Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects
Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emerg...
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| Published in | Skeletal radiology Vol. 49; no. 4; pp. 531 - 539 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.04.2020
Springer Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0364-2348 1432-2161 1432-2161 |
| DOI | 10.1007/s00256-019-03309-7 |
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| Abstract | Objective
The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.
Materials and methods
An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.
Results
In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (
p
< 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) (
p
= 0.002). The recommended treatment changed in 34 (16.4%) extremities.
Conclusions
Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. |
|---|---|
| AbstractList | The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.OBJECTIVEThe purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.MATERIALS AND METHODSAn ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities.RESULTSIn 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities.Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.CONCLUSIONSUltra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 [mu]Sv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 [mu]Sv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. Results In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively ( p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) ( p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Conclusions Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. ObjectiveThe purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.Materials and methodsAn ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.ResultsIn 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities.ConclusionsUltra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. Results In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively ( p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) ( p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Conclusions Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. Results In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 [mu]Sv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 [mu]Sv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Conclusions Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. |
| Audience | Academic |
| Author | Enocson, Anders Koskinen, Seppo K. Bujila, Robert Srivastava, Subhash Alagic, Zlatan |
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| Keywords | Radiography Low-dose CT Ankle injuries/treatment Wrist injuries/treatment Emergency radiology Multidetector CT Trauma |
| Language | English |
| License | Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. cc-by |
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| PublicationSubtitle | Journal of the International Skeletal Society A Journal of Radiology, Pathology and Orthopedics |
| PublicationTitle | Skeletal radiology |
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radiation dose of a MSCT, two CBCT and one conventional radiography device in the ankle region publication-title: J Foot Ankle Res doi: 10.1186/s13047-015-0067-8 – volume: 44 start-page: 797 issue: 6 year: 2015 end-page: 809 ident: CR18 article-title: Using cone-beam CT as a low-dose 3D imaging technique for the extremities: initial experience in 50 subjects publication-title: Skelet Radiol doi: 10.1007/s00256-015-2105-9 – volume: 64 start-page: 314 issue: 4 year: 2013 end-page: 318 ident: CR9 article-title: The emergence of ultra-low—dose computed tomography and the impending obsolescence of the plain radiograph? publication-title: Can Assoc Radiol J doi: 10.1016/j.carj.2013.09.004 – volume: 15 start-page: 27 issue: 1 year: 1986 end-page: 31 ident: CR6 article-title: Computed tomography and plain radiography in experimental fracture healing publication-title: Skelet Radiol doi: 10.1007/BF00355070 – volume: 90 start-page: 20170240 issue: 1077 year: 2017 ident: CR15 article-title: Radiation dose reduction in multidetector CT in fracture evaluation publication-title: Br J Radiol doi: 10.1259/bjr.20170240 – volume: 219 start-page: 11 issue: 1 year: 2001 end-page: 28.8 ident: CR2 article-title: Wrist fractures: what the clinician wants to know publication-title: Radiology doi: 10.1148/radiology.219.1.r01ap1311 – volume: 273 start-page: 153 issue: 1 year: 2014 end-page: 159 ident: CR10 article-title: Estimates of effective dose for CT scans of the lower extremities publication-title: Radiology doi: 10.1148/radiol.14132903 – volume: 153 start-page: 529 issue: 3 year: 1989 end-page: 532 ident: CR4 article-title: Occult fractures of the carpals and metacarpals: demonstration by CT publication-title: AJR Am J Roentgenol doi: 10.2214/ajr.153.3.529 – ident: CR11 – volume: 100 start-page: 13761 issue: 24 year: 2003 end-page: 13766 ident: CR20 article-title: Cancer risks attributable to low doses of ionizing radiation: assessing what we really know publication-title: Proc Natl Acad Sci U S A doi: 10.1073/pnas.2235592100 – volume: 259 start-page: 311 year: 2011 end-page: 316 ident: CR8 article-title: CT dose index and patient dose: they are not the same thing publication-title: Radiology doi: 10.1148/radiol.11101800 – year: 2006 ident: CR3 publication-title: Diagnostic and surgical imaging anatomy: musculoskeletal – volume: 48 start-page: 949 issue: 6 year: 2019 end-page: 957 ident: CR12 article-title: Single-shot CT after wrist trauma: impact on detection accuracy and treatment of fractures publication-title: Skeletal Radio doi: 10.1007/s00256-018-3097-z – volume: 31 start-page: 401 issue: 8 year: 2017 end-page: 406 ident: CR16 article-title: Optimizing radiation dose in computed tomography of articular fractures publication-title: J Orthop Trauma doi: 10.1097/BOT.0000000000000861 – volume: 18 start-page: 263 issue: 4 year: 2001 end-page: 269 ident: CR1 article-title: Diagnostic errors in an accident and emergency department publication-title: Emerg Med J doi: 10.1136/emj.18.4.263 – volume: 27 start-page: 3609 issue: 9 year: 2017 end-page: 3617 ident: CR13 article-title: Head CT: image quality improvement with ASIR-V using a reduced radiation dose protocol for children publication-title: Eur Radiol doi: 10.1007/s00330-017-4733-z – volume: 123 start-page: 765 issue: 10 year: 2018 end-page: 777 ident: CR19 article-title: Radiation dose in non-dental cone beam CT applications: a systematic review publication-title: Radiol Med doi: 10.1007/s11547-018-0910-7 – volume: 190 start-page: 10 issue: 1 year: 2008 ident: 3309_CR5 publication-title: AJR Am J Roentgenol doi: 10.2214/AJR.07.2699 – volume: 90 start-page: 20170240 issue: 1077 year: 2017 ident: 3309_CR15 publication-title: Br J Radiol doi: 10.1259/bjr.20170240 – volume: 64 start-page: 314 issue: 4 year: 2013 ident: 3309_CR9 publication-title: Can Assoc Radiol J doi: 10.1016/j.carj.2013.09.004 – volume: 18 start-page: 263 issue: 4 year: 2001 ident: 3309_CR1 publication-title: Emerg Med J 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The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist... The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle... Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist... ObjectiveThe purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist... |
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| SubjectTerms | Acute Disease Adolescent Adult Aged Aged, 80 and over Ankle Ankle - diagnostic imaging Ankle Fractures - diagnostic imaging Comparative analysis Computed tomography CT imaging Detectors Diagnostic imaging Digital imaging Emergency medical services Extremities - diagnostic imaging Extremities - injuries Female Fractures Fractures, Bone - diagnostic imaging Humans Imaging Injuries Male Medicine Medicine & Public Health Middle Aged Multidetector Computed Tomography - methods Multidetector CT . Trauma . Low-dose CT . Radiography . Wrist injuries/treatment . Ankle injuries/treatment . Emergency radiology Nuclear Medicine Orthopedics Pathology Radiation Dosage Radiographs Radiography Radiology Reproducibility of Results Scientific Scientific Article Sensitivity and Specificity Wrist Wrist - diagnostic imaging Wrist Injuries - diagnostic imaging Young Adult |
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| Title | Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects |
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