Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma

Abstract

CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT

“…Therefore, for more accurate evaluation of cartilage covering of articular surfaces of the talar dome and distal tibia and fibula, direct arthrographic techniques combined with CT and MRI may be useful (Figure 2d). Recently, Cone Beam Computed Tomography (CBCT) of small joints has been introduced as an alternative technique for Multi Detector CT, combining a very high spatial resolution, low radiation dose and low cost [3]. …”

“…It uses a conical X-ray beam and flat-panel detector collecting all volumetric data in one rotation of the gantry. It combines high spatial resolution, relatively low radiation dose and low equipment cost and is useful for evaluation of trauma of small bones and joints, particularly when there is clinical suspicion for a fracture despite negative plain radiographs [3]. The equipment is designed to perform exams in sitting or supine position and is relatively compact, allowing installation in many radiology departments and private practices.…”

Cone Beam CT of Trauma of Small Bones and Joints

“…MDCT. 6,7 In a previous study on CBCT of small joints, the effective dose (ED) ranged between 1 and 15.3 µSv applying a conversion factor of 0.01 mSv/Gy  cm 2 for peripheral joints, which is far below reported values for MDCT. However, these values are still considerably higher than the ED for conventional radiographs (CRs; 0.07-5 µSv).…”

“…However, these values are still considerably higher than the ED for conventional radiographs (CRs; 0.07-5 µSv). 7 Because the dose depends on field of view (FOV), it would be possible to further diminish the ED by decreasing the FOV. Ideally, the area of interest has to be predefined by meticulous clinical examination before the acquisition starts to avoid unnecessary irradiation.…”

“…Ideally, the area of interest has to be predefined by meticulous clinical examination before the acquisition starts to avoid unnecessary irradiation. 7 Other advantages of CBCT include higher spatial resolution ranging between 300 µm (standard scan) and 75 µm (high resolution), reduction of metal artifacts (e.g., for postoperative assessment of osteosynthesis), 3 and the relatively low cost of the equipment compared with MDCT. Major differences of cone beam computed tomography (CBCT) versus multidetector computed tomography (MDCT).…”