Early results of ultra-low-dose CT-scan for extremity traumas in emergency room

Taki Eddine Addala, Joël Greffier, Aymeric Hamard, Fehmi Snene, Xavier Bobbia, Sophie Bastide, Asmaa Belaouni, Hélène de Forges, Ahmed Larbi, Jean-Emmanuel de la Coussaye, Jean-Paul Beregi, Pierre-Géraud Claret, Julien Frandon, Taki Eddine Addala, Joël Greffier, Aymeric Hamard, Fehmi Snene, Xavier Bobbia, Sophie Bastide, Asmaa Belaouni, Hélène de Forges, Ahmed Larbi, Jean-Emmanuel de la Coussaye, Jean-Paul Beregi, Pierre-Géraud Claret, Julien Frandon

Abstract

Background: Ultra-low dose computed tomography (ULD-CT) was shown to be a good alternative to digital radiographs in various locations. This study aimed to assess the diagnostic sensitivity and specificity of ULD-CT versus digital radiographs in patients consulting for extremity traumas in emergency room.

Methods: Digital radiography and ULD-CT scan were performed in patients consulting at the emergency department (February-August 2018) for extremity traumas. Fracture detection was evaluated retrospectively by two blinded independent radiologists. Sensitivity and specificity were evaluated using best value comparator (BVC) and a Bayesian latent class model (LCM) approaches and clinical follow-up. Image quality, quality diagnostic and diagnostic confidence level were evaluated (Likert scale). The effective dose received was calculated.

Results: Seventy-six consecutive patients (41 men, mean age: 35.2±13.2 years), with 31 wrists/hands and 45 ankles/feet traumas were managed by emergency physicians. According to clinical data, radiography had 3 false positive and 10 false negative examinations, and ULD-CT, 2 of each. Radiography and ULD-CT specificities were similar; sensitivities were lower for radiography, with BVC and Bayesian. With Bayesian, ULD-CT and radiography sensitivities were 90% (95% CI: 87-93%) and 76% (95% CI: 71-81%, P<0.0001) and specificities 96% (95% CI: 93-98%) and 93% (95% CI: 87-97%, P=0.84). The inter-observer agreement was higher for ULD-CT for all subjective indexes. The effective dose for ULD-CT and radiography was 0.84±0.14 and 0.58±0.27 µSv (P=0.002) for hand/wrist, and 1.50±0.32 and 1.44±0.78 µSv (P=NS) for foot/ankle.

Conclusions: With an effective dose level close to radiography, ULD-CT showed better detection of extremities fractures in the emergency room and may allow treatment adaptation. Further studies need to be performed to assess impact of such examination in everyday practice.

Trial registration: ClinicalTrials.gov Identifier: NCT04832490.

Keywords: CT scan; Radiation dose; X-ray; emergency radiology; extremity traumatism.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-21-848/coif). The authors have no conflicts of interest to declare.

2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.

Figures

Figure 1
Figure 1
Examples of cases with fractures with ultra-low dose ULD-CT or radiography. (A) Case 1: 22-year-old man with wrist trauma; ULD-CT scan (bottom) found a fracture of the radial styloid (white arrow) not identified on radiography (top); (B) Case 2: 37-year-old man with ankle trauma; no fracture on radiography (top); fracture of the first metatarsal found on the ULD-CT scan (bottom, white arrows). ULD-CT, ultra-low dose computed tomography.
Figure 2
Figure 2
Marginal distributions of sensitivity (left) and specificity (right) of digital radiography and ULD-CT using the Bayesian interference approach. Red line: digital radiography; blue line: ULD-CT scan. ULD-CT scan, ultra-low dose computed tomography scan; P, Bayesian posterior P value.

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