title: Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly.
abstract: OBJECTIVE
  Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.
  
  
  METHODS
  Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55-92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose-area product values.
  
  
  RESULTS
  For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51-0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm2) for the combined examination. The resulting effective dose was 0.87 mSv.
  
  
  CONCLUSIONS
  Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.
  
  
  CONCLUSIONS
  • Tomosynthesis helps evaluate the thoracic spine in the elderly. • Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73). • Significantly more vertebrae and significantly more fractures were seen with tomosynthesis. • Tomosynthesis took longer to evaluate than radiography. • There was a clear preference among all observers for tomosynthesis over radiography.
authors.affiliation: Department of Radiology, Örebro University, Örebro, Sweden. mats.geijer@regionorebrolan.se.|Department of Clinical Sciences, Lund University, Lund, Sweden. mats.geijer@regionorebrolan.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Geijer
authors.affiliation: Department of Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Eirikur
authors.initials: E
authors.lastname: Gunnlaugsson
authors.affiliation: Department of Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Simon
authors.initials: S
authors.lastname: Götestrand
authors.affiliation: Department of Clinical Sciences, Lund University, Lund, Sweden.|Department of Radiation Physics, Skåne University Hospital, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Weber
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Geijer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods*; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Fracture; Image quality; Radiography; Thoracic vertebrae; Tomography; X-ray