Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

Abstract

Objective: To evaluate image quality and interobserver reliability of a novel cone-beam CT (CBCT) scanner in comparison with plain radiography for assessment of fracture healing in the presence of metal hardware. Methods: In this prospective institutional review boardapproved Health Insurance Portability and Accountability Act of 1996-complaint study, written informed consent was obtained from 27 patients (10 females and 17 males; mean age 44 years, age range 21-83 years) with either upper or lower extremity fractures, and with metal hardware, who underwent CBCT scans and had a clinical radiograph of the affected part. Images were assessed by two independent observers for quality and interobserver reliability for seven visualization tasks. Visual grading characteristic (VGC) curve analysis determined the differences in image quality between CBCT and plain radiography.Interobserver agreement was calculated using Pearson's correlation coefficient. Results: VGC results displayed preference of CBCT images to plain radiographs in terms of visualizing (1) cortical and (2) trabecular bones; (3) fracture line; (4) callus formation; (5) bridging ossification; and (6) screw thread-bone interface and its inferiority to plain radiograph in the visualization of (7) large metallic side plate contour with strong interobserver correlation (p-value , 0.05), except for visualizing large metallic side plate contour. Conclusion: For evaluation of fracture healing in the presence of metal hardware, CBCT image quality is preferable to plain radiograph for all visualization tasks, except for large metallic side plate contours. Advances in knowledge: CBCT has the potential to be a good diagnostic alternative to plain radiographs in evaluation of fracture healing in the presence of metal hardware.

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

“…The study of extremities by radiographs needs more than one plain film, and a bone fracture is not always detectable by two-dimensional medical imaging because of the geometric distortion effect and the superimposition of three-dimensional complex skeletal structures [53,54]. Therefore, we suppose that CBCT may sometimes replace a conventional X-ray examination in extremity bone trauma turned into a first-level imaging since CBCT assures high diagnostic accuracy in the detection of bone fractures [55][56][57][58] with an acceptable radiation dose.…”

The Effect of Age on Fracture Healing Time in Metacarpal Fractures

“…They scored 4 features of healing-periosteal reaction, callus, bridging, and remodeling-and concluded that for evaluation of fracture healing in the presence of metal hardware, CBCT image quality is superior to plain radiographs, except in the presence of large metallic side plate contours. 32 We use clinical and radiographic evaluations to decide on healing. As this is a retrospective study, ultimately the treating surgeon made the decision.…”

Computed Tomography

“…98,99 In conjunction with bone healing, studies are being conducted to evaluate extremity joints with and without the presence of metal hardware. 100…”