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European Radiology
Published in: European Radiology 6/2021

Open Access 01-06-2021 | Computed Tomography | Musculoskeletal

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

Authors: Jan-Peter Grunz, Lenhard Pennig, Tabea Fieber, Carsten Herbert Gietzen, Julius Frederik Heidenreich, Henner Huflage, Philipp Gruschwitz, Philipp Josef Kuhl, Bernhard Petritsch, Aleksander Kosmala, Thorsten Alexander Bley, Tobias Gassenmaier

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy.

Methods

Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard.

Results

CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography.

Conclusions

CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact.

Key Points

• With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography.
• Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma.
• For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.
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Metadata
Title
Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions
Authors
Jan-Peter Grunz
Lenhard Pennig
Tabea Fieber
Carsten Herbert Gietzen
Julius Frederik Heidenreich
Henner Huflage
Philipp Gruschwitz
Philipp Josef Kuhl
Bernhard Petritsch
Aleksander Kosmala
Thorsten Alexander Bley
Tobias Gassenmaier
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07563-5

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