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Conventional versus virtual radiographs of the injured pelvis and acetabulum

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Abstract

Background

Evaluation of the fractured pelvis or acetabulum requires both standard radiographic evaluation as well as computed tomography (CT) imaging. The standard anterior-posterior (AP), Judet, and inlet and outlet views can now be simulated using data acquired during CT, decreasing patient discomfort, radiation exposure, and cost to the healthcare system. The purpose of this study is to compare the image quality of conventional radiographic views of the traumatized pelvis to virtual radiographs created from pelvic CT scans.

Methods

Five patients with acetabular fractures and ten patients with pelvic ring injuries were identified using the orthopedic trauma database at our institution. These fractures were evaluated with both conventional radiographs as well as virtual radiographs generated from a CT scan. A web-based survey was created to query overall image quality and visibility of relevant anatomic structures. This survey was then administered to members of the Orthopaedic Trauma Association (OTA).

Results

Ninety-seven surgeons completed the acetabular fracture survey and 87 completed the pelvic fracture survey. Overall image quality was judged to be statistically superior for the virtual as compared to conventional images for acetabular fractures (3.15 vs. 2.98, p = 0.02), as well as pelvic ring injuries (2.21 vs. 1.45, p = 0.0001). Visibility ratings for each anatomic landmark were statistically superior with virtual images as well.

Discussion

Virtual radiographs of pelvic and acetabular fractures offer superior image quality, improved comfort, decreased radiation exposure, and a more cost-effective alternative to conventional radiographs.

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References

  1. Mostafavi HR, Tornetta 3rd P. Radiologic evaluation of the pelvis. Clin Orthop Relat Res. 1996;329:6–14.

    Article  PubMed  Google Scholar 

  2. Resnik CS et al. Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs. AJR Am J Roentgenol. 1992;158(1):109–12.

    Article  CAS  PubMed  Google Scholar 

  3. O’Toole RV et al. Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma. 2010;24(5):284–90.

    Article  PubMed  Google Scholar 

  4. Prasarn ML et al. Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation. Injury. 2012;43(6):757–61.

    Article  PubMed  Google Scholar 

  5. Borrelli Jr J et al. Computer-reconstructed radiographs are as good as plain radiographs for assessment of acetabular fractures. Am J Orthop (Belle Mead NJ). 2008;37(9):455–9. discussion 460.

    Google Scholar 

  6. Rafii M et al. The impact of CT in clinical management of pelvic and acetabular fractures. Clin Orthop Relat Res. 1983;178:228–35.

    PubMed  Google Scholar 

  7. Borrelli Jr J et al. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma. 2002;16(7):449–56. discussion 456–7.

    Article  PubMed  Google Scholar 

  8. Hudson S et al. Plain radiography may be safely omitted for selected major trauma patients undergoing whole body CT: database study. Emerg Med Int. 2012;2012:432537.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Hilty MP et al. Pelvic radiography in ATLS algorithms: a diminishing role? World J Emerg Surg. 2008;3:11.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Guillamondegui OD et al. Pelvic radiography in blunt trauma resuscitation: a diminishing role. J Trauma. 2002;53(6):1043–7.

    Article  PubMed  Google Scholar 

  11. Saks BJ. Normal acetabular anatomy for acetabular fracture assessment: CT and plain film correlation. Radiology. 1986;159(1):139–45.

    Article  CAS  PubMed  Google Scholar 

  12. Visutipol B et al. Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scan. J Orthop Surg (Hong Kong). 2000;8(1):33–7.

    Google Scholar 

  13. Pekmezci M et al. Are conventional inlet and outlet radiographs obsolete in the evaluation of pelvis fractures? J Trauma Acute Care Surg. 2013;74(6):1510–5.

    Article  PubMed  Google Scholar 

  14. Ricci WM et al. Pelvic inlet and outlet radiographs redefined. J Bone Joint Surg Am. 2010;92(10):1947–53.

    Article  PubMed  Google Scholar 

  15. Hart D, Hillier MC, Wall BF. National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. Br J Radiol. 2009;82(973):1–12.

    Article  CAS  PubMed  Google Scholar 

  16. Smith EA et al. Model-based iterative reconstruction: effect on patient radiation dose and image quality in pediatric body CT. Radiology. 2014;270(2):526–34.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Neubauer J et al. Comparing the image quality of a mobile flat-panel computed tomography and a multidetector computed tomography: a phantom study. Investig Radiol. 2014;49(7):491–7.

    Article  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest. Author JAB has received honoraria from Synthes and research support from Covidien. AJR, MAP, CFB, and MJB have no conflicts to report. This work did not receive any funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Julius A. Bishop, Allison J. Rao, Michael A. Pouliot & Michael Bellino

  2. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Christopher Beaulieu

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  1. Julius A. Bishop
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  2. Allison J. Rao
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  3. Michael A. Pouliot
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  4. Christopher Beaulieu
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  5. Michael Bellino
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Correspondence to Julius A. Bishop.

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Bishop, J.A., Rao, A.J., Pouliot, M.A. et al. Conventional versus virtual radiographs of the injured pelvis and acetabulum. Skeletal Radiol 44, 1303–1308 (2015). https://doi.org/10.1007/s00256-015-2171-z

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  • DOI: https://doi.org/10.1007/s00256-015-2171-z

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