Evaluation of the Diagnostic Performance of Tomosynthesis in Fractures of the Wrist

Ottenin, Marie-Alexia; Jacquot, Adrien; Grosprêtre, O.; Noël, Alain; Lecocq, S.; Louis, M.; Blum, Alain

doi:10.2214/ajr.11.6374

Cited by 57 publications

(44 citation statements)

References 23 publications

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“…89 Two recent studies evaluated tomosynthesis, which is generally not available in the ED setting. 92,93 The pooled estimate LR+ for CT is 15.4 (95% CI = 8.8 to 27.0, I 2 = 0%) and the LR-is 0.23 (95% CI = 0.16 to 0.34, I 2 = 2%; Table 6). The diagnostic accuracies do not differ significantly between four-slice and 64-slice CT studies, nor does the timing of the CT relative to the injury affect accuracy ( Figure 13).…”

Section: Ctmentioning

confidence: 99%

“…37,40,77,[88][89][90][91][92] The criterion standard reported varied significantly and included clinical follow-up up to 16 months, 77,92 6-week x-ray, 37,89,91 bone scan, 40 and MRI. 90 The timing of the CT relative to the injury varied from less than 1 day, 37,40,89 to within 4 days, 77,88,91 or 1 week.…”

Section: Ctmentioning

confidence: 99%

“…90 The timing of the CT relative to the injury varied from less than 1 day, 37,40,89 to within 4 days, 77,88,91 or 1 week. 90,92 The older studies reported using four-row spiral CTs (120-KV, 100-mA, and 1.5-second scan time with 1.0-to 1.2-mm slices, pitch 3.5, Figure 11. Bone scan forest plots.…”

Section: Ctmentioning

confidence: 99%

“…77,88,89 Studies that are more recent used 64-slice spiral CTs with 0.625-to 0.9-mm slices. 40,[90][91][92] Cruickshank et al 37 used four-slice and 64-slice spiral CTs. Sagittal plane images provided lateral views of the scaphoid as evaluated by the central longitudinal axis of the scaphoid, whereas coronal images provide posteroanterior perspectives.…”

Section: Ctmentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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Section: Ctmentioning

confidence: 99%

Section: Ctmentioning

confidence: 99%

Section: Ctmentioning

confidence: 99%

Section: Ctmentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…In a pilot study on scaphoid fracture detection at the two-weeks' follow-up of suspect occult fracture [13], radiography detected one scaphoid waist fracture not detected at radiography at the time of the trauma, while tomosynthesis detected this fracture and two additional fractures, not seen with radiography. In another study on 100 patients with wrist trauma [14], sensitivity of radiography for any fracture was 61-80 %, sensitivity of tomosynthesis 77-87 %, and of CT 86-95 %. It has also been used for evaluation of fracture healing [15], with similar results.…”

Section: Introductionmentioning

confidence: 94%

Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

et al. 2016

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High‐speed slot‐scanning radiography using small‐angle tomosynthesis: Investigation of spatial resolution

et al. 2019

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Purpose This paper studies spatial resolution that is achievable with a fast slot‐scanning tomosynthesis approach for orthopedic examinations. Hereby, we use parallel scanning motion implemented in a twin robotic x‐ray system. Methods We have measured and analyzed the modulation transfer function (MTF) for various combinations of scanning speed, x‐ray tube voltage, pulse length, the nominal focal spot size as well as source‐to‐object distances. Moreover, we present a theoretical model which describes the system in terms of the MTF. The system was equipped with newly developed linear trajectory prototypes for slot scanning. The acquired images form the basis for a small‐angle tomosynthesis reconstruction. In total, three different scanning speeds (27, 14, 8 cm/s), pulse lengths (1, 2, 4 ms), tube voltages (80, 100, 120 kV), two nominal focal spot sizes (0.6, 1.0), and three source‐to‐object distances (950, 1050, 1150 mm) were investigated. To determine the resolution capabilities, we measured the MTF for the given parameter space. The results were then used to design a filter that yields a desired resolution in the reconstructed image. In addition, we also measured the noise power spectrum (NPS) to show the influence of the aforementioned filters on the noise distribution. Results We have shown that the presented model is in good agreement with the performed measurements. Scanning speed and pulse width have an impact on the MTF in the scanning direction. Up to a travel distance of 0.3 mm during an x‐ray pulse, an isotropic resolution can be achieved. Longer pulse width or higher scanning speed cause anisotropic resolution. Moreover, it is shown that none of the investigated parameters have an influence on the MTF perpendicular to the scanning direction (slot direction). The 10% MTF value ranges between 9 and 18 lp/cm in the scanning direction and about 18 lp/cm in slot direction. Tube voltage, nominal focal spot size as well as the source‐to‐object distance showed no major impact on the system MTF. In terms of the anisotropic resolution capabilities, we have shown that limiting the resolution in the slot direction to obtain isotropic resolution is possible yet at the cost of an inhomogeneous noise pattern. However, maintaining the resolution in slot direction will provide a better edge response and a more homogeneous noise texture at the cost of an inhomogeneous image resolution. Conclusions We have demonstrated the feasibility of the slot‐scanning technique using a twin‐robotic x‐ray system. Even the fastest scanning mode (27 cm/s) yields image resolution on a level that is sufficient for typical orthopedic examinations in terms of musculoskeletal (MSK) measurements. Moreover, it could be shown that the application of specifically designed target MTFs on two‐dimensional x‐ray images is feasible.

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Evaluation of the Diagnostic Performance of Tomosynthesis in Fractures of the Wrist

Abstract: The diagnostic value of tomosynthesis is superior to that of standard radiography but inferior to that of CT.

Cited by 57 publications

References 23 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

High‐speed slot‐scanning radiography using small‐angle tomosynthesis: Investigation of spatial resolution

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