engleski

The use of tomosynthesis in musculoskeletal radiology - our experience

In the everyday setting of a musculoskeletal department it is often necessary to combine different imaging methods in order to obtain correct and timely diagnosis. This is especially important when dealing with complex bone and joint pathology. Various imaging methods have their advantages and disadvantages and adequate knowledge of these and on how they can be best utilized ensure maximal diagnostic information with as few negative effects for the patient as possible. Tomosynthesis is a digital X-ray tomography technology that combines computer tomography with digital image processing and is able to reconstruct multiple images from a single X-ray scan. A cross sectional image of any desired coronal or sagital plane can be reconstructed by acquiring a number of images from a single scan parallel to the table with the patient in any position. Short image acquisition time, high contrast resolution and relatively low exposure dose which is higher than in conventional radiography, but about 1/10 the dose of CT makes this method extremely valuable in MSK imaging. Images can be acquired with patient in different positions which reduces discomfort and allows functional and weight-bearing studies. Tomosynthesis is also less affected by metal artifacts than CT or MRI which makes it superior for postsurgical orthopedic imaging. It is especially useful in imaging of anatomical locations which are poorly visible on conventional X-ray images (e.g. cervicothoracic juncture, intervertebral joints) and anatomically complex joints (e.g. sacroiliac). Our standard use of tomosynthesis include traumatology ward patients (clinically suspicious fractures not or barely visible on conventional images, small wrist bone fractures, assessment of intraarticular extension, callus formation etc), orthopedic (postsurgical assessment of implant stability and complications, osteomyelitis) and rheumatology patients (wrist and hand bone erosion, sternoclavicular and sacroiliac joints pathology). In this lecture we will discuss basic physics, principles of tomosynthesis and specific image acquiring methods, various indications for the exam, radiation doses, disadvantages and comparison with other imaging methods. We shall present various examples from our own practice and briefly present the use of SLOT technology in orthopedic patients.

tomosynthesis ; digital imaging ; tomography ; musculoskeletal

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