The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

D’Amore, Taylor; Klein, Gregg R.; Lonner, Jess H.

doi:10.1016/j.artd.2022.03.008

Cited by 13 publications

(2 citation statements)

References 59 publications

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“…A compromise between image quality and radiation dose must be considered with the use of CT as it offers superior image resolution but at the expense of higher radiation dose deposited to the patient (18). This problem is exacerbated by the poor choice of CT parameters by clinicians and the lack of a single low-dose CT protocol (19).…”

Section: Image Quality Vs Radiation Dosementioning

confidence: 99%

The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation

Ramesh,

Di Laura,

Henckel

et al. 2023

EFORT Open Reviews

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CT is the principal imaging modality used for the pre-operative 3D planning and assessment of total hip arthroplasty (THA). The image quality offered by CT has a radiation penalty to the patient. Higher than necessary radiation exposure is of particular concern when imaging young patients and women of childbearing age, due to the greater risk of radiation-induced cancer in this group. A harmonised low-dose CT protocol is needed, evidenced by the huge variability in the 17 protocols reviewed. The majority of the protocols were incomplete, leading to uncertainty among radiographers when performing the scans. Only three protocols (20%) were optimised for both ‘field of view’ and image acquisition parameters. 10 protocols (60%) were optimised for ‘field of view’ only. These protocols included imaging of the relevant landmarks in the bony pelvis in addition to the knees – the reference for femoral anteversion. CT parameters, including the scanner kilovoltage (kV), milliamperage–time product (mAs) and slice thickness, must be optimised with a ‘field of view’ that includes the relevant bony landmarks. The recommended kV and mAs values were very wide ranging from 100 to 150 and from 100 to 250, respectively. The large variability that exists amongst the CT protocols illustrates the need for a more consistent low-dose CT protocol for the planning of THA. This must provide an optimal balance between image quality and radiation dose to the patient. Current CT scanners do not allow for measurements of functional pelvic orientation and additional upright imaging modalities are needed to augment them.

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Section: Image Quality Vs Radiation Dosementioning

confidence: 99%

The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation

Ramesh,

Di Laura,

Henckel

et al. 2023

EFORT Open Reviews

View full text Add to dashboard Cite

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“…obtaining correct rotation of femoral components (Hirschmann et al, 2011;Pietrzak et al, 2018). Computed tomography (CT) is state of the art for acquiring 3D bone models, but it exposes the patient to radiation (Brenner & Hall, 2007;D'Amore et al, 2022;Ponzio & Lonner, 2015) and is an expensive procedure. Another imaging technique is ultrasound (US).…”

Section: Introductionmentioning

confidence: 99%

3D Reconstruction of Femur using Ultrasound - Hand Guided Evaluation and Autonomous Robotic Approach

Phlippen,

Hohlmann,

Radermacher

EPiC Series in Health Sciences

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Total Knee Arthroplasty is a frequently performed surgery. Patient specific planning and implants may improve surgical outcome. For this purpose, 3D models of the bones are required, which are typically generated by using computed tomography. A radiation free and cheaper alternative could be ultrasound. However, bone segmentation and a competitive method of creating a complete bone model are a challenge.In this work a fully-automatic bone reconstruction pipeline using ultrasound, which includes machine learning based image segmentation and an interpolation algorithm for missing areas using statistical shape models, is presented and evaluation results with free hand probe guidance are outlined. A mean surface distance error of 0.96 mm for femur bone reconstruction is achieved. Furthermore, a robotic scanning approach is presented to automate the entire process. Autonomous scanning of the anterior distal femur was successful for 4 out of 5 probands. On average, 54 % of the accessed bone surface could be reconstructed.

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Medial posterior tibial slope measurements are overestimated on long radiographs and 3D CT compared to measurements on short lateral radiographs

Mabrouk,

Chou,

Duouguih

et al. 2024

J. exp. orthop.

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PurposeThis study assessed the measurements of the medial posterior tibial slope (MPTS) using long radiographs and three‐dimensional (3D) computed tomography (CT) scans and compared them to measurements taken on short lateral knee radiographs. The study aimed to identify whether the at‐risk slope measurements previously defined on the short radiographs would be similar to long radiographs and 3D CT scans.MethodsA retrospective radiological review of 52 cases, who underwent planning for a slope‐changing high tibial osteotomy and had short and long lateral radiographs and 3D CT scans of the tibia. Two independent observers measured the MPTS on the three modalities. The MPTS was defined as the angle between a tangent to the medial tibial plateau and the referenced tibia anatomical axis. The MPTS measurements from the short and long radiographs were compared to each other and then were compared to the measurements performed on the CT scan. False positives were defined as those cases with MPTS measurements of >78° on CT scans or long radiographs while having measurements ≤78° on short radiographs. These false positive cases are the ones which would be falsely labelled as having an abnormal slope based on the previously validated short radiograph slope threshold ≥12°.ResultsA total of 52 cases were analysed (67.9% males and 32.1% females). The mean age was 27 ± 5.4 years. The mean weight was 71.5 ± 7.7 kg, and the mean height was 1.8 ± 0.1 m. The mean MPTS measured on the short radiographs was 77.3 ± 2.3°; on the long radiographs, it was 75.8 ± 2.0°; and on the CT scan, it was 75.3 ± 2.1°. There was a positive correlation between the measurements taken on both the short and long radiographs (r = 0.9) (p < 0.001). Additionally, there was a positive correlation between CT tibial slope measurements and both short and long radiographs tibial slope measurements (r = 0.86, r = 0.87), respectively (both p < 0.001). False positives were 13 (25%) patients on long radiographs, and 12 (23.1%) patients on CT scans, who had their MPTS measurements ≤78° (equivalent of PTS ≥ 12°) while their measurements were >78° on the short radiographs.ConclusionMeasurements of the MPTS can be overestimated by 1.5–2° on long lateral knee radiographs or 3D CT scans compared to measurements taken on short lateral radiographs. Different thresholds for the abnormal PTS measurements on long radiographs and CT scans, should be defined, considering the overestimated measurements in these modalities.Level of EvidenceLevel IV case series.

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The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

Cited by 13 publications

References 59 publications

The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation

The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation

3D Reconstruction of Femur using Ultrasound - Hand Guided Evaluation and Autonomous Robotic Approach

Medial posterior tibial slope measurements are overestimated on long radiographs and 3D CT compared to measurements on short lateral radiographs

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