3D cone-beam CT of the ankle using a novel twin robotic X-ray system: Assessment of image quality and radiation dose

Grunz, Jan-Peter; Kunz, Andreas Steven; Gietzen, Carsten Herbert; Weng, Andreas Max; Veyhl-Wichmann, Maike; Ergün, Süleyman; Schmitt, Rainer; Bley, Thorsten Alexander; Gassenmaier, Tobias

doi:10.1016/j.ejrad.2019.108659

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…Furthermore, the limiting effect of the focal spot size on spatial resolution is reduced in CBCT scans by using a low-magnification acquisition geometry. In contrast to a previous ankle study with the commercially available CBCT scan mode, the tested prototype did not display more artefacts in bone than MDCT [15]. However, consistent with the literature [18], typical conebeam artefacts were still present in the soft tissue.…”

Section: Discussionsupporting

confidence: 72%

“…Its two telescopic arms and large detector allow for three-dimensional examination of most body parts and additional radiography and fluoroscopy. In earlier studies with a commercially available CBCT scan mode, a considerable reduction of radiation dose over standard MDCT was achieved for ankle [15] and wrist [16] studies using automatic tube current modulation. In this work, our goal was to establish reproducible clinical scan protocols with fixed acquisition parameters, thus enhancing comparability between the new CBCT prototype for the twin-robotic x-ray system and high-end MDCT in cadaveric elbow scans.…”

Section: Introductionmentioning

confidence: 99%

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3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

et al. 2020

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Background Elbow imaging is challenging with conventional multidetector computed tomography (MDCT), while cone-beam CT (CBCT) provides superior options. We compared intra-individually CBCT versus MDCT image quality in cadaveric elbows. Methods A twin robotic x-ray system with new CBCT mode and a high-resolution clinical MDCT were compared in 16 cadaveric elbows. Both systems were operated with a dedicated low-dose (LD) protocol (equivalent volume CT dose index [CTDIvol(16 cm)] = 3.3 mGy) and a regular clinical scan dose (RD) protocol (CTDIvol(16 cm) = 13.8 mGy). Image quality was evaluated by two radiologists (R1 and R2) on a seven-point Likert scale, and estimation of signal intensity in cancellous bone was conducted. Wilcoxon signed-rank tests and intraclass correlation coefficient (ICC) statistics were used. Results The CBCT prototype provided superior subjective image quality compared to MDCT scans (for RD, p ≤ 0.004; for LD, p ≤ 0.001). Image quality was rated very good or excellent in 100% of the cases by both readers for RD CBCT, 100% (R1) and 93.8% (R2) for LD CBCT, 62.6% and 43.8% for RD MDCT, and 0.0% and 0.0% for LD MDCT. Single-measure ICC was 0.95 (95% confidence interval 0.91–0.97; p < 0.001). Software-based assessment supported subjective findings with less “undecided” pixels in CBCT than dose-equivalent MDCT (p < 0.001). No significant difference was found between LD CBCT and RD MDCT. Conclusions In cadaveric elbow studies, the tested cone-beam CT prototype delivered superior image quality compared to high-end multidetector CT and showed a potential for considerable dose reduction.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

et al. 2020

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“…In previous studies, the system's automatic current modulation used with an earlier version of the CBCT scanning mode with 2 £ 2 binned pixel matrix allowed for reduction of radiation dose to approximately 15% of a clinical MDCT system with 64-slice configuration (Somatom Definition AS, Siemens Healthineers), while upholding diagnostic quality (21,22). For this work, we evaluated a novel CBCT scanning technique based on the multi-use X-ray system and compared its image quality to high-end, 384 slice MDCT (Somatom Force, Siemens Healthineers) in cadaveric wrist scans.…”

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confidence: 99%

Evaluation of Ultra-High-Resolution Cone-Beam CT Prototype of Twin Robotic Radiography System for Cadaveric Wrist Imaging

et al. 2021

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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 (CTDI vol(16cm) = 3.3 mGy) and full-dose protocols (CTDI vol(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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“…Effective radiation dose for CT imaging tasks of the appendicular skeleton is generally lower than for other body regions due to the small tissue-weighting factor. Nonetheless, the tested system possesses potential for dose reduction compared to state-of-the-art MDCT [21,22]. Whereas reported radiation dose for MDCT scans in small bone and joint trauma ranges from 10 to 800 μSv [10,14,32,33], a meta-analysis by Nardi et al stated an average effective dose of 7.1 μSv for CBCT examinations of extremities [34].…”

Section: Main Findingsmentioning

confidence: 99%

“…Being capable of radiography, fluoroscopy, and CBCT of most body parts, the scanner appears promising as a multi-use tool for trauma imaging. Recent studies were able to show potential for considerable dose reduction, when comparing the CBCT scan mode to MDCT in cadaveric specimens [21,22] and patients [23]. Literature analyzing the actual impact on treatment in acute trauma of the appendicular skeleton is lacking though.…”

Section: Introductionmentioning

confidence: 99%

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

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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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3D cone-beam CT of the ankle using a novel twin robotic X-ray system: Assessment of image quality and radiation dose

Cited by 11 publications

References 26 publications

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

Evaluation of Ultra-High-Resolution Cone-Beam CT Prototype of Twin Robotic Radiography System for Cadaveric Wrist Imaging

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

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