title: Initial Clinical Experience With Extremity Cone-Beam CT of the Foot and Ankle in Pediatric Patients.
abstract: OBJECTIVE
  Extremity cone-beam CT (CBCT) scanners have become available for clinical use in the United States. The purpose of this study was to review an initial clinical experience with CBCT of the foot and ankle in pediatric patients.
  
  
  METHODS
  A retrospective review was conducted of all foot or ankle CBCT examinations performed on patients 18 years old and younger at one institution from August 1, 2013, through February 28, 2015. A t test was used to compare mean effective dose for CBCT with that for MDCT foot or ankle examinations of age-matched control subjects. To assess changes in utilization, a t test also was used to compare the mean numbers of foot or ankle CT examinations per month before and after installation of the CBCT scanner at the institution.
  
  
  RESULTS
  Thirty-four CBCT examinations were performed. The mean effective dose was 0.013 ± 0.003 mSv compared with 0.023 ± 0.020 mSv for MDCT of age-matched control subjects (p < 0.005). The mean numbers of foot or ankle CT examinations per month were 3.4 in the 18 months before and 3.8 in the 18 months after installation of the CBCT scanner (p = 0.28). The mean number of foot or ankle MDCT examinations per month decreased significantly (3.4 vs 1.9, p = 0.03) over the same period. In 56% of patients, CBCT revealed important findings that were not visible on contemporaneous radiographs. In 68% of patients, the CBCT findings affected clinical management.
  
  
  CONCLUSIONS
  CBCT of the foot or ankle of pediatric patients is a viable lower-dose alternative to MDCT that provides important information that may affect clinical management.
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Pugmire
authors.affiliation: 2 Department of Radiology, Division of Pediatric Imaging, Massachusetts General Hospital, Boston, MA.
authors.forename: Randheer
authors.initials: R
authors.lastname: Shailam
authors.affiliation: 2 Department of Radiology, Division of Pediatric Imaging, Massachusetts General Hospital, Boston, MA.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Sagar
authors.affiliation: 3 Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Bob
authors.initials: B
authors.lastname: Liu
authors.affiliation: 3 Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Li
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: William E
authors.initials: WE
authors.lastname: Palmer
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: Ambrose J
authors.initials: AJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000842:Ankle / Q000000981:diagnostic imaging*; D002648:Child; D054893:Cone-Beam Computed Tomography; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging*; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011829:Radiation Dosage; D012189:Retrospective Studies
keywords: cone-beam CT; musculoskeletal imaging; pediatric imaging; radiation dose