European Radiology

, Volume 25, Issue 6, pp 1742–1751 | Cite as

Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system

  • S. DemehriEmail author
  • A. Muhit
  • W. Zbijewski
  • J. W. Stayman
  • J. Yorkston
  • N. Packard
  • R. Senn
  • D. Yang
  • D. Foos
  • G. K. Thawait
  • L. M. Fayad
  • A. Chhabra
  • J. A. Carrino
  • J. H. Siewerdsen



To assess visualization tasks using cone-beam CT (CBCT) compared to multi-detector CT (MDCT) for musculoskeletal extremity imaging.


Ten cadaveric hands and ten knees were examined using a dedicated CBCT prototype and a clinical multi-detector CT using nominal protocols (80kVp-108mAs for CBCT; 120kVp- 300mAs for MDCT). Soft tissue and bone visualization tasks were assessed by four radiologists using five-point satisfaction (for CBCT and MDCT individually) and five-point preference (side-by-side CBCT versus MDCT image quality comparison) rating tests. Ratings were analyzed using Kruskal–Wallis and Wilcoxon signed-rank tests, and observer agreement was assessed using the Kappa-statistic.


Knee CBCT images were rated “excellent” or “good” (median scores 5 and 4) for “bone” and “soft tissue” visualization tasks. Hand CBCT images were rated “excellent” or “adequate” (median scores 5 and 3) for “bone” and “soft tissue” visualization tasks. Preference tests rated CBCT equivalent or superior to MDCT for bone visualization and favoured the MDCT for soft tissue visualization tasks. Intraobserver agreement for CBCT satisfaction tests was fair to almost perfect (κ ~ 0.26–0.92), and interobserver agreement was fair to moderate (κ ~ 0.27–0.54).


CBCT provided excellent image quality for bone visualization and adequate image quality for soft tissue visualization tasks.

Key Points

CBCT provided adequate image quality for diagnostic tasks in extremity imaging.

CBCT images were “excellent” for “bone” and “good/adequate” for “soft tissue” visualization tasks.

CBCT image quality was equivalent/superior to MDCT for bone visualization tasks.


Cone-beam computed tomography Musculoskeletal Orthopedics Rheumatology Weight-bearing 

Abbreviations and acronyms


Cone-beam computed tomography


Multidetector computed tomography


Magnetic resonance imaging


Computed tomography dose index


Contrast-to-noise ratio



The scientific guarantor of this publication is Dr. Shadpour Demehri. The authors of this manuscript declare relationships with the following companies: Carestream Health, Inc. The research was supported by National Institutes of Health Grants 2R01-CA-112163 and R21-AR-062993 and academic-industry partnership with Carestream Health (Rochester NY). One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this study does not involve any human subjects. All data was collected using cadavers, and state and institutional requirements were followed. Methodology: retrospective, observational, performed at one institution


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • S. Demehri
    • 1
    • 4
    Email author
  • A. Muhit
    • 2
  • W. Zbijewski
    • 2
  • J. W. Stayman
    • 2
  • J. Yorkston
    • 3
  • N. Packard
    • 3
  • R. Senn
    • 3
  • D. Yang
    • 3
  • D. Foos
    • 3
  • G. K. Thawait
    • 1
  • L. M. Fayad
    • 1
  • A. Chhabra
    • 1
  • J. A. Carrino
    • 1
  • J. H. Siewerdsen
    • 1
    • 2
  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreUSA
  3. 3.Carestream HealthRochesterUSA
  4. 4.Musculoskeletal RadiologyJohns Hopkins Outpatient Center, JHOC 5168BaltimoreUSA

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