title: Conventional versus virtual radiographs of the injured pelvis and acetabulum.
abstract: BACKGROUND
  Evaluation of the fractured pelvis or acetabulum requires both standard radiographic evaluation as well as computed tomography (CT) imaging. The standard anterior-posterior (AP), Judet, and inlet and outlet views can now be simulated using data acquired during CT, decreasing patient discomfort, radiation exposure, and cost to the healthcare system. The purpose of this study is to compare the image quality of conventional radiographic views of the traumatized pelvis to virtual radiographs created from pelvic CT scans.
  
  
  METHODS
  Five patients with acetabular fractures and ten patients with pelvic ring injuries were identified using the orthopedic trauma database at our institution. These fractures were evaluated with both conventional radiographs as well as virtual radiographs generated from a CT scan. A web-based survey was created to query overall image quality and visibility of relevant anatomic structures. This survey was then administered to members of the Orthopaedic Trauma Association (OTA).
  
  
  RESULTS
  Ninety-seven surgeons completed the acetabular fracture survey and 87 completed the pelvic fracture survey. Overall image quality was judged to be statistically superior for the virtual as compared to conventional images for acetabular fractures (3.15 vs. 2.98, p = 0.02), as well as pelvic ring injuries (2.21 vs. 1.45, p = 0.0001). Visibility ratings for each anatomic landmark were statistically superior with virtual images as well.
  
  
  CONCLUSIONS
  Virtual radiographs of pelvic and acetabular fractures offer superior image quality, improved comfort, decreased radiation exposure, and a more cost-effective alternative to conventional radiographs.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA, jabishop@stanford.edu.
authors.forename: Julius A
authors.initials: JA
authors.lastname: Bishop
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Rao
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pouliot
authors.forename: Christopher
authors.initials: C
authors.lastname: Beaulieu
authors.forename: Michael
authors.initials: M
authors.lastname: Bellino
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging* / Q000293:injuries*; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D002983:Clinical Competence; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015588:Observer Variation; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014584:User-Computer Interface; D014962:X-Ray Film