Low-dose CT of postoperative pelvic fractures: a comparison with radiography

Eriksson, Tomas; Berg, Per; Olerud, Claes; Shalabi, Adel; Hänni, Mari

doi:10.1177/0284185118770919

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…The calculated median effective radiation dose for the low-dose protocol in our study (0.4-0.5 mSv) was in the lower range compared to other studies using low-dose CT of the pelvis (0.2-2.3 mSv) [4,9,10]. Our values can be compared to effective radiation doses of between 0.3 and 0.4 mSv for CR of the pelvis with 3-5 projections in recently reported data [4,23]. Attaining correct and comparable projections of the pelvis with CR can be challenging, and incorrect projections might demand repeated radiography in 6-20% of cases, resulting in higher radiation doses and patient inconvenience [21].…”

Section: Discussioncontrasting

confidence: 72%

Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study

Lundin

Olivecrona

Bakhshayesh

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose High-energy pelvic fractures are complex injuries often requiring surgical treatment. Different radiological methods exist to evaluate the reduction and healing process postoperatively but with certain limitations. The aim of this study was to evaluate Computed Tomography Micromotion Analysis (CTMA) in a clinical setting for follow-up of surgically treated pelvic fracture patients. Methods 10 patients surgically treated for a pelvic fracture were included and prospectively followed with Computed Tomography (CT) at 0, 6, 12 and 52 weeks postoperatively. CTMA was used to measure postoperative translation and rotation of the pelvic fracture during the 52 weeks follow-up. Clinical outcomes were collected through the questionnaires EQ-5D index score and Majeed score. Results 10 patients were included with mean age (± SD, min–max) 52 (16, 31–80) years and 70% (n = 7) were males. The median (IQR, min–max) global translation from 0 to 52 weeks was 6.0 (4.6, 1.4–12.6) millimeters and median global rotation was 2.6 (2.4, 0.7–4.7) degrees. The general trend was a larger translation between 0 and 6 weeks postoperatively compared to 6–12 and 12–52 weeks. For the clinical outcomes, the general trend was that all patients started from high scores which decreased in the first postoperative follow-up and recovered to different extent during the study period. Conclusion CTMA was successfully used in the follow-up of surgically treated pelvic fracture patients. Movement in the pelvic fractures after surgical fixation was largest between 0 and 6 weeks.

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Section: Discussioncontrasting

confidence: 72%

Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study

Lundin

Olivecrona

Bakhshayesh

et al. 2023

Eur J Orthop Surg Traumatol

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“…Examinations with particularly low-dose (LD) have become established in many areas, for example, in pulmonary 4,5 or paranasal sinus imaging, 6,7 but also in uroradiology. 8,9 In musculoskeletal (MSK) radiology, there are various studies dealing with the reduction of radiation dose in CT, [10][11][12][13][14] but clinical use has so far been limited. For example, fracture detection improved in LD CT images with the same 10 or only 2.5-fold 11 higher-dose exposure than in radiographs.…”

mentioning

confidence: 99%

“…8,9 In musculoskeletal (MSK) radiology, there are various studies dealing with the reduction of radiation dose in CT, [10][11][12][13][14] but clinical use has so far been limited. For example, fracture detection improved in LD CT images with the same 10 or only 2.5-fold 11 higher-dose exposure than in radiographs. In addition, dose reductions of 48% 14 to 93% 13 have been reported for LD CT images compared with standard-dose CT images for detecting lumbar spine and limb fractures, respectively, without a substantial loss in diagnostic image quality.…”

mentioning

confidence: 99%

Low-Dose CT Imaging of the Pelvis in Follow-up Examinations—Significant Dose Reduction and Impact of Tin Filtration

et al. 2022

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Objectives: Low-dose (LD) computed tomography (CT) is still rarely used in musculoskeletal (MSK) radiology. This study evaluates the potentials of LD CT for follow-up pelvic imaging with special focus on tin filtration (Sn) technology for normal and obese patients with and without metal implants. Materials and Methods: In a phantom study, 5 different LD and normal-dose (ND) CT protocols with and without tin filtration were tested using a normal and an obese phantom. Iterative reconstruction (IR) and filtered back projection (FBP) were used for CT image reconstruction. In a subsequent retrospective patient study, ND CT images of 45 patients were compared with follow-up tin-filtered LD CT images with a 90% dose reduction. Sixty-four percent of patients contained metal implants at the follow-up examination. Computed tomography images were objectively (image noise, contrast-to-noise ratio [CNR], dose-normalized contrast-to-noise ratio [CNRD]) and subjectively, using a 6-point Likert score, evaluated. In addition, the figure of merit was calculated. For group comparisons, paired t tests, Wilcoxon signed rank test, analysis of variance, or Kruskal-Wallis tests were used, where applicable. Results: The LD Sn protocol with 67% dose reduction resulted in equal values in qualitative (Likert score) and quantitative image analysis (image noise) compared with the ND protocol in the phantom study. For follow-up examinations, dose could be reduced up to 90% by using Sn LD CT scans without impairment in the clinical study. However, metal implants resulted in a mild impairment of Sn LD as well as ND CT images. Cancellous bone (P < 0.001) was assessed worse and cortical bone ( P = 0.063) equally in Sn LD CT images compared with ND CT images. Figure of merit values were significant ( P ≤ 0.02) lower and hence better in Sn LD as in ND protocols. Obese patients benefited in particular from tin filtration in LD MSK imaging in terms of image noise and CNR ( P ≤ 0.05). Conclusions: Low-dose CT scans with tin filtration allow maximum dose reduction while maintaining high image quality for certain clinical purposes, for example, follow-up examinations, especially metal implant position, material loosening, and consolidation controls. Overweight patients benefit particularly from tin filter technology. Although metal implants decrease image quality in ND as well as in Sn LD CT images, this is not a relevant limitation for assessability.

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“…CT diagnosis of all aspects of musculoskeletal diseases would increase dramatically over the following decades, and CT is today a workhorse of all musculoskeletal imaging. Low-dose musculoskeletal CT, achieving an effective dose comparable to that of conventional radiography of the same organ, has been reported in several papers for lumbar spine imaging (99-101) and the pelvis and hip (102,103) between 2014 and 2019.…”

Section: Techniquesmentioning

confidence: 98%

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica

et al. 2021

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During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.

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Low-dose CT of postoperative pelvic fractures: a comparison with radiography

Abstract: LDCT is more reliable than CR in assessing hardware position and fracture reduction. Joint congruency is sometimes not possible to assess with CR, due to overlapping hardware. The image quality is higher, but also the effective dose, with LDCT than with CR.

Cited by 12 publications

References 26 publications

Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study

Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study

Low-Dose CT Imaging of the Pelvis in Follow-up Examinations—Significant Dose Reduction and Impact of Tin Filtration

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica

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