
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
- 0000000123222966grid.6936.aTUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - K. Mei
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - B.J. Schwaiger
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - A.S. Gersing
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - F.K. Kopp
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - R. Bippus
- 0000 0004 0373 4886grid.418621.8Philips GmbH Innovative Technologies, Research Laboratories, Röntgenstr. 24-26, 22335 Hamburg, Germany
| | - C. Maegerlein
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - C. Zimmer
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - E.J. Rummeny
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - J.S. Kirschke
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - P.B. Noël
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - T. Baum
- 0000000123222966grid.6936.aDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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MDCT-based Finite Element Analysis of Vertebral Fracture Risk: What Dose is Needed? Clin Neuroradiol 2018; 29:645-651. [PMID: 30132090 DOI: 10.1007/s00062-018-0722-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to compare vertebral failure loads, predicted from finite element (FE) analysis of patients with and without osteoporotic vertebral fractures (OVF) at virtually reduced dose levels, compared to standard-dose exposure from multidetector computed tomography (MDCT) imaging and evaluate whether ultra-low dose derived FE analysis can still differentiate patient groups. MATERIALS AND METHODS An institutional review board (IRB) approval was obtained for this retrospective study. A total of 16 patients were evaluated at standard-dose MDCT; eight with and eight without OVF. Images were reconstructed at virtually reduced dose levels (i. e. half, quarter and tenth of the standard dose). Failure load was determined at L1-3 from FE analysis and compared between standard, half, quarter, and tenth doses and used to differentiate between fracture and control groups. RESULTS Failure load derived at standard dose (3254 ± 909 N and 3794 ± 984 N) did not significantly differ from half (3390 ± 890 N and 3860 ± 1063 N) and quarter dose (3375 ± 915 N and 3925 ± 990 N) but was significantly higher for one tenth dose (4513 ± 1762 N and 4766 ± 1628 N) for fracture and control groups, respectively. Failure load differed significantly between the two groups at standard, half and quarter doses, but not at tenth dose. Receiver operating characteristic (ROC) curve analysis also demonstrated that standard, half, and quarter doses can significantly differentiate the fracture from the control group. CONCLUSION The use of MDCT enables a dose reduction of at least 75% compared to standard-dose for an adequate prediction of vertebral failure load based on non-invasive FE analysis.
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Blum A, Noël A, Regent D, Villani N, Gillet R, Gondim Teixeira P. Tomosynthesis in musculoskeletal pathology. Diagn Interv Imaging 2018; 99:423-441. [DOI: 10.1016/j.diii.2018.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023]
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