title: Using cone-beam CT as a low-dose 3D imaging technique for the extremities: initial experience in 50 subjects.
abstract: OBJECTIVE
  To prospectively evaluate a dedicated extremity cone-beam CT (CBCT) scanner in cases with and without orthopedic hardware by (1) comparing its imaging duration and image quality to those of radiography and multidetector CT (MDCT) and (2) comparing its radiation dose to that of MDCT.
  
  
  METHODS
  Written informed consent was obtained for all subjects for this IRB-approved, HIPAA-compliant study. Fifty subjects with (1) fracture of small bones, (2) suspected intraarticular fracture, (3) fracture at the site of complex anatomy, or (4) a surgical site difficult to assess with radiography alone were recruited and scanned on an extremity CBCT scanner prior to FDA approval. Same-day radiographs were performed in all subjects. Some subjects also underwent MDCT within 1 month of CBCT. Imaging duration and image quality were compared between CBCT and radiographs. Imaging duration, effective radiation dose, and image quality were compared between CBCT and MDCT.
  
  
  RESULTS
  Fifty-one CBCT scans were performed in 50 subjects. Average imaging duration was shorter for CBCT than radiographs (4.5 min vs. 6.6 min, P = 0.001, n = 51) and MDCT (7.6 min vs. 10.9 min, P = 0.01, n = 7). Average estimated effective radiation dose was less for CBCT than MDCT (0.04 mSv vs. 0.13 mSv, P =  .02, n = 7). CBCT images yielded more diagnostic information than radiographs in 23/51 cases and more diagnostic information than MDCT in 1/7 cases, although radiographs were superior for detecting hardware complications.
  
  
  CONCLUSIONS
  CBCT performs high-resolution imaging of the extremities using less imaging time than radiographs and MDCT and lower radiation dose than MDCT.
authors: Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA, ajhuang@mgh.harvard.edu.
authors: Ambrose J
authors: AJ
authors: Huang
authors: Connie Y
authors: CY
authors: Chang
authors: Bijoy J
authors: BJ
authors: Thomas
authors: Peter J
authors: PJ
authors: MacMahon
authors: William E
authors: WE
authors: Palmer
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005121:Extremities / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010865:Pilot Projects; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011874:Radiometry; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
references: Korean J Orthod. 2012 Dec;42(6):329-34
references: 23323247
references: Braz Oral Res. 2013 Jan-Feb;27(1):48-54
references: 23306626
references: Imaging Sci Dent. 2012 Dec;42(4):219-24
references: 23301207
references: Int J Oral Maxillofac Surg. 2008 Oct;37(10 ):903-6
references: 18768294
references: Radiographics. 1992 Sep;12(5):1041-6
references: 1529128
references: Br J Radiol. 2009 Jan;82(973):35-40
references: 18852212
references: Eur Radiol. 1998;8(9):1558-64
references: 9866761
references: Invest Radiol. 2014 Aug;49(8):532-9
references: 24691141
references: Clin Oral Implants Res. 2010 Nov;21(11):1201-8
references: 21039890
references: Skeletal Radiol. 2013 May;42(5):649-57
references: 22990597
references: Eur J Radiol. 2005 Dec;56(3):413-7
references: 15978765
references: J Vasc Interv Radiol. 2011 Apr;22(4):455-61
references: 21463755
references: Eur J Radiol. 2011 Dec;80(3):e389-93
references: 21035293
references: Z Med Phys. 2011 Sep;21(3):174-82
references: 21530200
references: Rofo. 2008 May;180(5):396-401
references: 18543414
references: Dentomaxillofac Radiol. 2011 Jul;40(5):265-73
references: 21697151
references: Dentomaxillofac Radiol. 2011 Jan;40(1):24-34
references: 21159912
references: J Orofac Orthop. 2005 Nov;66(6):434-44
references: 16331544
references: Med Phys. 2009 Mar;36(3):741-52
references: 19378735
references: Health Phys. 1998 Nov;75(5):492-9
references: 9790558
references: Eur Radiol. 2014 Mar;24(3):553-8
references: 24071992
references: Med Phys. 2013 Dec;40(12):121913
references: 24320524
references: Dentomaxillofac Radiol. 2004 Mar;33(2):83-6
references: 15313998
references: Phys Med Biol. 2013 Jan 7;58(1):1-17
references: 23221023
references: Clin Oral Investig. 2006 Mar;10(1):1-7
references: 16482455
references: Med Phys. 2001 Apr;28(4):469-74
references: 11339743
references: Phys Med Biol. 2011 May 7;56(9):2755-66
references: 21464532
references: Radiat Prot Dosimetry. 2013 Dec;157(4):515-24
references: 23825221
references: Skeletal Radiol. 2001 Mar;30(3):151-6
references: 11357453
references: Med Phys. 2014 Jan;41(1):011907
references: 24387515
references: Skeletal Radiol. 2012 Jan;41(1):93-6
references: 21603872
references: Korean J Orthod. 2012 Dec;42(6):291-6
references: 23323243
references: Curr Probl Diagn Radiol. 2010 Jul-Aug;39(4):125-36
references: 20510751
references: Dentomaxillofac Radiol. 2013;42(7):20130022
references: 23625065
references: Acad Radiol. 2012 Mar;19(3):320-5
references: 22173320
references: Radiol Med. 2009 Dec;114(8):1308-18
references: 19789956
references: J Comput Assist Tomogr. 1995 Sep-Oct;19(5):777-81
references: 7560325
references: Med Phys. 2011 Aug;38(8):4700-13
references: 21928644
references: Skeletal Radiol. 2010 Nov;39(11):1087-95
references: 20224906
references: J Orthop Trauma. 1989;3(1):29-32
references: 2709201
references: AJR Am J Roentgenol. 2013 Jan;200(1):146-8
references: 23255755
references: AJNR Am J Neuroradiol. 2009 Aug;30(7):1285-92
references: 19461061
references: AJR Am J Roentgenol. 2009 Apr;192(4):881-6
references: 19304690
references: Otol Neurotol. 2009 Apr;30(3):299-303
references: 19174709
references: Dentomaxillofac Radiol. 2009 Feb;38(2):79-85
references: 19176649
references: Radiology. 2014 Mar;270(3):816-24
references: 24475803
references: Int J Oral Maxillofac Surg. 2009 Jun;38(6):609-25
references: 19464146
references: Radiographics. 2008 Nov-Dec;28(7):2009-22
references: 19001655