Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly

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Tomosynthesis of the thoracic spine : added value in diagnosing vertebral fractures in the elderly. / Geijer, Mats; Gunnlaugsson, Eirikur; Götestrand, Simon; Weber, Lars; Geijer, Håkan.

In: European Radiology, Vol. 27, No. 2, 02.2017, p. 491-497.

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TY - JOUR

T1 - Tomosynthesis of the thoracic spine

T2 - added value in diagnosing vertebral fractures in the elderly

AU - Geijer, Mats

AU - Gunnlaugsson, Eirikur

AU - Götestrand, Simon

AU - Weber, Lars

AU - Geijer, Håkan

PY - 2017/2

Y1 - 2017/2

N2 - Objectives: Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly. Methods: Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55–92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose–area product values. Results: For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P <0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51–0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm2) for the combined examination. The resulting effective dose was 0.87 mSv. Conclusion: Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose. Key Points: • Tomosynthesis helps evaluate the thoracic spine in the elderly.• Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73).• Significantly more vertebrae and significantly more fractures were seen with tomosynthesis.• Tomosynthesis took longer to evaluate than radiography.• There was a clear preference among all observers for tomosynthesis over radiography.

AB - Objectives: Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly. Methods: Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55–92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose–area product values. Results: For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P <0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51–0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm2) for the combined examination. The resulting effective dose was 0.87 mSv. Conclusion: Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose. Key Points: • Tomosynthesis helps evaluate the thoracic spine in the elderly.• Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73).• Significantly more vertebrae and significantly more fractures were seen with tomosynthesis.• Tomosynthesis took longer to evaluate than radiography.• There was a clear preference among all observers for tomosynthesis over radiography.

KW - Fracture

KW - Image quality

KW - Radiography

KW - Thoracic vertebrae

KW - Tomography

KW - X-ray

UR - http://www.scopus.com/inward/record.url?scp=84973129798&partnerID=8YFLogxK

U2 - 10.1007/s00330-016-4392-5

DO - 10.1007/s00330-016-4392-5

M3 - Article

VL - 27

SP - 491

EP - 497

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 2

ER -