Tomosynthesis in musculoskeletal pathology

Abstract

Tomosynthesis is an imaging technique that uses standard X-ray equipment with digital flat panel detectors to create tomographic images from very low-dose projections obtained at different angles. These images are parallel to the plane of the detector. Filtered back-projection or iterative reconstruction algorithms can be used to produce them. Iterative reconstruction used with a metal artifact reduction algorithm reduces metal artifacts, and therefore, improve image quality and in-depth spatial resolution. The radiation dose is lower compared to that of computed tomography and is two to three times the dose of a standard radiography. Tomosynthesis is intended for the analysis of high-contrast structures and especially for bones. It is superior to projection radiography when bone superimpositions are important or when metal structures hide regions of interest. The high in-plane resolution and its ability to perform exams in weight-bearing positioning are some of the main advantages of this technique. The impossible production of perpendicular multiplanar reconstruction and a limited contrast resolution are its main limitations. Tomosynthesis must be considered as an extension or an addition to standard radiography, as it can be performed in the same diagnostic step. The purpose of this article was to describe the principles, advantages and limitations, and current and future applications in musculoskeletal pathology of tomosynthesis.

Digital Tomosynthesis versus Conventional Radiography for Evaluating Osteonecrosis of the Femoral Head

“…DTS is widely used in various imaging fields owing to its high in-plane resolution. For musculoskeletal studies, DTS is useful for analyzing high-contrast structures such as the bones [ 12 ]. DTS is superior to radiography for visualizing superimposed anatomical structures because multiple images from various angles are taken while the X-ray tube is swept within a specified range [ 17 22 ].…”

“…Digital tomosynthesis (DTS) is a recently developed imaging modality that uses standard X-ray equipment with digital flat panel detectors to create images from a series of projection radiographs obtained at different angles [ 10 11 12 ]. It has been shown to be useful for imaging various body parts, including the breast [ 13 14 ], chest [ 15 ], head and neck [ 16 ], and musculoskeletal system [ 17 18 19 ].…”

Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb

“…Tomosynthesis offers the advantage of being performed at the same time as standard radiography, and it offers greater precision in the detection of bone anomalies. 4,[29][30][31]…”

Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction

“…It is currently being used in routine clinical practice for imaging of the chest and breast, and it is beginning to be used for bone healing. [1][2][3][4][5] Ha et al 2 reported that tomosynthesis provided superior diagnostic information compared with other imaging methods during the postoperative evaluation of wrist fractures. Simoni et al 6 also reported that tomosynthesis and computed tomography (CT) detected a similar number of erosions in patients with rheumatic arthritis.…”

“…Tomosynthesis is starting to attract attention from those who perform musculoskeletal diagnosis. 1,[7][8][9][10] Anterior cruciate ligament (ACL) reconstruction frequently is used to treat athletes and young patients who experience ligament injury. Although various grafts are considered for ACL reconstruction, the hamstring tendon or boneepatellar tendonebone (BPTB) graft is mainly used for the procedure.…”