title: Digital Tomosynthesis to Evaluate Fracture Healing: Prospective Comparison With Radiography and CT.
abstract: OBJECTIVE
  Radiography, currently the standard for postoperative fracture imaging, is limited by overlapping bone and hardware. Tomosynthesis has the benefit of level-by-level imaging without the disadvantages of metal artifacts, increased radiation, and higher costs of CT, the current problem-solving tool. The purpose of this study was to compare tomosynthesis with radiography for evaluating fracture healing.
  
  
  METHODS
  In a prospective study, patients within 1 year of wrist hardware fixation underwent radiography, tomosynthesis, and CT, and the images were interpreted by three readers. The diagnostic accuracy of radiology and tomosynthesis was assessed with ROC curves, and interreader agreement was assessed with Cohen kappa. Fracture scores were correlated with Disabilities of the Arm, Shoulder, and Hand (DASH) and pain scores.
  
  
  RESULTS
  The study participants were 49 patients with 51 fractures. The most common fracture sites were distal radius (43%), scaphoid (18%), and metacarpals (18%). Rates of cortex obscuration by hardware were 2% for CT, 8% for tomosynthesis, and 15% for radiography (p < 0.01 between one modality and another). Detection of cortical fracture lines was significantly better with tomosynthesis than with radiography (AUC, 0.84 vs 0.76, p = 0.01). Inter-reader agreement was moderate for both radiography and tomosynthesis (κ = 0.44 vs 0.55, p = 0.051). There was no significant correlation between fracture scores and DASH scores. There was significant correlation between reported pain levels and both tomosynthesis (r = 0.28, p = 0.03) and CT (r = 0.29, p = 0.04) fracture scores.
  
  
  CONCLUSIONS
  Tomosynthesis provides diagnostic information superior to that of ra diography in postoperative evaluation of wrist fractures with lower cost and radiation than CT and should be considered in fracture follow-up imaging of other bones.
authors.affiliation: 1 All authors: Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ha
authors.affiliation: 1 All authors: Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.
authors.forename: Amie Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: 1 All authors: Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: 1 All authors: Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.
authors.forename: Shinn-Huey S
authors.initials: SH
authors.lastname: Chou
authors.affiliation: 1 All authors: Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105.
authors.forename: Felix S
authors.initials: FS
authors.lastname: Chew
mesh_terms: D000328:Adult; D050280:Arm Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D004185:Disability Evaluation; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: fracture healing; hardware; tomosynthesis