Incorporating Cone-Beam CT Into the Diagnostic Algorithm for Suspected Radiocarpal Fractures: A New Standard of Care?

Gibney, Brian; Smith, M.G.H.; Moughty, Adrian; Kavanagh, Eoin C.; Hynes, D. M.; MacMahon, Peter

doi:10.2214/ajr.19.21478

Cited by 31 publications

(22 citation statements)

References 27 publications

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“…This is not the case for extremity cone-beam CT which usually enables the patient to be seated with their arm placed in the scanner gantry. 6 It is therefore important that those reviewing cross-sectional imaging understand the impact of the issues. This is particularly relevant where DRUJ congruity is being assessed and specifically when comparing studies which may have been obtained in different positions.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The incidence of wrist fractures is rising, 4,5 with sports injuries, road traffic collisions and falls representing the most common mechanisms. Despite reservations about the sensitivity of radiography for some fracture types, 6 it remains the primary imaging modality. 7 However, key to its utility is the quality of imaging examinations and assurance that the images accurately demonstrate the patient's anatomy.…”

Section: Introductionmentioning

confidence: 99%

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Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

et al. 2020

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Introduction In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% ( n = 40/238), and this improved to 47.8% ( n = 77/161) post-intervention, but declined to 32.8% ( n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort ( p < 0.001) and the late post-intervention group ( p = 0.002) but not in the examinations performed two weeks after staff education ( p = 0.239). Conclusion Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

et al. 2020

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“…Due to the high spatial resolution and low radiation exposure, cone-beam computed tomography (CT) is increasingly applied in musculoskeletal imaging. Several studies have demonstrated the value of using cone-beam CT in evaluating wrist injuries and other pathologies (Gibney et al., 2019; Neubauer et al., 2016; Pallaver and Honigmann, 2019).…”

Section: Introductionmentioning

confidence: 99%

Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

Suojärvi

Lindfors

Höglund

et al. 2020

J Hand Surg Eur Vol

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We examined the reliability of a computer-aided cone-beam CT analysis of radiographic parameters of 50 normal distal radii and compared it with interobserver agreement of measurements made by three groups of physicians on two-dimensional plain radiographs. The intra-rater reliability of the computer-aided analysis was evaluated on 33 wrists imaged twice by cone-beam CT. The longitudinal axis, anterior tilt, radial inclination and ulnar variance were measured. The reliability of computer-aided analysis was excellent (intraclass correlation coefficient (ICC) 0.94–0.96) while the interobserver agreement of two-dimensional radiograph interpretation was good (ulnar variance, ICC 0.80–0.84) to poor (anterior tilt and radial inclination, ICC 0.20–0.42). We conclude that computer-aided cone-beam CT analysis was a reliable tool for radiographic parameter determination, whereas physicians demonstrated substantial variability especially in interpreting the angular parameters.

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“…After superseding MDCT as the imaging standard for maxillofacial surgery and dentistry in the 1980s and 1990s, CBCT has also gained recognition for the appendicular skeleton during the last decade [14][15][16][17]. With the emergence of dedicated extremity scanners, the combination of flexible positioning, weight-bearing options, decreased radiation dose, and first-rate image quality led to CBCT being increasingly used for trauma imaging [18][19][20]. Despite their advantages, one point of criticism towards CBCT scanners remains the lack of versatility compared to MDCT systems due to restrictions of scanner architecture (e.g., small source-to-image distance, narrow FOV).…”

Section: Introductionmentioning

confidence: 99%

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

et al. 2020

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Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.

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Incorporating Cone-Beam CT Into the Diagnostic Algorithm for Suspected Radiocarpal Fractures: A New Standard of Care?

Cited by 31 publications

References 27 publications

Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

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