Computed Tomography with Low-dose Radiation Versus Standard-dose Radiation for Diagnosing Fractures: Systematic Review and Meta-analysis

Overview

Journal Sao Paulo Med J

Specialty General Medicine

Date 2021 Aug 4

PMID 34346965

Citations 1

Authors

Marcio Luis Duarte

Lucas Ribeiro Dos Santos

Acary Souza Bulle Oliveira

Wagner Iared

Maria Stella Peccin

Affiliations

Soon will be listed here.

Abstract

Background: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT.

Objective: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures.

Design And Setting: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil.

Methods: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation.

Results: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either.

Conclusion: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated.

Registration Number: CRD42019148491 at the PROSPERO database.

Citing Articles

Osteoporotic vertebral compression fracture (OVCF) detection using artificial neural networks model based on the AO spine-DGOU osteoporotic fracture classification system.

Liawrungrueang W, Cho S, Kotheeranurak V, Jitpakdee K, Kim P, Sarasombath P N Am Spine Soc J. 2024; 19:100515.

PMID: 39188670 PMC: 11345903. DOI: 10.1016/j.xnsj.2024.100515.

References

Kim P, Gracias V, Maidment A, OShea M, Reilly P, Schwab C . Cumulative radiation dose caused by radiologic studies in critically ill trauma patients. J Trauma. 2004; 57(3):510-4. DOI: 10.1097/01.ta.0000141028.97753.67. View

Lee R, Chu W, Graham C, Rainer T, Ahuja A . Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emerg Med J. 2011; 29(4):306-8. DOI: 10.1136/emermed-2011-200481. View

Alshamari M, Geijer M, Norrman E, Liden M, Krauss W, Wilamowski F . Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice. Acta Radiol. 2015; 57(5):602-11. DOI: 10.1177/0284185115595667. View

Ruchalski K, Gutierrez A, Genshaft S, Abtin F, Suh R . The evidence for low-dose CT screening of lung cancer. Clin Imaging. 2015; 40(2):288-95. DOI: 10.1016/j.clinimag.2015.07.001. View

Banerjee P, Thomas M . CT scans to exclude spine fractures in children after negative radiographs may lead to increase in future cancer risk. Eur J Orthop Surg Traumatol. 2019; 29(5):983-988. DOI: 10.1007/s00590-019-02396-5. View

Mookiah M, Baum T, Mei K, Kopp F, Kaissis G, Foehr P . Effect of radiation dose reduction on texture measures of trabecular bone microstructure: an in vitro study. J Bone Miner Metab. 2017; 36(3):323-335. DOI: 10.1007/s00774-017-0836-5. View

Brisco J, Fuller K, Lee N, Andrew D . Cone beam computed tomography for imaging orbital trauma--image quality and radiation dose compared with conventional multislice computed tomography. Br J Oral Maxillofac Surg. 2013; 52(1):76-80. DOI: 10.1016/j.bjoms.2013.09.011. View

Jin L, Ge X, Lu F, Sun Y, Li C, Gao P . Low-dose CT examination for rib fracture evaluation: A pilot study. Medicine (Baltimore). 2018; 97(30):e11624. PMC: 6078715. DOI: 10.1097/MD.0000000000011624. View

Konda S, Goch A, Haglin J, Egol K . Ultralow-Dose CT (REDUCTION Protocol) for Extremity Fracture Evaluation Is as Safe and Effective as Conventional CT: An Evaluation of Quality Outcomes. J Orthop Trauma. 2018; 32(5):216-222. DOI: 10.1097/BOT.0000000000001137. View

10.

Kocyigit A, Serinken M, Ceven Z, Yilmaz A, Kaya F, Hatipoglu C . A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; could we improve CT use in children with mild head injury?. Clin Imaging. 2014; 38(3):236-40. DOI: 10.1016/j.clinimag.2013.12.004. View

11.

Yi J, Park H, Lee S, Rho M, Hong H, Choi Y . Radiation dose reduction in multidetector CT in fracture evaluation. Br J Radiol. 2017; 90(1077):20170240. PMC: 5858798. DOI: 10.1259/bjr.20170240. View

12.

Kim P, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance M . Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005; 29(12):1557-62. DOI: 10.1007/s00268-005-0106-x. View

13.

Moritz J, Hoffmann B, Sehr D, Keil K, Eggerking J, Groth G . Evaluation of ultra-low dose CT in the diagnosis of pediatric-like fractures using an experimental animal study. Korean J Radiol. 2012; 13(2):165-73. PMC: 3303899. DOI: 10.3348/kjr.2012.13.2.165. View

14.

Konda S, Goch A, Leucht P, Christiano A, Gyftopoulos S, Yoeli G . The use of ultra-low-dose CT scans for the evaluation of limb fractures: is the reduced effective dose using ct in orthopaedic injury (REDUCTION) protocol effective?. Bone Joint J. 2016; 98-B(12):1668-1673. DOI: 10.1302/0301-620X.98B12.BJJ-2016-0336.R1. View

15.

Alshamari M, Geijer M, Norrman E, Geijer H . Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality. Acta Radiol. 2013; 55(7):824-32. DOI: 10.1177/0284185113509615. View

16.

Afadzi M, Fossa K, Andersen H, Aalokken T, Martinsen A . Image Quality Measured From Ultra-Low Dose Chest Computed Tomography Examination Protocols Using 6 Different Iterative Reconstructions From 4 Vendors, a Phantom Study. J Comput Assist Tomogr. 2020; 44(1):95-101. DOI: 10.1097/RCT.0000000000000947. View

17.

Mansfield C, Ali S, Komperda K, Zhao H, Rehman S . Optimizing Radiation Dose in Computed Tomography of Articular Fractures. J Orthop Trauma. 2017; 31(8):401-406. DOI: 10.1097/BOT.0000000000000861. View

18.

Whiting P, Rutjes A, Westwood M, Mallett S, Deeks J, Reitsma J . QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155(8):529-36. DOI: 10.7326/0003-4819-155-8-201110180-00009. View

19.

Zacchino M, Bonaffini P, Corso A, Minetti V, Nasatti A, Tinelli C . Inter-observer agreement for the evaluation of bone involvement on Whole Body Low Dose Computed Tomography (WBLDCT) in Multiple Myeloma (MM). Eur Radiol. 2015; 25(11):3382-9. DOI: 10.1007/s00330-015-3733-0. View

20.

Brenner D, Hall E . Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007; 357(22):2277-84. DOI: 10.1056/NEJMra072149. View