TY  - JOUR
A1  - Grunz, Jan-Peter
A1  - Pennig, Lenhard
A1  - Fieber, Tabea
A1  - Gietzen, Carsten Herbert
A1  - Heidenreich, Julius Frederik
A1  - Huflage, Henner
A1  - Gruschwitz, Philipp
A1  - Kuhl, Philipp Josef
A1  - Petritsch, Bernhard
A1  - Kosmala, Aleksander
A1  - Bley, Thorsten Alexander
A1  - Gassenmaier, Tobias
T1  - Twin robotic x-ray system in small bone and joint trauma: Impact of cone-beam computed tomography on treatment decisions
JF  - European Radiology
N2  - 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.
KW  - cone-beamcomputed tomography
KW  - extremities
KW  - fractures, bone
KW  - radiography
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235233
SN  - 0938-7994
VL  - 31
ER  - 
TY  - CHAP
A1  - Weinert, Franz E.
A1  - Schneider, Wolfgang
A1  - Asendorpf, Jens
A1  - Helmke, Andreas
A1  - Knopf, Monika
A1  - Kuhl, Julius
A1  - Nunner-Winkler, Gertrud
A1  - Strube, Gerhard
T1  - Entwicklung im Vorschulalter: Bericht über eine Längsschnittstudie
N2  - Dargestellt werden die theoretischen Ziele, das methodische Vorgehen und die ersten Ergebnisse einer Longitudinalstudie zur Genese individueller Kompetenzen (LOGIK) im Vorschulalter. Dabei geht es vor allem um generelle Merkmale und differentielle Verläufe bei der Entwicklung kognitiver, sozialer und motivationaler Kompetenzen.
KW  - Vorschulkind
KW  - Entwicklung
Y1  - 1988
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-86699
ER  -