Universität zu Köln

Grunz, Jan-Peter ORCID: 0000-0002-4524-1620, Pennig, Lenhard, Fieber, Tabea, Gietzen, Carsten Herbert, Heidenreich, Julius Frederik, Huflage, Henner, Gruschwitz, Philipp, Kuhl, Philipp Josef, Petritsch, Bernhard, Kosmala, Aleksander, Bley, Thorsten Alexander and Gassenmaier, Tobias . Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions. Eur. Radiol.. NEW YORK: SPRINGER. ISSN 1432-1084

Full text not available from this repository.

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 (kappa = 0.41 [95% confidence interval 0.35-0.47]; p < 0.001), agreement after CBCT was almost perfect (kappa = 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 mu Sv [3.3-5.3 mu Sv] compared to 0.2 mu Sv [0.1-0.2 mu Sv] 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Grunz, Jan-Peter UNSPECIFIED orcid.org/0000-0002-4524-1620 UNSPECIFIED Pennig, Lenhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Fieber, Tabea UNSPECIFIED UNSPECIFIED UNSPECIFIED Gietzen, Carsten Herbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Julius Frederik UNSPECIFIED UNSPECIFIED UNSPECIFIED Huflage, Henner UNSPECIFIED UNSPECIFIED UNSPECIFIED Gruschwitz, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhl, Philipp Josef UNSPECIFIED UNSPECIFIED UNSPECIFIED Petritsch, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Kosmala, Aleksander UNSPECIFIED UNSPECIFIED UNSPECIFIED Bley, Thorsten Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Gassenmaier, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-308611
DOI:	10.1007/s00330-020-07563-5
Journal or Publication Title:	Eur. Radiol.
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-1084
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITERIA ACUTE TRAUMA; WEIGHT-BEARING; IMAGE QUALITY; CT SYSTEM; RADIATION; PERFORMANCE; AGREEMENT Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/30861