Optimizing Radiation Dose in Computed Tomography of Articular Fractures

Mansfield, C.M.; Ali, Sayed; Komperda, Kazimierz; Zhao, Huaqing; Rehman, Saqib

doi:10.1097/bot.0000000000000861

Cited by 11 publications

(13 citation statements)

References 27 publications

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“…Clinical studies have shown that implementation of ASIR-V can decrease the mean RD between 34 and 35% while maintaining image quality [13,14]. Previously reported mean RD for low-dose CT evaluation of fractures of the peripheral skeleton has been in the range of 10-800 μSv [12,[15][16][17][18] and for cone-beam CT (CBCT) in the range of 0.9-14.3 μSv [19]. Our ULD-CT protocol has, to our knowledge, the lowest reported mean RD (0.59 μSv) for the peripheral skeleton in the literature, corresponding to around 1.7 h of exposure to background radiation [20].…”

Section: Discussionmentioning

confidence: 99%

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

et al. 2019

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Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. Results In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Conclusions Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.

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Section: Discussionmentioning

confidence: 99%

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

et al. 2019

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“…Derived from similar studies that evaluated injuries about the knee and ankle, 5,6 five different protocols were created, all of which kept the kVp value constant at 120, and varied by sequentially lowered mAs values of 75, 60, 45, 30, and 15. To define these sequentially lowered radiation doses, we calculated the average amount of radiation (using DLP) used in 20 patient knee CTs performed within the last year at our institution.…”

Section: Ct Protocol Developmentmentioning

confidence: 99%

“…A delicate balance exists between image quality and radiation exposure in the evaluation of orthopaedic trauma patients. [1][2][3][4][5][6][7] The ability to characterize unique fracture patterns and musculoskeletal anatomy has significantly im-proved with advances in computed tomography (CT) techniques. 1,[8][9][10][11][12][13][14][15] However, the collective radiation burden sustained by the population has also increased substantially.…”

Section: Introductionmentioning

confidence: 99%

“…25 By manipulating certain CT parameters, recent studies have developed strategies to accurately evaluate fractures at significantly decreased radiation doses. [4][5][6] These findings stem from adherence to the ALARA (As Low As Reasonably Achievable) principle, a concept defined by obtaining acceptable imaging studies at the lowest possible radiation dose, thereby avoiding any unnecessary exposure to the patient. 26 The aim of this cadaver study was to evaluate surgeon's ability to confidently provide an accurate fracture classification and treatment plan for complex distal femur fractures imaged at significantly decreased CT radiation doses.…”

Section: Introductionmentioning

confidence: 99%

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Radiation Dose Reduction of Computed Tomography in Complex Distal Femur Fractures: A Cadaver Study to Develop a Low Dose Scanning Protocol

O'Neill

Wisniewski

Adams

et al. 2019

Spartan Medical Research Journal

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CONTEXT CONTEXT Recent advances in diagnostic imaging have made computed tomography (CT) a widely used test in trauma patients. Consequently, the collective radiation burdened sustained by this patient population has increased substantially. The purpose of this cadaveric study was to determine if a significantly lowered CT radiation dose protocol would provide adequate imaging studies for the surgeon, using the distal femur as a model. METHODS METHODS Ten adult cadaveric knee specimens were used to create Orthopaedic Trauma Association (AO/OTA) 33-C3 distal femur fractures with associated coronal plane Hoffa fractures and varying intra-articular displacements. Using a single CT scanner, each cadaver was scanned at 5 separate protocols defined by sequentially lowered radiation doses, the highest of which was one-third the value of our institution's current protocol. These images were then evaluated by fellowship-trained orthopedic surgeons, an orthopedic trauma fellow, and residents. Observer reliability and confidence levels were calculated for measuring fracture displacement, assessing the quality of 3D reconstructions, and developing treatment plans. RESULTS RESULTS Across all reviewers and specimens, there was an average difference of 0.66 millimeters (mm) between the measured fracture gap and true fracture gap. The highest intraclass correlation coefficient (ICC) calculated for the inter-rater reliability of gap measurements was 0.983 at 75 mAs (95% CI: 0.955-0.996), followed by 0.973 (95% CI: 0.930-0.993) and 0.958 (95% CI: 0.896-0.988) at 15 mAs and 60 mAs, respectively. All 3D reconstructions obtained at 75 mAs and 45 mAs values (N = 8) were of acceptable imaging quality to all reviewers, while only 3 of 4 3D reconstructions obtained at 15 mAs were considered acceptable. There was no difference in treatment plans across all reviewers, regardless of radiation dose. CONCLUSIONS CONCLUSIONS In summary, our results indicate that CT scans of complex distal femur fractures at one-third the amount of radiation exposure may provide adequate imaging necessary to develop an appropriate treatment plan. At significantly lowered doses, the reviewers were able to accurately measure the amount of fracture displacement and identify the presence of each Hoffa fracture. Future studies are necessary to compare this protocol's diagnostic capacity and limitations in evaluating complex fractures with that of our institution's standard protocol in a clinical setting.

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“…12 Thus, there is a growing awareness of the need to use the lowest possible radiation dose level that is capable of providing appropriate diagnostic information, also known as the ALARA principle (As Low As Reasonably Achievable). 9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] CT is the gold standard for diagnosing fractures, 10,[25][26][27] characterizing them in greater detail, identifying hidden fractures and showing incomplete union. 27,28 In musculoskeletal radiology, lowdose CT has shown good results in studies with pre and postoperative scoliosis evaluations, as well as in diagnosing lytic injuries and fractures in patients with multiple myeloma.…”

mentioning

confidence: 99%

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

Duarte¹,

Santos

Oliveira

et al. 2021

Sao Paulo Med. J.

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Ionizing radiation such as X-rays is a singular form of energy that surmounts the binding energy of electrons that orbit atoms and molecules. 1 In biological material exposed to X-rays, the most common consequential scenario is that this creates hydroxyl radicals from interactions between X-rays and water molecules. These radicals, in turn, interact with deoxyribonucleic acid (DNA) to cause breakage of bonds or damage to the base. 1 Thus, mutations, chromosomal translocations and fusions between genes can occur, which in some cases may lead to cancer. 1 All X-ray-based imaging methods have the characteristic in common of a trade-off between image quality and radiation dose, since all forms of ionizing radiation can damage tissues. 2 In patients undergoing radiographic and/or tomographic monitoring, the patient's exposure to radiation needs to be considered, and this poses a challenge to radiologists regarding dose reduction. 3,4 The main concern in diagnostic imaging is that a stochastic lesion of radiation-induced cancer could develop, which can occur with any radiation dose. [5][6][7] Conversely, deterministic effects occur only when the threshold has been exceeded and, above that, the incidence and severity of the injury increase with the radiation dose. 6,7 It also needs to be taken into account that the pediatric population is 10 times more sensitive to radiation than adults. 8 To date, no safe dose of ionizing radiation, below which there is no risk of cell damage and subsequent risk of cancer, has been established. 9,10 However, it has been estimated in the United States that about 1.5%-2.0% of all malignancies can be attributed to radiation from computed tomography (CT) scans. 1,6 Taking all imaging examinations into account, this proportion ranges

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Optimizing Radiation Dose in Computed Tomography of Articular Fractures

Cited by 11 publications

References 27 publications

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

Radiation Dose Reduction of Computed Tomography in Complex Distal Femur Fractures: A Cadaver Study to Develop a Low Dose Scanning Protocol

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

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