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Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma

(2015) SKELETAL RADIOLOGY. 44(8). p.1111-1117
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Abstract
OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma. MATERIALS AND METHODS: Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared. RESULTS: Fracture detection on CBCT increased by 35 % and 37 % for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236 % and 185 %. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT. CONCLUSION: CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.
Keywords
Cone-beamCT, Digital radiography, Trauma, Imaging modalities, DIGITAL VOLUME TOMOGRAPHY, COMPUTED-TOMOGRAPHY, WRIST, REDUCTION, HAND

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Chicago
De Smet, E, G De Praeter, Koenraad Verstraete, K Wouters, L De Beuckeleer, and Filip Vanhoenacker. 2015. “Direct Comparison of Conventional Radiography and Cone-beam CT in Small Bone and Joint Trauma.” Skeletal Radiology 44 (8): 1111–1117.
APA
De Smet, E, De Praeter, G., Verstraete, K., Wouters, K., De Beuckeleer, L., & Vanhoenacker, F. (2015). Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. SKELETAL RADIOLOGY, 44(8), 1111–1117.
Vancouver
1.
De Smet E, De Praeter G, Verstraete K, Wouters K, De Beuckeleer L, Vanhoenacker F. Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. SKELETAL RADIOLOGY. 2015;44(8):1111–7.
MLA
De Smet, E, G De Praeter, Koenraad Verstraete, et al. “Direct Comparison of Conventional Radiography and Cone-beam CT in Small Bone and Joint Trauma.” SKELETAL RADIOLOGY 44.8 (2015): 1111–1117. Print.
@article{5929776,
  abstract     = {OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma.
MATERIALS AND METHODS: Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared.
RESULTS: Fracture detection on CBCT increased by 35 \% and 37 \% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236 \% and 185 \%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT.
CONCLUSION: CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.},
  author       = {De Smet, E and De Praeter, G and Verstraete, Koenraad and Wouters, K and De Beuckeleer, L and Vanhoenacker, Filip},
  issn         = {0364-2348},
  journal      = {SKELETAL RADIOLOGY},
  language     = {eng},
  number       = {8},
  pages        = {1111--1117},
  title        = {Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma},
  url          = {http://dx.doi.org/10.1007/s00256-015-2127-3},
  volume       = {44},
  year         = {2015},
}

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