title: Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures.
  
  
  METHODS
  As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.
  
  
  RESULTS
  Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities' specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001).
  
  
  CONCLUSIONS
  The diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Jakob
authors: J
authors: Neubauer
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Matthias
authors: M
authors: Benndorf
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Carolin
authors: C
authors: Reidelbach
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Tobias
authors: T
authors: Krauß
authors: Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany.
authors: Florian
authors: F
authors: Lampert
authors: Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany.
authors: Horst
authors: H
authors: Zajonc
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Elmar
authors: E
authors: Kotter
authors: Department of Radiology, University Medical Center Freiburg, Freiburg, Germany.
authors: Mathias
authors: M
authors: Langer
authors: Department of Medical Physics and Radiation Protection, University of Applied Sciences Gießen, Gießen, Germany.
authors: Martin
authors: M
authors: Fiebich
authors: Department of Radiology, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany.
authors: Sebastian M
authors: SM
authors: Goerke
mesh_terms: D000328:Adult; D002348:Carpal Bones / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography / Q000379:methods / Q000592:standards; D017759:Fractures, Malunited / Q000000981:diagnostic imaging; D006801:Humans; D061330:Multidetector Computed Tomography / Q000379:methods / Q000592:standards; D011829:Radiation Dosage; D011859:Radiography / Q000379:methods / Q000592:standards; D011885:Radius Fractures / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014458:Ulna Fractures / Q000000981:diagnostic imaging; D014953:Wrist / Q000000981:diagnostic imaging; D014954:Wrist Injuries / Q000000981:diagnostic imaging*