Ultra-low-dose CT versus radiographs for minor spine and pelvis trauma: a Bayesian analysis of accuracy

Hamard, Aymeric; Greffier, Joël; Bastide, Sophie; Larbi, Ahmed; Addala, Takieddine; Sadate, Alexandre; Beregi, Jean‐Paul; Frandon, Julien

doi:10.1007/s00330-020-07304-8

Cited by 15 publications

(9 citation statements)

References 44 publications

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“…The higher sensitivity of ULD-CT compared to that of radiography was found a statistically significant difference according to the Bayesian model (P recovery <0.001). Similar results were recently described for fractures of the spine and pelvis ( 21 ).…”

Section: Discussionsupporting

confidence: 90%

“…The “fracture” status corresponded to the detection of at least one fracture. In the absence of conventional CT or MRI performed as gold-standard test, the sensitivity and specificity were computed with two different reference tests, as previously published ( 21 ). First, the best value comparator (BVC) based on a systematic review of both imaging tests by the two readers, who determined in consensus the final fracture status for each patient.…”

Section: Methodsmentioning

confidence: 99%

“…These last years, the use of iterative reconstruction algorithms has allowed a substantial dose reduction and the ultra-low dose (ULD) concept has emerged: CT with doses close to that of radiography, with 3D analysis. ULD acquisitions give images of although degraded quality, but sufficient and adapted for diagnosis ( 18 , 20 , 21 ). Hamard et al ( 21 ) have showed a higher sensitivity and specificity for detection of minor spinal, pelvic or hip traumas with ULD-CT than with radiography, using the same approaches.…”

Section: Introductionmentioning

confidence: 99%

“…ULD acquisitions give images of although degraded quality, but sufficient and adapted for diagnosis ( 18 , 20 , 21 ). Hamard et al ( 21 ) have showed a higher sensitivity and specificity for detection of minor spinal, pelvic or hip traumas with ULD-CT than with radiography, using the same approaches. For peripheral skeleton imaging, Alagic et al ( 22 ) have demonstrated that ULD-CT was a useful alternative to digital radiography, but no study has yet studied the diagnostic performance of these ULD-CT acquisitions in extremity traumas.…”

Section: Introductionmentioning

confidence: 99%

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Early results of ultra-low-dose CT-scan for extremity traumas in emergency room

Addala¹,

Greffier²,

Hamard³

et al. 2022

Quant Imaging Med Surg

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Background Ultra-low dose computed tomography (ULD-CT) was shown to be a good alternative to digital radiographs in various locations. This study aimed to assess the diagnostic sensitivity and specificity of ULD-CT versus digital radiographs in patients consulting for extremity traumas in emergency room. Methods Digital radiography and ULD-CT scan were performed in patients consulting at the emergency department (February–August 2018) for extremity traumas. Fracture detection was evaluated retrospectively by two blinded independent radiologists. Sensitivity and specificity were evaluated using best value comparator (BVC) and a Bayesian latent class model (LCM) approaches and clinical follow-up. Image quality, quality diagnostic and diagnostic confidence level were evaluated (Likert scale). The effective dose received was calculated. Results Seventy-six consecutive patients (41 men, mean age: 35.2±13.2 years), with 31 wrists/hands and 45 ankles/feet traumas were managed by emergency physicians. According to clinical data, radiography had 3 false positive and 10 false negative examinations, and ULD-CT, 2 of each. Radiography and ULD-CT specificities were similar; sensitivities were lower for radiography, with BVC and Bayesian. With Bayesian, ULD-CT and radiography sensitivities were 90% (95% CI: 87–93%) and 76% (95% CI: 71–81%, P<0.0001) and specificities 96% (95% CI: 93–98%) and 93% (95% CI: 87–97%, P=0.84). The inter-observer agreement was higher for ULD-CT for all subjective indexes. The effective dose for ULD-CT and radiography was 0.84±0.14 and 0.58±0.27 µSv (P=0.002) for hand/wrist, and 1.50±0.32 and 1.44±0.78 µSv (P=NS) for foot/ankle. Conclusions With an effective dose level close to radiography, ULD-CT showed better detection of extremities fractures in the emergency room and may allow treatment adaptation. Further studies need to be performed to assess impact of such examination in everyday practice. Trial Registration ClinicalTrials.gov Identifier: NCT04832490.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early results of ultra-low-dose CT-scan for extremity traumas in emergency room

Addala¹,

Greffier²,

Hamard³

et al. 2022

Quant Imaging Med Surg

Self Cite

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“…In their study with trauma patients, Hamard et al showed that ULD-CT was superior to radiographs in fracture detection, although standard CT technique was used. However, effective dose of the pelvic ULD-CT scans with mean 1.43 mSv was higher compared to our tin-filtered ULD-CT scans with median 0.38 mSv [22].…”

Section: Discussioncontrasting

confidence: 76%

Pelvic bone CT: can tin-filtered ultra-low-dose CT and virtual radiographs be used as alternative for standard CT and digital radiographs?

et al. 2021

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Objectives To compare ultra-low-dose CT (ULD-CT) of the osseous pelvis with tin filtration to standard clinical CT (CT), and to assess the quality of computed virtual pelvic radiographs (VRs). Methods CT protocols were optimized in a phantom and three pelvic cadavers. Thirty prospectively included patients received both standard CT (automated tube voltage selection and current modulation) and tin-filtered ULD-CT of the pelvis (Sn140kV/50mAs). VRs of ULD-CT data were computed using an adapted cone beam–based projection algorithm and were compared to digital radiographs (DRs) of the pelvis. CT and DR dose parameters and quantitative and qualitative measures (1 = worst, 4 = best) were compared. CT and ULD-CT were assessed for osseous pathologies. Results Dose reduction of ULD-CT was 84% compared to CT, with a median effective dose of 0.38 mSv (quartile 1–3: 0.37–0.4 mSv) versus 2.31 mSv (1.82–3.58 mSv; p < .001), respectively. Mean dose of DR was 0.37 mSv (± 0.14 mSv). The median signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone were significantly higher for CT (64.3 and 21.5, respectively) compared to ULD-CT (50.4 and 18.8; p ≤ .01), while ULD-CT was significantly more dose efficient (figure of merit (FOM) 927.6) than CT (FOM 167.6; p < .001). Both CT and ULD-CT were of good image quality with excellent depiction of anatomy, with a median score of 4 (4–4) for both methods (p = .1). Agreement was perfect between both methods regarding the prevalence of assessed osseous pathologies (p > .99). VRs were successfully calculated and were equivalent to DRs. Conclusion Tin-filtered ULD-CT of the pelvis at a dose equivalent to standard radiographs is adequate for assessing bone anatomy and osseous pathologies and had a markedly superior dose efficiency than standard CT. Key Points • Ultra-low-dose pelvic CT with tin filtration (0.38 mSv) can be performed at a dose of digital radiographs (0.37 mSv), with a dose reduction of 84% compared to standard CT (2.31 mSv). • Tin-filtered ultra-low-dose CT had lower SNR and CNR and higher image noise than standard CT, but showed clear depiction of anatomy and accurate detection of osseous pathologies. • Virtual pelvic radiographs were successfully calculated from ultra-low-dose CT data and were equivalent to digital radiographs.

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