Jan-Peter Grunz, Andreas Steven Kunz, Mila Marie Paul, Karsten Sebastian Luetkens, Henner Huflage, Nora Conrads, Süleyman Ergün, Thomas Weber, Magdalena Herbst, Sophia Herold, Thorsten Alexander Bley, Theresa Sophie Patzer
{"title":"术后四肢断层摄影--标准放射摄影的无叠加替代品？","authors":"Jan-Peter Grunz, Andreas Steven Kunz, Mila Marie Paul, Karsten Sebastian Luetkens, Henner Huflage, Nora Conrads, Süleyman Ergün, Thomas Weber, Magdalena Herbst, Sophia Herold, Thorsten Alexander Bley, Theresa Sophie Patzer","doi":"10.1097/RLI.0000000000001085","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms.</p><p><strong>Materials and methods: </strong>After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement.</p><p><strong>Results: </strong>Radiation dose in radiography was 0.48 ± 0.26 dGy·cm2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms (P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols (P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis (P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598-0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599-0.903), implant positioning (ICC, 0.855; 95% CI, 0.729-0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556-0.934).</p><p><strong>Conclusions: </strong>In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.</p>","PeriodicalId":14486,"journal":{"name":"Investigative Radiology","volume":null,"pages":null},"PeriodicalIF":7.0000,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462900/pdf/","citationCount":"0","resultStr":"{\"title\":\"Postoperative Extremity Tomosynthesis-A Superimposition-Free Alternative to Standard Radiography?\",\"authors\":\"Jan-Peter Grunz, Andreas Steven Kunz, Mila Marie Paul, Karsten Sebastian Luetkens, Henner Huflage, Nora Conrads, Süleyman Ergün, Thomas Weber, Magdalena Herbst, Sophia Herold, Thorsten Alexander Bley, Theresa Sophie Patzer\",\"doi\":\"10.1097/RLI.0000000000001085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Rationale and objectives: </strong>This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms.</p><p><strong>Materials and methods: </strong>After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement.</p><p><strong>Results: </strong>Radiation dose in radiography was 0.48 ± 0.26 dGy·cm2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms (P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols (P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis (P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598-0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599-0.903), implant positioning (ICC, 0.855; 95% CI, 0.729-0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556-0.934).</p><p><strong>Conclusions: </strong>In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.</p>\",\"PeriodicalId\":14486,\"journal\":{\"name\":\"Investigative Radiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.0000,\"publicationDate\":\"2024-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462900/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Investigative Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/RLI.0000000000001085\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Investigative Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/RLI.0000000000001085","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Postoperative Extremity Tomosynthesis-A Superimposition-Free Alternative to Standard Radiography?
Rationale and objectives: This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms.
Materials and methods: After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement.
Results: Radiation dose in radiography was 0.48 ± 0.26 dGy·cm2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms (P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols (P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis (P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598-0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599-0.903), implant positioning (ICC, 0.855; 95% CI, 0.729-0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556-0.934).
Conclusions: In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.
期刊介绍：
Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.
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