Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

Abstract

PurposeTo compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures.MethodsAs study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.ResultsPooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities’ specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001).ConclusionThe diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

Radiation dose in non-dental cone beam CT applications: a systematic review

“…The ear study requires a high resolution to detect the tiny structures of which it is constituted; consequently, a high radiation dosage is needed [32]. The dose can be generally reduced in the paranasal sinuses, cervical spine, and extremities studies, where the image quality is adequate even with low-dose protocols [32,33,50]. Low-dose protocols should be set in all imaging techniques with ionising radiation, especially in CBCT, because of several units with extremely variable acquisition parameters and therefore very different exposures, as shown in the current review.…”

Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

“…Due to the high spatial resolution and low radiation exposure, cone-beam computed tomography (CT) is increasingly applied in musculoskeletal imaging. Several studies have demonstrated the value of using cone-beam CT in evaluating wrist injuries and other pathologies (Gibney et al., 2019; Neubauer et al., 2016; Pallaver and Honigmann, 2019).…”

Computer‐aided 3D analysis of anatomy and radiographic parameters of the distal radius

“…The major advantages of CBCT are high spatial resolution, easy installation, lower costs (Honigmann & Frueh, 2018), and relatively low radiation dose (Koivisto et al, 2018; Koskinen et al, 2013). CBCT has gained popularity in primary fracture diagnostics and several reports have even suggested replacing radiographs with CBCT in detection of traumatic wrist pathologies (Borel et al, 2017; Edlund et al, 2016; Gibney et al, 2019; Neubauer et al, 2016; Pallaver & Honigmann, 2019). As a modern 3D imaging modality, CBCT provides a useful tool for evaluation of the anatomy using mathematical modeling.…”