CT Should Replace Three-View Radiographs as the Initial Screening Test in Patients at High, Moderate, and Low Risk for Blunt Cervical Spine Injury: A Prospective Comparison

Bailitz, John; Starr, Frederic; Beecroft, Matthew J.; Bankoff, J.; Roberts, Richard M.; Bokhari, Faran; Joseph, Kimberly; Wiley, Dorian; Dennis, Andrew; Gilkey, Susan; Erickson, Paul F.; Raksin, P.B.; Nagy, Kimberly

doi:10.1097/ta.0b013e3181a5b0cc

Cited by 99 publications

(69 citation statements)

References 13 publications

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“…Many studies have demonstrated that cervical spine CT diagnoses many more injuries than plain cervical spine radiographs, and recent literature suggests that chest CT similarly detects many more thoracic injuries, such as rib fractures and pulmonary contusions, than plain CXR. Given that sternal fracture is not readily seen on the single anterior-posterior view radiographs primarily used in trauma patients and the upsurge in chest CT use with much greater sensitivity for injury, it is likely that more sternal fractures -especially minor ones -are now being diagnosed [7][8][9][10][11][12][13]. Traditional teachings regarding diagnosis and management may therefore no longer apply with these minor SF diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Sternal fracture in the age of pan-scan

Perez¹,

Rodriguez²,

Baumann³

et al. 2015

Injury

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Section: Introductionmentioning

confidence: 99%

Sternal fracture in the age of pan-scan

Perez¹,

Rodriguez²,

Baumann³

et al. 2015

Injury

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“…un-witnessed fall at home) and non-standardised referral clinical data. A report from Bailitz et al 8 also found cervical spine trauma is not uncommon in older patients at low clinical risk.…”

Section: Discussionmentioning

confidence: 99%

The Role of CT and MRI in Suspected Acute Cervical Spine Trauma

Brownlee¹

2014

Hong Kong Journal of Emergency Medicine

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Objective: To evaluate the accuracy of computed tomography (CT) in evaluation of patients with acute cervical spinal injury. Design: Retrospective case series. Setting: Three major public emergency departments in the southern hemisphere. Methods: We performed a retrospective review of patients with neck injury aged at least 16, with CT cervical spine examinations performed for blunt trauma over a 6 month period (1 January 2011 to 30 June 2011) and magnetic resonance imaging (MRI) cervical spine performed for same indications over two and a half years (12 January 2010 to 22 June 2012). Results: Acute cervical spine trauma was present on CT in 35 of 783 patients (4.5%) and on MRI in 98 of 206 patients (48%). Eleven of the 35 patients (31%) with CT confirmed trauma did not meet the Hanson criteria; the majority were at least 60 years of age and none had unstable injuries. CT is 100% sensitive in excluding an unstable injury if there is no soft tissue abnormality or fracture (with MRI as gold standard). An abnormal CT (including subtle paravertebral fat stranding) is often non-specific and often cannot reliably confirm an unstable ligamentous injury. Close attention to soft tissue axial and sagittal soft tissue CT reconstructions is important, as abnormalities can be subtle.

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“…17 There is ample evidence that CT outperforms plain radiography in many aspects. [18][19][20][21] According to previous studies, the radiation dose is reported up to 10 times higher than that in conventional plain radiography in two planes (mean effective dose is 0.9-4.0 mSv). 18,22 It is essential to modify CT techniques and protocols to reduce the radiation dose without compromising the image quality.…”

Section: Discussionmentioning

confidence: 99%

The use of adaptive statistical iterative reconstruction (ASiR) technique in evaluation of patients with cervical spine trauma: impact on radiation dose reduction and image quality

Patro¹,

Chakraborty²,

Sheikh³

2016

BJR

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This study was presented in the Adaptive Statistical Iterative Reconstruction 2014: American Society of Spine Radiology Annual Symposium, 13-16 February 2014, Miami Beach, FL, USA, and received the best paper award in the oral presentation category.Objective: The aim of this study was to evaluate the impact of adaptive statistical iterative reconstruction (ASiR) technique on the image quality and radiation dose reduction. The comparison was made with the traditional filtered back projection (FBP) technique. Methods: We retrospectively reviewed 78 patients, who underwent cervical spine CT for blunt cervical trauma between 1 June 2010 and 30 November 2010. 48 patients were imaged using traditional FBP technique and the remaining 30 patients were imaged using the ASiR technique. The patient demographics, radiation dose, objective image signal and noise were recorded; while subjective noise, sharpness, diagnostic acceptability and artefacts were graded by two radiologists blinded to the techniques. Results: We found that the ASiR technique was able to reduce the volume CT dose index, dose-length product and effective dose by 36%, 36.5% and 36.5%, respectively, compared with the FBP technique. There was no significant difference in the image noise (p 5 0.39), signal (p 5 0.82) and signal-to-noise ratio (p 5 0.56) between the groups. The subjective image quality was minimally better in the ASiR group but not statistically significant. There was excellent interobserver agreement on the subjective image quality and diagnostic acceptability for both groups. Conclusion: The use of ASiR technique allowed approximately 36% radiation dose reduction in the evaluation of cervical spine without degrading the image quality. Advances in knowledge: The present study highlights that the ASiR technique is extremely helpful in reducing the patient radiation exposure while maintaining the image quality. It is highly recommended to utilize this novel technique in CT imaging of different body regions. INTRODUCTIONCT has now become one of the main modalities for routine imaging. The number of CT procedures has significantly increased in recent times with a growth rate of 10% every year.

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CT Should Replace Three-View Radiographs as the Initial Screening Test in Patients at High, Moderate, and Low Risk for Blunt Cervical Spine Injury: A Prospective Comparison

Cited by 99 publications

References 13 publications

Sternal fracture in the age of pan-scan

Sternal fracture in the age of pan-scan

The Role of CT and MRI in Suspected Acute Cervical Spine Trauma

The use of adaptive statistical iterative reconstruction (ASiR) technique in evaluation of patients with cervical spine trauma: impact on radiation dose reduction and image quality

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