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  -