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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations—a review of the literature

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A Correction to this article was published on 03 May 2023

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Abstract

Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test–retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements.

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© Onsight 3-D Extremity system (https://www.carestream.com/en/us/)

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Authors and Affiliations

  1. Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Signe Brinch, Mikael Ploug Boesen, Janus Uhd Nybing & Philip Hansen

  2. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Location AMC, Amsterdam, Netherlands

    Ruud H. H. Wellenberg, Mario Maas & Geert J. Streekstra

  3. Department of Sports Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Finn Elkjær Johannsen

  4. Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK

    Tom Turmezei

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Brinch, S., Wellenberg, R.H.H., Boesen, M.P. et al. Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations—a review of the literature. Skeletal Radiol 52, 1073–1088 (2023). https://doi.org/10.1007/s00256-022-04223-1

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