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Ultra-low-dose cone-beam CT compared to standard dose in the assessment for acute fractures

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Abstract

Purpose

Multi-detector computed tomography (MDCT) is superior in fracture detection than conventional radiography; however, dose is increased. Cone-beam computed tomography (CBCT) offers higher spatial resolution and lower dose than MDCT. Manufacturers offer an ultra-low-dose algorithm. This study compares the diagnostic accuracy of the ultra-low-dose CBCT (ULDCBCT) with that of the standard-dose CBCT (SDCBCT).

Materials and methods

In total, 64 patients were scanned with both the SDCBCT and the ULDCBCT protocols. Both studies were reported by two consultant radiologists with fellowship training in emergency radiology separated in time. The reporter recorded a diagnosis of fracture or normal and diagnostic confidence using a 5-point Likert scale. The gold standard was taken as the SDCBCT. Reporters were blinded to the indication and the SDCBCT report. Cases of discrepancy were resolved by consensus.

Results

There were 34 fractures and 30 cases had no fracture. Several fractures were missed using the UDCBCT, and there were also several cases of overdiagnosis. ULD was inferior to SD for fracture diagnosis (p < 0.00001). The diagnostic accuracy of ULDCBCT was 82.8% (75.1–88.9 CI). The diagnostic accuracy of plain radiograph was 64% (55.1–75.7% CI). Diagnostic confidence was reduced; the mean confidence for SDCBCT was 4.68 vs 4.12 for ULDCBCT (p < 0.001). The Kappa for interobserver agreement was 0.6.

Conclusion

ULDCBCT is inferior to SDCBCT in fracture detection and confidence is reduced. For diagnostic studies, the standard dose should be used.

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Author information

Authors and Affiliations

  1. Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland

    M. C. Murphy, B. Gibney, J. Walsh, F. Bolster & P. J. MacMahon

  2. Department of Radiography, Mater Misericordiae University Hospital, Dublin 7, Ireland

    G. Orpen

  3. Department of Medical Physics, Mater Misericordiae University Hospital, Dublin 7, Ireland

    E. Kenny

  4. School of Medicine, University College Dublin, Dublin, Ireland

    F. Bolster & P. J. MacMahon

Authors
  1. M. C. Murphy
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  2. B. Gibney
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  7. P. J. MacMahon
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Correspondence to M. C. Murphy.

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Murphy, M.C., Gibney, B., Walsh, J. et al. Ultra-low-dose cone-beam CT compared to standard dose in the assessment for acute fractures. Skeletal Radiol 51, 153–159 (2022). https://doi.org/10.1007/s00256-021-03825-5

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  • DOI: https://doi.org/10.1007/s00256-021-03825-5

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