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Baboeram NSVL, Sanders FRK, Wellenberg RHH, Dobbe JGG, Streekstra GJ, Maas M, Schepers T. Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis. Arch Orthop Trauma Surg 2024; 144:755-762. [PMID: 38129717 DOI: 10.1007/s00402-023-05120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images. MATERIALS AND METHODS In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary's angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires. RESULTS Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary's angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied. CONCLUSION Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
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Affiliation(s)
- N S V L Baboeram
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - F R K Sanders
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Schepers
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Hamard M, Sans Merce M, Gorican K, Poletti PA, Neroladaki A, Boudabbous S. The Role of Cone-Beam Computed Tomography CT Extremity Arthrography in the Preoperative Assessment of Osteoarthritis. Tomography 2023; 9:2134-2147. [PMID: 38133071 PMCID: PMC10747585 DOI: 10.3390/tomography9060167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Osteoarthritis (OA) is a prevalent disease and the leading cause of pain, disability, and quality of life deterioration. Our study sought to evaluate the image quality and dose of cone-beam computed tomography arthrography (CBCT-A) and compare them to digital radiography (DR) for OA diagnoses. Overall, 32 cases of CBCT-A and DR with OA met the inclusion criteria and were prospectively analyzed. The Kellgren and Lawrence classification (KLC) stage, sclerosis, osteophytes, erosions, and mean joint width (MJW) were compared between CBCT-A and DR. Image quality was excellent in all CBCT-A cases, with excellent inter-observer agreement. OA under-classification was noticed with DR for MJW (p = 0.02), osteophyte detection (<0.0001), and KLC (p < 0.0001). The Hounsfield Unit (HU) values obtained for the cone-beam computed tomography CBCT did not correspond to the values for multi-detector computed tomography (MDCT), with a greater mean deviation obtained with the MDCT HU for Modeled Based Iterative Reconstruction 1st (MBIR1) than for the 2nd generation (MBIR2). CBCT-A has been found to be more reliable for OA diagnosis than DR as revealed by our results using a three-point rating scale for the qualitative image analysis, with higher quality and an acceptable dose. Moreover, the use of this imaging technique permits the preoperative assessment of extremities in an OA diagnosis, with the upright position and bone microarchitecture analysis being two other advantages of CBCT-A.
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Affiliation(s)
| | | | | | | | | | - Sana Boudabbous
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; (M.H.); (M.S.M.); (K.G.); (P.-A.P.); (A.N.)
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Wellenberg RHH, Schallig W, Steenbergen P, Tex PD, Dobbe JGG, Streekstra GJ, Witbreuk MMEH, Buizer AI, Maas M. Assessment of foot deformities in individuals with cerebral palsy using weight-bearing CT. Skeletal Radiol 2022; 52:1313-1320. [PMID: 36585514 DOI: 10.1007/s00256-022-04272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aims of this study were to visualize and quantify relative bone positions in the feet of individuals with cerebral palsy (CP) with a foot deformity and compare bone positions with those of typically developed (TD) controls. MATERIALS AND METHODS Weight-bearing CT images of 14 individuals with CP scheduled for tendon transfer and/or bony surgery and of 20 TD controls were acquired on a Planmed Verity WBCT scanner. Centroids of the navicular and calcaneus with respect to the talus were used to quantify foot deformities. All taluses were aligned and the size and dimensions of the individuals' talus were scaled to correct for differences in bone sizes. In order to visualize and quantify variations in relative bone positions, 95% CI ellipsoids and standard deviations in its principle X-, Y-, and Z-directions were determined. RESULTS In individuals with CP (age 11-17), a large variation in centroid positions was observed compared to data of TD controls. Radiuses of the ellipsoids, representing the standard deviations of the 95% CI in the principle X-, Y-, and Z-directions, were larger in individuals with CP compared to TD controls for both the calcaneus (3.16 vs 1.86 mm, 4.26 vs 2.60 mm, 9.19 vs 3.60 mm) and navicular (4.63 vs 1.55 mm, 5.18 vs 2.10 mm, 16.07 vs 4.16 mm). CONCLUSION By determining centroids of the calcaneus and navicular with respect to the talus on WBCT images, normal and abnormal relative bone positions can be visualized and quantified in individuals with CP with various foot deformities.
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Affiliation(s)
- R H H Wellenberg
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. .,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - W Schallig
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Steenbergen
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P den Tex
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J G G Dobbe
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - G J Streekstra
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - M M E H Witbreuk
- Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - A I Buizer
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam UMC, Pediatric Rehabilitation, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - M Maas
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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Brandenburg LS, Siegel M, Neubauer J, Merz J, Bode G, Kühle J. Measuring standing hindfoot alignment: reliability of different approaches in conventional x-ray and cone-beam CT. Arch Orthop Trauma Surg 2022; 142:3035-3043. [PMID: 33885961 PMCID: PMC9522738 DOI: 10.1007/s00402-021-03904-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Currently there is no consensus how hindfoot alignment (HA) should be assessed in CBCT scans. The aim of this study is to investigate how the reliability is affected by the anatomical structures chosen for the measurement. MATERIALS AND METHODS Datasets consisting of a Saltzman View (SV) and a CBCT of the same foot were acquired prospectively and independently assessed by five raters regarding HA. In SVs the HA was estimated as follows: transversal shift between tibial shaft axis and heel contact point (1); angle between tibial shaft axis and a tangent at the medial (2) or lateral (3) calcaneal wall. In CBCT the HA was estimated as follows: transversal shift between the centre of the talus and the heel contact point (4); angle between a perpendicular line and a tangent at the medial (5) or lateral (6) calcaneal wall; angle between the distal tibial surface and a tangent at the medial calcaneal wall (7). Intraclass correlation coefficients (ICC) were calculated to assess inter-rater reliability. A linear regression was performed to compare the different measurement regarding their correlation. RESULTS 32 patients were included in the study. The ICCs for the measurements 1-7 were as follows: (1) 0.924 [95% CI 0.876-0.959] (2) 0.533 [95% CI 0.377-0.692], (3) 0.553 [95% CI 0.399-0.708], (4) 0.930 [95% CI 0.866-0.962], (5) 0.00 [95% CI - 0.111 to 0.096], (6) 0.00 [95% CI - 0.103 to 0.111], (7) 0.152 [95% CI 0.027-0.330]. A linear regression between measurement 1 and 4 showed a correlation of 0.272 (p = 0.036). CONCLUSIONS It could be shown that reliability of measuring HA depends on the investigated anatomical structure. Placing a tangent along the calcaneus (2, 3, 5, 6, 7) was shown to be unreliable, whereas determining the weight-bearing heel point (1, 4) appeared to be a reliable approach. The correlation of the measurement workflows is significant (p = 0.036), but too weak (0.272) to be used clinically.
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Affiliation(s)
- Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Markus Siegel
- Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Jakob Neubauer
- Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Johanna Merz
- Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
- Sporthopaedicum Straubing, Bahnhofsplatz 27, 94315 Straubing, Germany
| | - Jan Kühle
- Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
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Jandl NM, Rolvien T, Rupp T, Schumacher U, Püschel K, Maas KJ, Amling M, Henes FO, Spink C. Diagnostic yield of cone beam computed tomography for small foreign body detection in the hand in comparison with radiography, MSCT and MRI: an ex vivo study. Injury 2021; 52:2841-2847. [PMID: 33487409 DOI: 10.1016/j.injury.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Detection of symptomatic foreign bodies (FB) after penetrating hand injuries can be challenging. Multiplanar radiography is most frequently used for FB detection and may be complemented by multislice computed tomography (MSCT) if suspected FBs cannot be identified and clinical symptoms are persisting. Cone beam computed tomography (CBCT) is a promising imaging modality for traumatology aside from fracture detection. The aim of this study was to evaluate the diagnostic yield of CBCT for different small FBs in the hand in comparison with radiography, MSCT and magnetic resonance imaging (MRI). METHODS In ten cadaveric hands of voluntary body donors, 20 different FBs (metal, glass, stone, wood, thorn) in predefined sizes (0.5, 1 and 2mm) were randomly placed in the central hand and the basal phalanges. All hands were imaged using radiography, 256-slice CT, CBCT, and 3T MRI. A total of 200 subcutaneous and intramuscular particles were analyzed for their visibility by two observers at two time points. The Cohens Kappa coefficient was calculated as a measure of interobserver agreement and intraobserver reliability. The particle detection rate between different imaging modalities was compared using McNemar Chi2-tests. RESULTS CBCT and MSCT provided a higher detection rate (94.6% and 86.3%) for detecting metal, glass and stone particles compared to standard radiography (70.0%; each p<0.001). MRI did not provide a diagnostic benefit. Wood particles and thorns were not reliably recognizable by any imaging technique. The interobserver agreement (K=0.768; p<0.001) and the intraobserver reliability for both observers (K1=0.914 and K2=0.907; p<0.001) were good. The dose length product (DLP) was 2-fold lower in CBCT than in MSCT (39.2 ± 2.1 vs. 81.4 ± 2.9 mGy*cm; p<0.001). CONCLUSIONS In this ex vivo study, CBCT provided a high detection rate for small metal, glass, and stone particles while the radiation exposure was significantly lower compared to MSCT. These results suggest that CBCT instead of MSCT seems a reasonable option in supplementary diagnostics to exclude of FBs. The primary use of CBCT instead of radiography may be considered for symptomatic patients with expected small radiopaque particles <1mm. Organic FBs can be visualized indirectly in MRI and CBCT/MSCT by entrapped surrounding air. LEVEL OF EVIDENCE Level I, diagnostic study.
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Affiliation(s)
- Nico Maximilian Jandl
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tobias Rupp
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Evaluation of Ultra-High-Resolution Cone-Beam CT Prototype of Twin Robotic Radiography System for Cadaveric Wrist Imaging. Acad Radiol 2021; 28:e314-e322. [PMID: 32654956 DOI: 10.1016/j.acra.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES Cone-beam CT (CBCT) applications possess potential for dose reduction in musculoskeletal imaging. This study evaluates the ultra-high-resolution CBCT prototype of a twin robotic X-ray system in wrist examinations compared to high-resolution multidetector CT (MDCT). MATERIALS AND METHODS Sixteen wrists of body donors were examined with the CBCT scan mode and a 384 slice MDCT system. Radiation-equivalent low-dose (CTDIvol(16cm) = 3.3 mGy) and full-dose protocols (CTDIvol(16cm) = 13.8 mGy) were used for both systems. Two observers assessed image quality on a seven-point Likert scale. In addition, software-assisted quantification of signal intensity fractions in cancellous bone was performed. Fewer pixels with intermediate signal intensity were considered to indicate superior depiction of bone microarchitecture. RESULTS Subjective image quality in CBCT was superior to dose equivalent MDCT with p ≤ 0.03 for full-dose and p < 0.001 for low-dose scans, respectively. Median Likert values were 7/7 (reader 1 / reader 2) in full-dose CBCT, 6/6 in full-dose MDCT, 5/6 in low-dose CBCT and 3/3 in low-dose MDCT. Intraclass correlation coefficient was 0.936 (95% confidence interval, 0.897-0.961; p < 0.001), indicating excellent reliability. Objective analysis displayed smaller fractions of "indecisive" pixels with intermediate signal intensity for full-dose CBCT (0.57 [interquartile range 0.13]) compared to full-dose MDCT (0.68 [0.21]), low-dose CBCT (0.72 [0.19]), and low-dose MDCT (0.80 [0.15]) studies. No significant difference was observed between low-dose CBCT and full-dose MDCT. CONCLUSION The new CBCT prototype provides superior image quality for trabecula and bone marrow in cadaveric wrist studies and enables dose reduction up to 75% compared to high-resolution MDCT.
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Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi X, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys 2021; 22:128-138. [PMID: 33811787 PMCID: PMC8130242 DOI: 10.1002/acm2.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of the study was to estimate and to compare effective doses in the elbow region resulting from four different x-ray imaging modalities. Absorbed organ doses were measured using 11 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom-made anthropomorphic elbow RANDO phantom. Examinations were performed using Shimadzu FH-21 HR radiography device, Siemens Sensation Open 24-slice MSCT-device, NewTom 5G CBCT device, and Planmed Verity CBCT device, and the effective doses were calculated according to ICRP 103 recommendations. The effective dose for the conventional radiographic device was 1.5 µSv. The effective dose for the NewTom 5G CBCT ranged between 2.0 and 6.7 µSv, for the Planmed Verity CBCT device 2.6 µSv and for the Siemens Sensation MSCT device 37.4 µSv. Compared with conventional 2D radiography, this study demonstrated a 1.4-4.6 fold increase in effective dose for CBCT and 25-fold dose for standard MSCT protocols. When compared with 3D CBCT protocols, the study showed a 6-19 fold increase in effective dose using a standard MSCT protocol. CBCT devices offer a feasible low-dose alternative for elbow 3D imaging when compared to MSCT.
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Affiliation(s)
- Juha Koivisto
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery/Oral PathologyVU University Medical CenterAmsterdamThe Netherlands
| | - John Ludlow
- University of North CarolinaAdams School of DentistryChapel HillNCUSA
| | | | - Xie‐Qi Shi
- Section of Oral Maxillofacial RadiologyDepartment of Clinical DentistryFaculty of Medicine and DentistryUniversity of BergenBergenNorway
| | - Jan Wolff
- Department of Oral Maxillofacial SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Division of Regenerative Orofacial MedicineHamburgGermany
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Tuncer K, Topal M, Tekin E, Sade R, Pirimoglu RB, Polat G. The new ultralow dose CT protocol for the diagnosis of fractures of the ankle: A prospective comparative study with conventional CT. J Orthop Surg (Hong Kong) 2021; 28:2309499020960238. [PMID: 32985384 DOI: 10.1177/2309499020960238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Computerized tomography (CT) imaging is increasingly being used to evaluate patients with ankle trauma. However, conventional CT (C CT) has a significantly higher radiation dose (RD) than plain radiography. This study aimed to evaluate the diagnostic accuracy and reliability of ultra-low-dose CT (ULDCT) protocol for ankle fractures. METHODS Ninety-eight consecutive patients who had ankle CT for suspected ankle fracture were included in our prospective study. C CT and ULDCT protocols were simultaneously performed on these 98 patients. Two observers independently evaluated ULDCT and C CT images. The effective RD of the ULDCT and C CT groups was calculated. RESULTS The interobserver agreement was 1 (perfect). ULDCT and C CT group images showed no significant difference in image quality. The effective RD of the ULDCT was significantly lower than the C CT (p < 0.001). CONCLUSIONS By evaluating the results of this study, ULDCT proved to be a reliable diagnostic imaging method for fractures of the ankle. The satisfactory diagnostic image quality of the ULDCT protocol provides promising results. LEVEL OF EVIDENCE Level II/lesser quality RCT or prospective comparative study.
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Affiliation(s)
- Kutsi Tuncer
- Department of Orthopedics and Traumatology, 64060Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Murat Topal
- Department of Orthopedics and Traumatology, 485657Kastamonu University Faculty of Medicine, Kastamonu, Turkey
| | - Erdal Tekin
- Department of Emergency Medicine, 64060Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Recep Sade
- Department of Radiology, 64060Ataturk University Faculty of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, 64060Ataturk University, Erzurum, Turkey
| | | | - Gokhan Polat
- Department of Radiology, 64060Ataturk University Faculty of Medicine, Erzurum, Turkey
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Jacques T, Morel V, Dartus J, Badr S, Demondion X, Cotten A. Impact of introducing extremity cone-beam CT in an emergency radiology department: A population-based study. Orthop Traumatol Surg Res 2021; 107:102834. [PMID: 33524633 DOI: 10.1016/j.otsr.2021.102834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Musculoskeletal cone-beam CT (CBCT) recently appeared on the market, with image quality comparable to that of high-resolution CT. It was previously implemented mainly in craniofacial surgery and in orthopedic limb surgery for weight-bearing imaging, but without large-scale assessment in emergency settings. We therefore conducted a retrospective comparative study in an emergency radiology department: 1) to assess whether introduction of CBCT dedicated to extremity traumatology reduced radiation dose delivered to the patient undergoing cross-sectional imaging, 2) to assess whether it increased turnover, and 3) to study the feasibility and practical consequences. Study hypothesis Introducing CBCT dedicated to traumatology in an emergency radiology department reduces radiation dose related to cross-sectional imaging in extremity trauma. PATIENTS AND METHODS Two periods were distinguished: in May-November 2016, the only cross-sectional imaging available in our emergency radiology department was multi-detector CT (MDCT); in May-November 2017, both MDCT and CBCT were available. Thus, the population in period 1 (n=165) had undergone only MDCT extremity imaging, while patients in period 2 underwent either CBCT (n=139) or MDCT (n=85). Study parameters notably included dose-length product (DLP) and length of patient stay in the radiology department (turnover). RESULTS Mean DLP was significantly reduced with the introduction of CBCT: 210.3±133.6 mGy.cm (range, 20-595) in period 1, versus 138.4±92.7 mGy.cm (range, 32-623) in period 2 (p<0.0001). Taking both periods together, mean DLP was 50.7% lower with CBCT (n=139) than MDCT (n=249): respectively, 101.6±14.9 mGy.cm (range, 50.6-126.9) versus 206.5±131.8 mGy.cm (range, 20-623) (p<0.0001). Turnover accelerated with the introduction of CBCT, with mean stay of 84.9minutes in period 1 versus 72.1minutes in period 2 (p=0.011). In period 2, turnover was 23.6% faster with CBCT than MDCT: respectively, 64.9minutes versus 85.0minutes (p=0.0004). DISCUSSION Introducing CBCT dedicated to the extremities in an emergency radiology department was feasible. It reduced overall radiation dose and accelerated turnover. LEVEL OF EVIDENCE III; comparative case-control study.
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Affiliation(s)
- Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France; Lille University School of Medicine, Faculté de Médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France.
| | - Vincent Morel
- Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - Julien Dartus
- Lille University School of Medicine, Faculté de Médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Department of Orthopedic Surgery, Lille University Hospital, Hôpital Roger Salengro, CHU de Lille, 2, avenue Oscar Lambret, 59037 Lille cedex, France
| | - Sammy Badr
- Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France
| | - Xavier Demondion
- Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France; Lille University School of Medicine, Faculté de Médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France; Lille University School of Medicine, Faculté de Médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
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10
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Broos M, Berardo S, Dobbe JGG, Maas M, Streekstra GJ, Wellenberg RHH. Geometric 3D analyses of the foot and ankle using weight-bearing and non weight-bearing cone-beam CT images: The new standard? Eur J Radiol 2021; 138:109674. [PMID: 33798932 DOI: 10.1016/j.ejrad.2021.109674] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We hypothesize that three-dimensional (3D) geometric analyses in weight bearing CT-images of the foot and ankle are more reproducible compared to two-dimensional (2D) analyses. Therefore, we compared 2D and 3D analyses on bones of weight-bearing and non weight-bearing cone-beam CT images of healthy volunteers. METHODS Twenty healthy volunteers (10 male, 10 female, mean age 37.5 years) underwent weight-bearing and non weight-bearing cone-beam CT imaging of both feet. Clinically relevant height and angle measurements were performed in 2D and 3D (for example: cuboid height, calcaneal pitch, talo-calcaneal angle, Meary's angle, intermetatarsal angle). Three-dimensional measurements were obtained using automated software. Intra-observer and inter-observer agreement were evaluated for all 2D measurements. RESULTS Overall intraclass correlation coefficients (ICC's) were higher than 0.750 for most 2D measurements, ranging from 0.352 to 0.995. Calcaneal pitch, angle between the first metatarsal (MT1) and proximal phalange 1, between the fifth metatarsal (MT5) and the calcaneus and heights of the sesamoid bones, navicular, cuboid and talus decreased during weight-bearing in both 2D and 3D results (p < 0.01). Meary's angle was not statistically different in 2D (p = 0.627) and 3D (p = 0.765). Higher coefficients of variation in 2D geometric analysis parameters (0.27 versus 0.16) indicate that 3D analyses are more precise compared to 2D (p < 0.01). Results of left and right feet are comparable for 2D and 3D analyses. CONCLUSION Although 2D and 3D geometrical analyses are fundamentally different, automated 3D analyses are more reproducible and precise compared to 2D analyses. In addition, 3D evaluation better demonstrates differences in bone configurations between weight-bearing and non weight-bearing conditions, which may be of value to demonstrate pathology.
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Affiliation(s)
- M Broos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - S Berardo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Novara, Italy.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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11
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Singh A, Zwirner J, Templer F, Kieser D, Klima S, Hammer N. On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study. Sci Rep 2021; 11:5986. [PMID: 33727610 PMCID: PMC7966405 DOI: 10.1038/s41598-021-85251-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023] Open
Abstract
Current treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF's insertional length (r = 0.80), and between the CSAs of AT's and PF's insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.
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Affiliation(s)
- A Singh
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Templer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - D Kieser
- Department of Orthopedic Surgery and MSM, Christchurch Hospital, Christchurch, New Zealand
| | - S Klima
- Orthopaedicus, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - N Hammer
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria.
- Fraunhofer Institute for Machine Tools and Forming Technology, Section of Medical Engineering, Dresden, Germany.
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12
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A cone beam CT based 3D-assessment of bony forefoot geometry after modified Lapidus arthrodesis. Foot Ankle Surg 2020; 26:883-889. [PMID: 31843521 DOI: 10.1016/j.fas.2019.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/26/2019] [Accepted: 11/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modified Lapidus arthrodesis (MLA) is a well-established treatment modality for hallux valgus deformities (HVD) associated with instability of the first ray. Although the three-dimensional (3D) nature of HVD has long been recognized, diagnostics still focus on plain radiographs. The objective of this study was to validate 3D Cone Beam CT (CBCT) in the perioperative assessment of HVD with focus on the alignment of the forefoot. METHODS In a prospective clinical study, MLA was performed on 30 patients (25 females, 5 males; mean age: 63.2 years). Pre- and postoperatively standard radiographs and CBCT with full weight-bearing were acquired. For the CBCT based assessment, reproducible criteria have been defined, measured, and correlated with established radiological indicators. RESULTS Evaluation of standard radiographic parameters (hallux-valgus angle [HVA], intermetatarsal angle 1-2 [IMA 1-2], distal metatarsal articular angle [DMAA], tibial sesamoid position [TSP]) showed significant improvement postoperatively. Comparison of measurements obtained from plain radiographs and CBCT were significantly correlated between both measuring techniques, indicating high reliability. Pronation of the first metatarsal and the sesamoids were significantly reduced by the procedure. Due to this repositioning effect, the second metatarsal head was elevated by 3.1mm, and the lateral sesamoid was lowered by 3.8mm. However, there was no correlation between the amount of pronation and conventional radiographic measures. CONCLUSIONS Compared to plain radiographs, CBCT allows a more detailed view of the forefoot alignment in the coronal plain after MLA. MLA was able to recenter the sesamoids under der first metatarsal head and conversely led to elevation of the second metatarsal head.
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13
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Sun YJ, Lou J, Xu QL, Xing YG, Zhao XZ, Zhao LL, Wang XN. Comparison of clinical diagnostic value of spiral CT with different dose in patients with early-stage peripheral lung cancer. Clin Transl Oncol 2020; 23:1128-1133. [PMID: 33222059 DOI: 10.1007/s12094-020-02503-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the clinical diagnostic value of spiral CT scan with different dose in patients with early-stage peripheral lung cancer. METHODS A total of 163 cases of patients with early-stage peripheral lung cancer who came to People's Hospital of Rizhao for treatment from June 2014 to January 2017 were retrospectively analyzed. A total of 78 cases of patients who received low-dose CT scanning were the low-dose group, another 84 cases of patients who received routine dose CT scanning were the routine dose group. Multislice helical CT (MSCT) scanning was performed in both groups, with tube voltage of 120 kV. Tube current was 25 m A in the low-dose group and 250 m A in the routine dose group. In addition, a total of 80 patients with lobar pneumonia were added as the control group of diagnostic sensitivity, specificity and accuracy. Pathological diagnosis was taken as the gold standard to compare the diagnostic sensitivity, specificity and accuracy of the two groups. RESULTS The image quality, nodules and signs of the two groups were compared, and the results of radiation dose of the two groups were compared. The diagnostic sensitivity, specificity and accuracy of the low-dose group were 82.05%, 87.50% and 84.81%, respectively. The diagnostic sensitivity, specificity and accuracy of the routine dose group were 85.71%, 86.25% and 85.97%, respectively. The diagnostic value of the two groups was not statistically significant (p > 0.05). However, the radiation dose in the low-dose group was significantly lower than that in the routine group. CONCLUSION Low-dose MSCT scanning can meet the clinical requirements for imaging diagnosis of peripheral lung cancer, and can reduce the radiation dose of patients.
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Affiliation(s)
- Y J Sun
- Department of Radiology, People's Hospital of Rizhao, Rizhao, 276826, People's Republic of China
| | - J Lou
- Department of General Surgery Ward, Jinan Zhangqiu District Hospital of TCM, Jinan, 250200, People's Republic of China
| | - Q L Xu
- Health Care Ward, The People's Hospital of Zhangqiu Area, Jinan, 250200, People's Republic of China
| | - Y G Xing
- Department of Ultrasound, The People's Hospital of Zhangqiu Area, Jinan, 250200, People's Republic of China
| | - X Z Zhao
- Pediatric Ward 2, The People's Hospital of Zhangqiu Area, Jinan, 250200, People's Republic of China
| | - L L Zhao
- Department of Respiratory Medicine, People's Hospital of Rizhao, Rizhao, 276826, People's Republic of China
| | - X N Wang
- Department of Radiology, Qingdao No. 6 People's Hospital, No. 9 Fushun Road, Qingdao, 266033, People's Republic of China.
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14
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Faccioli N, Santi E, Foti G, Mansueto G, Corain M. Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation. Musculoskelet Surg 2020; 106:169-177. [PMID: 33211300 PMCID: PMC9130154 DOI: 10.1007/s12306-020-00687-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.
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Affiliation(s)
- N Faccioli
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy.
| | - E Santi
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - G Foti
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - G Mansueto
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - M Corain
- Hand Surgery Department, G.B. Rossi University Hospital, Piazzale L.A.Scuro 10, 37134, Verona, Italy
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15
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Mouloodi S, Rahmanpanah H, Burvill C, Davies HMS. Prediction of displacement in the equine third metacarpal bone using a neural network prediction algorithm. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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16
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Accuracy of cone-beam computed tomography for syndesmosis injury diagnosis compared to conventional computed tomography. Foot Ankle Surg 2020; 26:265-272. [PMID: 30992183 DOI: 10.1016/j.fas.2019.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Syndesmosis injury can lead to ankle mortise instability and early osteoarthritis. Several multiple detector computed tomography (MDCT) methods for measurement have been developed. Weight-bearing cone beam CT (WB CBCT) is an emerging technique that offers the possibility of upright-position scanning and lower doses. This study sought to assess the diagnostic accuracy of WB CBCT in syndesmose injury compared to MDCT, with instability confirmed via manual testing upon arthroscopic examination. METHODS Three musculoskeletal radiologists with different levels of expertise prospectively analyzed 11 MDCT and eight WB CBCT scans of the same trauma-afflicted ankles with clinical suspicion of syndesmosis lesion over a period of 5 months. They evaluated 10 methods of measurement in both sides. Syndesmosis was considered pathological on arthroscopic examination in four patients. Correlation between readers was evaluated with intra-class correlation testing (p < 0.05 was considered significant). Capacity of discrimination was assessed by area under the curve (AUC) for all methods. RESULTS Inter-observer agreement was near excellent for both WB CBCT and MDCT for the anterior tibio-fibular (TF) distance (ICC = 0.781 and 0.831, respectively), posterior TF distance (ICC = 0.841 and 0.826), minimal TF distance (ICC = 0.899 and 0.875), and TF surface (ICC = 0.93 and 0.84). AUC were better for MDCT than WB CBCT in assessing syndesmosis instability for: anterior TF distance (ROC = 0.869 vs. 0.555, p = 0.01), minimal TF distance (ROC = 0.883 vs. 0.608, p = 0.02) and antero-posterior fibular translation (ROC = 0.894 vs. 0.467, p = 0.006). CONCLUSIONS MDCT demonstrated better ability to distinguish pathological syndesmosis than WB CBCT, with the antero-posterior fibular translation the best discriminating measurement. The physiological widening of the contralateral syndesmosis occurring with the WB CBCT upright position may explain these results.
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17
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Tran DML, Vilayphiou N, Koller B. Clinical in Vivo Assessment of Bone Microarchitecture With CT Scanners: An Enduring Challenge. J Bone Miner Res 2020; 35:415-416. [PMID: 31821605 DOI: 10.1002/jbmr.3919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/24/2019] [Indexed: 11/09/2022]
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18
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Mys K, Varga P, Gueorguiev B, Hemmatian H, Stockmans F, van Lenthe GH. Reply Letter to the Editor: Clinical in Vivo Assessment of Bone Microarchitecture With CT Scanners: An Enduring Challenge. J Bone Miner Res 2020; 35:413-414. [PMID: 31805211 DOI: 10.1002/jbmr.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium.,Biomedical Development, AO Research Institute Davos, Davos, Switzerland
| | - Peter Varga
- Biomedical Development, AO Research Institute Davos, Davos, Switzerland
| | - Boyko Gueorguiev
- Biomedical Development, AO Research Institute Davos, Davos, Switzerland
| | - Haniyeh Hemmatian
- Department of Osteology and Biomechanics (IOBM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Filip Stockmans
- Muscles and Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
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Tschauner S, Marterer R, Nagy E, Singer G, Riccabona M, Sorantin E. Experiences with image quality and radiation dose of cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) in pediatric extremity trauma. Skeletal Radiol 2020; 49:1939-1949. [PMID: 32535775 PMCID: PMC7652807 DOI: 10.1007/s00256-020-03506-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Novel dedicated extremity cone beam computed tomography (CBCT) devices, recently introduced to the market, raised attention as a possible alternative in advanced diagnostic pediatric trauma imaging, today usually performed by multidetector computed tomography (MDCT). This work aimed to compare image quality and radiation dose of CBCT and MDCT. MATERIALS AND METHODS Fifty-four CBCT-MDCT examination pairs, containing nine MDCTs acquired in parallel prospectively and 45 MDCTs matched in retrospect, were included in this study. Image quality was analyzed semi-objectively by measuring noise, contrast-to-noise ratio (CNR), and signal-to-noise ratios (SNR) and subjectively by performing image impression ratings. CT dose records were readout. RESULTS Image noise was significantly lower in CBCT compared with MDCT, both semi-objectively and subjectively (both p < 0.001). CNR and SNRs were also in favor of CBCT, though CBCT examinations exhibited significantly more beam hardening artifacts that diminished the advantages of the superior semi-objective image quality. These artifacts were believed to occur more often in children due to numerous bone-cartilage transitions in open growth plates and may have led to a better subjective diagnostic certainty rating (p = 0.001). Motion artifacts were infrequently, but exclusively observed in CBCT. CT dose index (CTDIvol) was substantially lower in CBCT (p < 0.001). CONCLUSION Dedicated extremity CBCT could be an alternative low-dose modality in the diagnostic pathway of pediatric fractures. At lower doses compared with MDCT and commonly affected by beam hardening artifacts, semi-objective CBCT image quality parameters were generally better than in MDCT.
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Affiliation(s)
- Sebastian Tschauner
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
| | - Robert Marterer
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Eszter Nagy
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, Graz, 8036, Austria
| | - Michael Riccabona
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
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Alagic Z, Bujila R, Enocson A, Srivastava S, Koskinen SK. Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects. Skeletal Radiol 2020; 49:531-539. [PMID: 31501959 PMCID: PMC7021773 DOI: 10.1007/s00256-019-03309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
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.
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Affiliation(s)
- Zlatan Alagic
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Robert Bujila
- Functional Unit for Medical Radiation Physics and Nuclear Medicine, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden ,Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Subhash Srivastava
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden
| | - Seppo K. Koskinen
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Quantifying Subresolution 3D Morphology of Bone with Clinical Computed Tomography. Ann Biomed Eng 2019; 48:595-605. [PMID: 31583552 PMCID: PMC6949315 DOI: 10.1007/s10439-019-02374-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023]
Abstract
The aim of this study was to quantify sub-resolution trabecular bone morphometrics, which are also related to osteoarthritis (OA), from clinical resolution cone beam computed tomography (CBCT). Samples (n = 53) were harvested from human tibiae (N = 4) and femora (N = 7). Grey-level co-occurrence matrix (GLCM) texture and histogram-based parameters were calculated from CBCT imaged trabecular bone data, and compared with the morphometric parameters quantified from micro-computed tomography. As a reference for OA severity, histological sections were subjected to OARSI histopathological grading. GLCM and histogram parameters were correlated to bone morphometrics and OARSI individually. Furthermore, a statistical model of combined GLCM/histogram parameters was generated to estimate the bone morphometrics. Several individual histogram and GLCM parameters had strong associations with various bone morphometrics (|r| > 0.7). The most prominent correlation was observed between the histogram mean and bone volume fraction (r = 0.907). The statistical model combining GLCM and histogram-parameters resulted in even better association with bone volume fraction determined from CBCT data (adjusted R2 change = 0.047). Histopathology showed mainly moderate associations with bone morphometrics (|r| > 0.4). In conclusion, we demonstrated that GLCM- and histogram-based parameters from CBCT imaged trabecular bone (ex vivo) are associated with sub-resolution morphometrics. Our results suggest that sub-resolution morphometrics can be estimated from clinical CBCT images, associations becoming even stronger when combining histogram and GLCM-based parameters.
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Grunz JP, Kunz AS, Gietzen CH, Weng AM, Veyhl-Wichmann M, Ergün S, Schmitt R, Bley TA, Gassenmaier T. 3D cone-beam CT of the ankle using a novel twin robotic X-ray system: Assessment of image quality and radiation dose. Eur J Radiol 2019; 119:108659. [DOI: 10.1016/j.ejrad.2019.108659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022]
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Durastanti G, Leardini A, Siegler S, Durante S, Bazzocchi A, Belvedere C. Comparison of cartilage and bone morphological models of the ankle joint derived from different medical imaging technologies. Quant Imaging Med Surg 2019; 9:1368-1382. [PMID: 31559166 DOI: 10.21037/qims.2019.08.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurate geometrical models of bones and cartilage are necessary in biomechanical modelling of human joints, and in planning and designing of joint replacements. Image-based subject-specific model development requires image segmentation, spatial filtering and 3-dimensional rendering. This is usually based on computed tomography (CT) for bone models, on magnetic resonance imaging (MRI) for cartilage models. This process has been reported extensively in the past, but no studies have ever compared the accuracy and quality of these models when obtained also by merging different imaging modalities. The scope of the present work is to provide this comparative analysis in order to identify optimal imaging modality and registration techniques for producing 3-dimensional bone and cartilage models of the ankle joint. Methods One cadaveric leg was instrumented with multimodal markers and scanned using five different imaging modalities: a standard, a dual-energy and a cone-beam CT (CBCT) device, and a 1.5 and 3.0 Tesla MRI devices. Bone, cartilage, and combined bone and cartilage models were produced from each of these imaging modalities, and registered in space according to matching model surfaces or to corresponding marker centres. To assess the quality in overall model reconstruction, distance map analyses were performed and the difference between model surfaces obtained from the different imaging modalities and registration techniques was measured. Results The registration between models worked better with model surface matching than corresponding marker positions, particularly with MRI. The best bone models were obtained with the CBCT. Models with cartilage were defined better with the 3.0 Tesla than the 1.5 Tesla. For the combined bone and cartilage models, the colour maps and the numerical results from distance map analysis (DMA) showed that the smallest distances and the largest homogeneity were obtained from the CBCT and the 3.0 T MRI via model surface registration. Conclusions These observations are important in producing accurate bone and cartilage models from medical imaging and relevant for applications such as designing of custom-made ankle replacements or, more in general, of implants for total as well as focal joint replacements.
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Affiliation(s)
- Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
CLINICAL/METHODICAL ISSUE Digital volume tomography (DVT) and cone-beam computed tomography (CT) with C‑arm systems have become established three-dimensional imaging systems as an alternative to CT in some application areas. STANDARD RADIOLOGICAL METHODS The technology of the systems is well developed so that they have become a competing method to CT imaging in terms of image quality and radiation exposure. PERFORMANCE An advantage is the better spatial resolution, preferably with dedicated scanner systems, especially in the z direction. The radiation exposure of CT, cone beam CT and DVT are comparable, if the exposure parameter in CT imaging can be adjusted to the lower exposure levels. ACHIEVEMENTS Advantages of these systems are that they can be used for imaging in a better workflow or to acquire images under conditions not possible in CT, e. g. imaging under stress in orthopedics or to take images in the corona technique with a horizontal gantry in cone-beam CT mammography PRACTICAL RECOMMENDATIONS: The use of three-dimensional imaging is becoming more frequent and will replace planar radiography in additional clinical situations. The three-dimensional imaging without superpositioning of structures has advantages in the visibility of structures and the spatial relation to other organs and structures. In guidelines and recommendations, the number of recommendations given for the use of three-dimensional imaging is increasing. This leads to a small increase in the radiation exposure of patients, a trend which is reflected in the annual reports of the Federal Office for Radiation Protection.
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Mys K, Varga P, Gueorguiev B, Hemmatian H, Stockmans F, van Lenthe GH. Correlation Between Cone-Beam Computed Tomography and High-Resolution Peripheral Computed Tomography for Assessment of Wrist Bone Microstructure. J Bone Miner Res 2019; 34:867-874. [PMID: 30912861 DOI: 10.1002/jbmr.3673] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 11/10/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is considered as the best technique to measure bone microarchitecture in vivo. However, a breakthrough for medical applications is inhibited because of the restricted field of view (∼9 mm) and a relatively long acquisition time (∼3 minutes). The goal of this study was to compare the accuracy of cone-beam computed tomography (CBCT) and HR-pQCT and to determine the agreement between CBCT and HR-pQCT in quantifying bone structural parameters. Nineteen trapezia of arthritic patients were scanned four times ex vivo: 1) CBCT (NewTom 5G, Cefla, at 75 μm); 2) HR-pQCT (XTremeCT-I, Scanco, at 82 μm); 3) HR-pQCT (XTremeCT-II, Scanco, at 60.7 μm); and 4) microCT (SkyScan1172, Bruker, at 19.84 μm). XTremeCT-I and XtremeCT-II were reconstructed, segmented, and analyzed following the manufacturer's guidelines. CBCT was reconstructed with in-house developed software and analyzed twice: once with an adaptive segmentation technique combined with a direct analysis method (AT-DM) and once with a Laplace-Hamming filtering technique combined with an indirect analysis method (LH-IM). Parameters of interest included bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp), and number (Tb.N). The analyses of the CBCT data showed that the AT-DM analysis correlated better with microCT for BV/TV, Tb.Sp, and Tb.N, whereas the LH-IM technique correlated better for Tb.Th. Evaluated over all parameters, the coefficient of determination for XtremeCT-I, XtremeCT-II, and CBCT were higher as R2 = 0.68, 0.72, and 0.67, respectively. For CBCT, the correlations improved when three samples with very thin trabeculae close to each other were excluded and became similar to those for XtremeCT-I and XtremeCT-II. Interesting for clinical practice is that those bones could be identified automatically with the CBCT scanner. We conclude that CBCT produced similar accuracy as HR-pQCT in bone morphometric analyses of trapezia. The broader range of application, larger field of view, and shorter acquisition time make CBCT a valuable alternative to HR-pQCT. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium.,Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Peter Varga
- Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Boyko Gueorguiev
- Biomedical Development AO Research Institute Davos, Davos, Switzerland
| | - Haniyeh Hemmatian
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Filip Stockmans
- Muscles and Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
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Accuracy Quantification of the Reverse Engineering and High-Order Finite Element Analysis of Equine MC3 Forelimb. J Equine Vet Sci 2019; 78:94-106. [PMID: 31203991 DOI: 10.1016/j.jevs.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 02/08/2023]
Abstract
Shape is a key factor in influencing mechanical responses of bones. Considered to be smart viscoelastic and inhomogeneous materials, bones are stimulated to change shape (model and remodel) when they experience changes in the compressive strain distribution. Using reverse engineering techniques via computer-aided design (CAD) is crucial to create a virtual environment to investigate the significance of shape in biomechanical engineering. Nonetheless, data are lacking to quantify the accuracy of generated models and to address errors in finite element analysis (FEA). In the present study, reverse engineering through extrapolating cross-sectional slices was used to reconstruct the diaphysis of 15 equine third metacarpal bones (MC3). The reconstructed geometry was aligned with, and compared against, computed tomography-based models (reference models) of these bones and then the error map of the generated surfaces was plotted. The minimum error of reconstructed geometry was found to be +0.135 mm and -0.185 mm (0.407 mm ± 0.235, P > .05 and -0.563 mm ± 0.369, P > .05 for outside [convex] and inside [concave] surface position, respectively). Minor reconstructed surface error was observed on the dorsal cortex (0.216 mm ± 0.07, P > .05) for the outside surface and -0.185 mm ± 0.13, P > .05 for the inside surface. In addition, a displacement-based error estimation was used on 10 MC3 to identify poorly shaped elements in FEA, and the relations of finite element convergence analysis were used to present a framework for minimizing stress and strain errors in FEA. Finite element analysis errors of 3%-5% provided in the literature are unfortunate. Our proposed model, which presents an accurate FEA (error of 0.12%) in the smallest number of iterations possible, will assist future investigators to maximize FEA accuracy without the current runtime penalty.
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Matenine D, Schmittbuhl M, Bedwani S, Després P, de Guise JA. Iterative reconstruction for image enhancement and dose reduction in diagnostic cone beam CT imaging. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:805-819. [PMID: 31450539 DOI: 10.3233/xst-190523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Iterative reconstruction is well-established in diagnostic multidetector computed tomography (MDCT) for dose reduction and image quality enhancement. Its application to diagnostic cone beam computed tomography (CBCT) is only emerging and warrants a quantitative evaluation. METHODS Several phantoms and a canine head specimen were imaged using a commercially available small-field CBCT scanner. Raw projection data were reconstructed using the Feldkamp-Davis-Kress (FDK) method with different filters, including denoising via total variation (TV) minimization (FDK-TV). Iterative reconstruction was carried out using the TV-regularized ordered subsets convex technique (OSC-TV). Signal-to-noise ratio (SNR), noise power spectrum (NPS) and spatial resolution of images were estimated. Dose levels were measured via the weighted computed tomography dose index, while low-dose image quality degradation was estimated via structural similarity (SSIM). RESULTS OSC-TV and FDK-TV were shown to significantly improve image signal-to-noise ratio (SNR) compared to FDK with a standard filter, 5.8 and 4.0 times, respectively. Spatial resolution attained with different algorithms varied moderately across different experiments. For low-dose acquisitions, image quality decreased dramatically for FDK but not for FDK-TV nor OSC-TV. For low-dose canine head images acquired using about 1/5 of the dose compared to a reference image, SSIM dropped to about 0.3 for FDK, while remaining at 0.92 for FDK-TV and 0.96 for OSC-TV. CONCLUSION OSC-TV was shown to improve image quality compared to FDK and FDK-TV. Moreover, this iterative approach allowed for significant dose reduction while maintaining image quality.
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Affiliation(s)
- Dmitri Matenine
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
| | - Matthieu Schmittbuhl
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - Stéphane Bedwani
- Département de physique, Université de Montréal, Montréal, QC, Canada
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Philippe Després
- Département de physique, de génie physique et d'optique and Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
- Département de radio-oncologie and Centre de recherche du CHU de Québec, Québec (QC) G1R 2J6, Canada
| | - Jacques A de Guise
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
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Ludlow JB, Johnson BK, Ivanovic M. Estimation of effective doses from MDCT and CBCT imaging of extremities. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1371-1383. [PMID: 30255853 DOI: 10.1088/1361-6498/aae44b] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little research has been published on the radiation burden of cone beam computed tomography (CBCT) in comparison with multi-row detector computed tomography (MDCT) for extremity imaging. This manuscript reports effective doses produced by standard and reduced dose imaging protocols for a 128-slice MDCT unit and a dedicated extremity imaging device using CBCT technology. Anthropomorphic phantoms with x-ray attenuation characteristics simulating adult hand-wrist, foot-ankle, and knee areas were modified to receive optically stimulated luminescent dosimeters (OSL). Standard and lower kVp reduced dose (Lite) exposures were compared. Effective doses for four age groups (five years old to adult) were calculated following 2007 recommendations of the ICRP. Standard CBCT imaging protocols produced effective doses (1.3-21.1 μSv) that were on the order of daily US ubiquitous background radiation doses. CBCT doses were on average 90% less than comparable MDCT views of the same anatomy (9.1-204 μSv). Child doses were significantly greater than adult doses (p = 0.0001). CBCT doses could be further reduced by 36%-51% with Lite exposure protocols. These protocols can be recommended for children and in cases where increased image noise will not interfere with the diagnostic task.
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Affiliation(s)
- John B Ludlow
- Department of Diagnostic Sciences, University of North Carolina School of Dentistry, United States of America
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Ludlow JB. Hand-wrist, knee, and foot-ankle dosimetry and image quality measurements of a novel extremity imaging unit providing CBCT and 2D imaging options. Med Phys 2018; 45:4955-4963. [PMID: 30229941 DOI: 10.1002/mp.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/27/2018] [Accepted: 09/06/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Radiation dose is a general concern in diagnostic imaging and a special concern for children who are at greater risk from radiation effects. This study evaluates effective doses (E) produced during 2D and volume imaging with a novel cone beam computed tomography (CBCT) based extremity imaging device. The device's compact size and protocol options offer image choices that enhance the potential for reduced dose and improved diagnostics when evaluating sports injuries. METHODS Hand-wrist, foot-ankle, and knee phantoms were developed for use with optically stimulated luminescent dosimeters (OSL). Dosimetry of transmission radiographs (2D) and CBCT volumes (3D) was assessed for Standard and lowered dose (Lite) exposure protocols. Effective dose was calculated for child and adult age groups. Image quality was assessed with contrast-to-noise ratio (CNR) and modulation transfer function (MTF). A figure of merit was calculated as the square of CNR divided by E. RESULTS Standard 2D doses ranged from 0.001-0.06 μSv for adults, 0.001-0.05 μSv for 15-yr olds, 0.003-0.13 μSv for 10-yr olds, and 0.005-0.20 for 5-yr olds. Dose reductions with Lite protocols ranged from 26 to 51%. Standard CBCT doses ranged from 0.3-4.6 μSv for adults, 0.3-4.4 μSv for 15-yr olds, 0.6-9.8 μSv for 10-yr olds, and 1-22.6 μSv for 5-yr olds. For both 2D and 3D a trend of increasing imaging dose with reduced age was present and was statistically significant for children below the age of 10 (P = 0.0009). Lite dose reductions averaged 47%. CNR was statistically reduced in Lite dose scans (P = 0.0384) but was not statistically different using FOM analysis (P = 0.3089). MTF was not significantly affected by the two dose protocols (P = 0.8104). CONCLUSION CBCT effective doses calculated from anthropomorphic phantom exposures following manufacturer suggested protocols appear to be substantially less than previously reported doses for similar MDCT extremity examinations. In this study, effective dose from 2D radiographic imaging was approximately two orders of magnitude less than CBCT imaging. Doses were on the order of a few minutes to hours of ubiquitous per-capita background dose for 2D imaging and a few hours to days for 3D imaging. Dose significantly increased for children younger than age 10. Lite protocols resulted in substantial dose reductions and can be recommended for children and those examinations where reduced CNR will not affect diagnosis. Flexibility of 2D and 3D imaging options with low-dose protocols make this technology a promising option for radiographic evaluation of the extremities. Efficacy studies are needed to determine when MDCT, CBCT or Digital Radiography are best used for particular diagnostic tasks.
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Affiliation(s)
- John B Ludlow
- Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, NC, 27599-7455, USA
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Mys K, Stockmans F, Vereecke E, van Lenthe GH. Quantification of bone microstructure in the wrist using cone-beam computed tomography. Bone 2018; 114:206-214. [PMID: 29909060 DOI: 10.1016/j.bone.2018.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/15/2018] [Accepted: 06/10/2018] [Indexed: 11/19/2022]
Abstract
Due to the rising life expectancy, bone diseases (e.g. osteoporosis, osteoarthritis) and trauma (e.g. fracture) have become an important socio-economic burden. Accurate visualization and quantification of the bone microstructure in vivo is seen as an important step to enhance diagnosis and treatment. Micro-computed tomography (microCT) has become the gold standard in three-dimensional (3D) imaging of trabecular bone structure. Yet, usage is limited to ex vivo analyses, hence, it cannot be used to evaluate bone and bone adaptive responses in a patient. High-resolution peripheral computed tomography (HR-pQCT) is considered the best technique to measure the bone microarchitecture in vivo. By design HR-pQCT is limited to scanning extremities, such as the distal radius and distal tibia with a limited field of view and long scanning time (~2 à 3 min. for a stack of 0.9 cm). Cone-beam computed tomography (CBCT) is a promising alternative with a much larger field of view. Yet, CBCT is challenged by artefacts that reduce image contrast, such that it is currently being used for qualitative evaluation only. Therefore, the aims of this work were first to enhance image contrast and second to determine the accuracy of high-resolution CBCT for bone microarchitectural assessment. Trapezia of nineteen female arthritic patients were scanned twice ex vivo; once using CBCT (NewTom 5G, Cefla, Verona, Italy) at a nominal voxel size of 75 μm and once using microCT (SkyScan 1172, Bruker, Kontich, Belgium) at a voxel size of 19.84 μm. The CBCT-scans were reconstructed following 2 protocols: (1) using the commercial software delivered with the scanner and (2) using in-house developed software. After reconstruction and image processing, the images were segmented using adaptive thresholding. Bone morphometric parameters including bone volume (BV), total tissue volume (TV), bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N) were calculated. Statistical evaluations were made at a significance level of 5%. Significant correlations were found between the CBCT-based bone parameters and the microCT-based parameters with R2 > 0.68 The in-house reconstructed software outperformed the commercial software. Smaller bias (overestimation of Tb.Th decreased from 114.24% to 59.96%) as well as higher correlations were observed for the in-house processed images. Still, a significant overestimation was observed for BV/TV and Tb. Th and an underestimation for Tb.N. We conclude that our CBCT image reconstruction improved image contrast which allowed for an accurate quantification of trabecular bone microarchitecture.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium.
| | - Filip Stockmans
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie Vereecke
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium
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Radiation dose in non-dental cone beam CT applications: a systematic review. LA RADIOLOGIA MEDICA 2018; 123:765-777. [DOI: 10.1007/s11547-018-0910-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
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Koivisto J, van Eijnatten M, Kiljunen T, Shi XQ, Wolff J. Effective Radiation Dose in the Wrist Resulting from a Radiographic Device, Two CBCT Devices and One MSCT Device: A Comparative Study. RADIATION PROTECTION DOSIMETRY 2018; 179:58-68. [PMID: 29040707 DOI: 10.1093/rpd/ncx210] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
The objective of the present study was to assess and compare the effective doses in the wrist region resulting from conventional radiography device, multislice computed tomography (MSCT) device and two cone beam computed tomography (CBCT) devices using MOSFET dosemeters and a custom made anthropomorphic RANDO phantom according to the ICRP 103 recommendation. The effective dose for the conventional radiography was 1.0 μSv. The effective doses for the NewTom 5 G CBCT ranged between 0.7 μSv and 1.6 μSv, for the Planmed Verity CBCT 2.4 μSv and for the MSCT 8.6 μSv. When compared with the effective dose for AP- and LAT projections of a conventional radiographic device, this study showed an 8.6-fold effective dose for standard MSCT protocol and between 0.7 and 2.4-fold effective dose for standard CBCT protocols. When compared to the MSCT device, the CBCT devices offer a 3D view of the wrist at significantly lower effective doses.
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Affiliation(s)
- Juha Koivisto
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Timo Kiljunen
- International Docrates Cancer Center, Helsinki, Finland; Saukonpaadenranta 2, FI-00180, Helsinki, Finland
| | - Xie-Qi Shi
- Section of Oral Maxillofacial Radiology, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
- Sektionen för bild- och funktionsfysik, C2-63Karolinska Universitetssjukhuset, Huddinge, SE-141 86 Stockholm, Sweden
| | - Jan Wolff
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 2018; 9:35-45. [PMID: 29302798 PMCID: PMC5825310 DOI: 10.1007/s13244-017-0582-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this pictorial review is to illustrate the use of CBCT in a broad spectrum of musculoskeletal disorders and to compare its diagnostic merit with other imaging modalities, such as conventional radiography (CR), Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging. Background Cone Beam Computed Tomography (CBCT) has been widely used for dental imaging for over two decades. Discussion Current CBCT equipment allows use for imaging of various musculoskeletal applications. Because of its low cost and relatively low irradiation, CBCT may have an emergent role in making a more precise diagnosis, assessment of local extent and follow-up of fractures and dislocations of small bones and joints. Due to its exquisite high spatial resolution, CBCT in combination with arthrography may be the preferred technique for detection and local staging of cartilage lesions in small joints. Evaluation of degenerative joint disorders may be facilitated by CBCT compared to CR, particularly in those anatomical areas in which there is much superposition of adjacent bony structures. The use of CBCT in evaluation of osteomyelitis is restricted to detection of sequestrum formation in chronic osteomyelitis. Miscellaneous applications include assessment of (symptomatic) variants, detection and characterization of tumour and tumour-like conditions of bone. Teaching Points • Review the spectrum of MSK disorders in which CBCT may be complementary to other imaging techniques. • Compare the advantages and drawbacks of CBCT compared to other imaging techniques. • Define the present and future role of CBCT in musculoskeletal imaging.
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Affiliation(s)
- Magdalena Posadzy
- Department of Radiology, W. Dega Orthopaedic and Rehabilitation University Hospital of Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
| | - Julie Desimpel
- Department of Radiology, Antwerp University Hospital, Antwerp University, Antwerp, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | - Filip Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Antwerp University, Antwerp, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Faculty of Medicine and Health sciences, Ghent University, Ghent, Belgium
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CT image segmentation methods for bone used in medical additive manufacturing. Med Eng Phys 2018; 51:6-16. [DOI: 10.1016/j.medengphy.2017.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 01/07/2023]
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Stewart RC, Honkanen JT, Kokkonen HT, Tiitu V, Saarakkala S, Joukainen A, Snyder BD, Jurvelin JS, Grinstaff MW, Töyräs J. Contrast-Enhanced Computed Tomography Enables Quantitative Evaluation of Tissue Properties at Intrajoint Regions in Cadaveric Knee Cartilage. Cartilage 2017; 8:391-399. [PMID: 28934883 PMCID: PMC5613888 DOI: 10.1177/1947603516665443] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to investigate whether the concentration of the anionic contrast agent ioxaglate, as quantitated by contrast-enhanced computed tomography (CECT) using a clinical cone-beam CT (CBCT) instrument, reflects biochemical, histological, and biomechanical characteristics of articular cartilage imaged in an ex vivo, intact human knee joint. Design An osteoarthritic human cadaveric knee joint (91 years old) was injected with ioxaglate (36 mg I/mL) and imaged using CBCT over 61 hours of ioxaglate diffusion into cartilage. Following imaging, the joint surfaces were excised, rinsed to remove contrast agent, and compressive stiffness (equilibrium and instantaneous compressive moduli) was measured via indentation testing ( n = 17 sites). Each site was sectioned for histology and assessed for glycosaminoglycan content using digital densitometry of Safranin-O stained sections, Fourier transform infrared spectroscopy for collagen content, and morphology using both the Mankin and OARSI semiquantitative scoring systems. Water content was determined using mass change after lyophilization. Results CECT attenuation at all imaging time points, including those <1 hour of ioxaglate exposure, correlated significantly ( P < 0.05) with cartilage water and glycosaminoglycan contents, Mankin score, and both equilibrium and instantaneous compressive moduli. Early time points (<30 minutes) also correlated ( P < 0.05) with collagen content and OARSI score. Differences in cartilage quality between intrajoint regions were distinguishable at diffusion equilibrium and after brief ioxaglate exposure. Conclusions CECT with ioxaglate affords biochemical and biomechanical measurements of cartilage health and performance even after short, clinically relevant exposure times, and may be useful in the clinic as a means for detecting early signs of cartilage pathology.
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Affiliation(s)
- Rachel C. Stewart
- Department of Biomedical Engineering, Boston University, Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Juuso T.J. Honkanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Juuso T. J. Honkanen, Department of Applied Physics, University of Eastern Finland, POB 1627, 70211 Kuopio, Finland.
| | - Harri T. Kokkonen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Virpi Tiitu
- Institute of Biomedicine, Anatomy, University of Eastern Finland, Kuopio, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Brian D. Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jukka S. Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Mark W. Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA, USA,Department of Chemistry, Boston University, Boston, MA, USA
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Tschauner S, Marterer R, Nagy E, Apfaltrer G, Riccabona M, Singer G, Stücklschweiger G, Guss H, Sorantin E. Surface radiation dose comparison of a dedicated extremity cone beam computed tomography (CBCT) device and a multidetector computed tomography (MDCT) machine in pediatric ankle and wrist phantoms. PLoS One 2017; 12:e0178747. [PMID: 28570626 PMCID: PMC5453596 DOI: 10.1371/journal.pone.0178747] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/18/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate and compare surface doses of a cone beam computed tomography (CBCT) and a multidetector computed tomography (MDCT) device in pediatric ankle and wrist phantoms. Methods Thermoluminescent dosimeters (TLD) were used to measure and compare surface doses between CBCT and MDCT in a left ankle and a right wrist pediatric phantom. In both modalities adapted pediatric dose protocols were utilized to achieve realistic imaging conditions. All measurements were repeated three times to prove test-retest reliability. Additionally, objective and subjective image quality parameters were assessed. Results Average surface doses were 3.8 ±2.1 mGy for the ankle, and 2.2 ±1.3 mGy for the wrist in CBCT. The corresponding surface doses in optimized MDCT were 4.5 ±1.3 mGy for the ankle, and 3.4 ±0.7 mGy for the wrist. Overall, mean surface dose was significantly lower in CBCT (3.0 ±1.9 mGy vs. 3.9 ±1.2 mGy, p<0.001). Subjectively rated general image quality was not significantly different between the study protocols (p = 0.421), whereas objectively measured image quality parameters were in favor of CBCT (p<0.001). Conclusions Adapted extremity CBCT imaging protocols have the potential to fall below optimized pediatric ankle and wrist MDCT doses at comparable image qualities. These possible dose savings warrant further development and research in pediatric extremity CBCT applications.
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Affiliation(s)
- Sebastian Tschauner
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Robert Marterer
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Eszter Nagy
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Georg Apfaltrer
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Riccabona
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Division of General Pediatric and Adolescence Surgery, Medical University of Graz, Graz, Austria
| | - Georg Stücklschweiger
- Competence Centre for Medical Physics and Radiation Protection, University Hospital Graz, Graz, Austria
| | - Helmuth Guss
- Competence Centre for Medical Physics and Radiation Protection, University Hospital Graz, Graz, Austria
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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Lepojärvi S, Niinimäki J, Pakarinen H, Koskela L, Leskelä HV. Rotational Dynamics of the Talus in a Normal Tibiotalar Joint as Shown by Weight-Bearing Computed Tomography. J Bone Joint Surg Am 2016; 98:568-75. [PMID: 27053585 DOI: 10.2106/jbjs.15.00470] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate the normal anatomy and rotational dynamics of the talus in the tibiotalar joint using weight-bearing cone-beam computed tomography (WBCT). METHODS In a cross-sectional study of thirty-two healthy subjects divided into two age groups (twenty-six to thirty-six years of age and sixty to sixty-four years of age), low-dose WBCT scans of both uninjured ankles were obtained. The rotation of the talus, medial clear space, anterior and posterior widths of the tibiotalar joint, translation of the talus, and talar tilt were measured. The primary outcome measures were intersubject and intrasubject (bilateral) variation of the talar movements between maximal internal and external rotation. The secondary outcome measures were the effect of sex and age on the movements of the talus. RESULTS When the ankle is rotated, the talus rotates a mean of 10° with no substantial widening of the medial clear space. All of the measured values changed subtly but statistically significantly between maximal internal and maximal external rotation, with mean changes of 10° (standard deviation [SD] = 5.8°) in talar rotation (p = 0.006), 2.0° (SD = 1.5°) in talar tilt (p = 0.0015), -0.2 mm (SD = 0.5 mm) in the medial clear space (p = 0.01), 0.9 mm (SD = 0.8 mm) in the anterior width of the tibiotalar joint (p = 0.003), -0.4 mm (SD = 0.9 mm) in the posterior width of the tibiotalar joint (p = 0.011), and 2.9 mm (SD = 2.2 mm) in translation of the talus (p = 0.002). Intersubject variation was large, but there was very little intrasubject variation in the total rotational range of motion. There were no differences between men and women with regard to any of the measurements. CONCLUSIONS This study provides reference values with which to evaluate the dynamics of the normal tibiotalar joint in order to clarify rotational stability of the ankle mortise. The internal control of the contralateral ankle seems to be a better reference than population-based normal values.
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Affiliation(s)
- Sannamari Lepojärvi
- Department of Diagnostic Radiology (S.L. and J.N.) and Division of Orthopaedic and Trauma Surgery, Department of Surgery (H.P., L.K., and H.-V.L.), Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology (S.L. and J.N.) and Division of Orthopaedic and Trauma Surgery, Department of Surgery (H.P., L.K., and H.-V.L.), Oulu University Hospital, Oulu, Finland
| | - Harri Pakarinen
- Department of Diagnostic Radiology (S.L. and J.N.) and Division of Orthopaedic and Trauma Surgery, Department of Surgery (H.P., L.K., and H.-V.L.), Oulu University Hospital, Oulu, Finland
| | - Laura Koskela
- Department of Diagnostic Radiology (S.L. and J.N.) and Division of Orthopaedic and Trauma Surgery, Department of Surgery (H.P., L.K., and H.-V.L.), Oulu University Hospital, Oulu, Finland
| | - Hannu-Ville Leskelä
- Department of Diagnostic Radiology (S.L. and J.N.) and Division of Orthopaedic and Trauma Surgery, Department of Surgery (H.P., L.K., and H.-V.L.), Oulu University Hospital, Oulu, Finland
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Suojärvi N, Sillat T, Lindfors N, Koskinen SK. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images. Skeletal Radiol 2015; 44:1769-75. [PMID: 26272335 DOI: 10.1007/s00256-015-2231-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/23/2015] [Accepted: 08/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. MATERIALS AND METHODS Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. RESULTS Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. CONCLUSIONS For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, P.0. Box 266, 00029 HUS, Finland.
| | - T Sillat
- Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, P.O. Box 266, 00029 HUS, Finland
| | - N Lindfors
- Department of Hand Surgery, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, P.0. Box 266, 00029 HUS, Finland
| | - S K Koskinen
- Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, P.O. Box 266, 00029 HUS, Finland
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