Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

• Published in: Skeletal radiology Vol. 49; no. 4; pp. 531 - 539
• Main Authors: Alagic, Zlatan, Bujila, Robert, Enocson, Anders, Srivastava, Subhash, Koskinen, Seppo K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2020; Springer; Springer Nature B.V
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ankle; Ankle - diagnostic imaging; Ankle Fractures - diagnostic imaging; Comparative analysis; Computed tomography; CT imaging; Detectors; Diagnostic imaging; Digital imaging; Emergency medical services; Extremities - diagnostic imaging; Extremities - injuries; Female; Fractures; Fractures, Bone - diagnostic imaging; Humans; Imaging; Injuries; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Multidetector CT . Trauma . Low-dose CT . Radiography . Wrist injuries/treatment . Ankle injuries/treatment . Emergency radiology; Nuclear Medicine; Orthopedics; Pathology; Radiation Dosage; Radiographs; Radiography; Radiology; Reproducibility of Results; Scientific; Scientific Article; Sensitivity and Specificity; Wrist; Wrist - diagnostic imaging; Wrist Injuries - diagnostic imaging; Young Adult; Radiography; Low-dose CT; Ankle injuries/treatment; Wrist injuries/treatment; Emergency radiology; Multidetector CT; Trauma
• ISSN: 0364-2348; 1432-2161; 1432-2161
• DOI: 10.1007/s00256-019-03309-7

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.