Aims To evaluate whether an ultra-low-dose CT protocol can diagnose selected limb fractures as well as conventional CT (C-CT).
Patients and Methods We prospectively studied 40 consecutive patients with a limb fracture in whom a CT scan was indicated. These were scanned using an ultra-low-dose CT Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury (REDUCTION) protocol. Studies from 16 selected cases were compared with 16 C-CT scans matched for age, gender and type of fracture. Studies were assessed for diagnosis and image quality. Descriptive and reliability statistics were calculated. The total effective radiation dose for each scanned site was compared.
Results The mean estimated effective dose (ED) for the REDUCTION protocol was 0.03 milliSieverts (mSv) and 0.43 mSv (p < 0.005) for C-CT. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the REDUCTION protocol to detect fractures were 0.98, 0.89, 0.98 and 0.89 respectively when two occult fractures were excluded. Inter- and intra-observer reliability for diagnosis using the REDUCTION protocol (κ = 0.75, κ = 0.71) were similar to those of C-CT (κ = 0.85, κ = 0.82). Using the REDUCTION protocol, 3D CT reconstructions were equivalent in quality and diagnostic information to those generated by C-CT (κ = 0.87, κ = 0.94).
Conclusion With a near 14-fold reduction in estimated ED compared with C-CT, the REDUCTION protocol reduces the amount of CT radiation substantially without significant diagnostic decay. It produces images that appear to be comparable with those of C-CT for evaluating fractures of the limbs.
Cite this article: Bone Joint J 2016;98-B:1668-73.
S. R. Konda: Designed the study, Assisted with the implementation of the study, Writing and editing the paper.
A. M. Goch: Assisted with the implementation of the study, Writing and editing the paper.
P. Leucht: Designed the study, Writing and editing the paper.
A. Christiano: Assisted with the implementation of the study, Writing and editing the paper.
S. Gyftopoulos: Designed the study, Writing and editing the paper.
G. Yoeli: Designed the study, Writing and editing the paper.
K. A. Egol: Designed the study, Writing and editing the paper.
The authors would like to acknowledge the contributions of those who served as evaluators of the CT images either in pilot form, or for the final manuscript, other than the authors of the study: M. Cantlon, T. McLaurin, S. Mehta, M. Vrahas, M. Karunakar, F. Liporace and N. Tejwar.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by A. C. Ross.
- Received April 28, 2016.
- Accepted August 23, 2016.
- ©2016 The British Editorial Society of Bone & Joint Surgery