Artikel
The Cone Beam Computed Tomography: An alternative imaging modality for the hand surgery
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Autoren
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Horst Zajonc
- Clinic for Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
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Nico Leibig
- Clinic for Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
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Jan Thiele
- Clinic for Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
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Jakob Neubauer
- Department of Radiology, University Clinic Freiburg, Freiburg, Germany
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Sebastian Goerke
- Institute of Radiology, Ortenau Clinic, Offenburg-Gengenbach, Offenburg, Germany
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Bjoern Stark
- Clinic for Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The Cone Beam Computed Tomography (CBCT) is already an established standard procedure in imaging of head and neck. In compairison with Multidetector Computed Tomography (MDCT), the CBCT seems to have a lower radiation dose.
Since 5 years we use the CBCT routinely for handsurgical questions in our clinic.
We compared the diagnostic accuracy of CBCT with MDCT pictures in protocols and radiation dose, which are equivalent to the projection radiography in two layers.
In addition we compared in a phantom study the diagnostic accuracy of both section diagram methods (CBCT and MDCT) at the identification of fractures, cortical defects and material of osteosynthesis.
Methods: As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting.
We performed radiation dose equivalent radiography (settings as in standard clinical care), MDCT in a 320 row with single shot mode and CBCT in a device dedicated to musculoskeletal imaging.
The results of fractures and the level of confidence for each finding were evaluated by three raters independendly. Gold standard was evaluated by consensus reading of a high-dose MDCT.
In addition 18 feet of European roe deer were fractured in a universal testing machine. Another 3 feet were prepared with cortical defects and screws, or both combined.
Six observers rated the scans according to number of fragments, size of defects, size of defects opposite orthopedic screws, and the length of different screws. The image quality regarding depiction of the cortical bone was assessed. The gold standard (real number of fragments) was evaluated by autopsy.
Results: On the cadaveric human hands, the section diagram methods showed at same radiation dose better sensitivity in fracture detectionning compared to radiography.
(MDCT: 0,89; CBCT: 0,81; projection radiography: 0,54 [P = < ,004])
Between both section diagram methodes there was no significant difference.
In the phantom study of European deer feet both modalities proved to be comparable regarding the visualisation.
Conclusions: Clinical and experimental experience showed that CBCT has he potential to replace the convential radiography in different areas.
Most beneficial is the high quality of imaging with excellent spatial resolution and the minor radiation dose.
