Imaging Pearls ❯ Musculoskeletal ❯ 3D Imaging
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- “Lower extremity trauma is one of the most common injury patterns seen in emergency medical and surgical practice. Vascular injuries occur in less than one percent of all civilian fractures. However, if not treated promptly, such injuries can lead to ischemia and death. Computed tomography angiography (CTA) is the non-invasive imaging gold standard and plays a crucial part in the decision-making process for treating lower extremity trauma. A novel, FDA-approved 3D reconstruction technique known as cinematic rendering (CR) yields photorealistic reconstructions of lower extremity vascular injuries depicting clinically important aspects of those injuries, aiding in patient workup and surgical planning, and thus improving patient outcomes. In this article, we provide clinical examples of the use of CR in evaluating lower extremity vascular injuries, including the relationship of these injuries to adjacent osseous structures and overlying soft tissues, and its role in management of lower extremity trauma.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “Lower extremity trauma is one of the most common injury patterns seen in emergency medical and surgical practice, ranging from falls and motor vehicle accidents to blast and fragmentation injuries [4]. Accurate and rapid evaluation of clinical status, along with physical exam, within the context of the overall resuscitation of the patient according to Advanced Trauma Life Support protocols, is crucial in the management of lower extremity vascular injuries [5]. Limb vascular injuries may exhibit “absolute signs” or “hard signs,” including ischemia, absent pulses, active bleeding, and pulsatile hematoma, all of which have a high positive predictive value for severe vascular injury and require urgent surgical intervention. On the other hand, “relative signs” or “soft signs” consist of significant hemorrhage on history, decreased pulse in comparison to the contralateral extremity, injury to osseous structures or proximity to a penetrating wound, unexplained hypotension, and small hematoma.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “Patients with multiple injuries, not limited to the extremities, who are hemodynamically stable, will routinely undergo multiphasic CT with imaging of injured body regions in the appropriate phase of contrast enhancement. Any discrepancies between clinical and CT angiographic fndings prompt further assessment with digital subtraction angiography (DSA). However, an invasive diagnostic approach may delay treatment, resulting in complications such as arteriovenous fstulae, aneurysms, and/ or gangrene, and eventually increasing the risk of amputation and physical disability. In these cases of uncertainty, highly detailed CR visualizations may aid in prompt diagnosis of extremity vascular injuries, as well as any associated complications, and reduce patient morbidity. Diagnosis and treatment within 6–12 h after injury signifcantly improves survival.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “MIP images have also been the standard through which vascular occlusions or segmental narrowing of the vessel lumen have been identifed . Vascular occlusions are a result of external compression, dissection, thrombus, or vasospasm, which may be reactive or secondary to vascular contusion. For example, Fig. 5 demonstrates MIP and 3D CR visualizations of a gunshot entry wound in the upper medial thigh suggesting nearly occlusive SFA thrombus as a result of the injury. CR visualizations accurately depict SFA anatomy and demonstrate distal vasospasm of the vessel, which could otherwise be misinterpreted for extensive thrombus on 2D CT images.
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “The global illumination model employed by CR enhances visualization of fne vascular detail compared to classic VR and may provide an overall view that combines the traditional advantages of both MIP and VR. CR visualizations generate a 3D vascular map of the extremity that may be evaluated either in isolation through the “peeling away” technique [13] or relative to surrounding anatomic structures, including bones and soft tissues. The “peeling away” technique involves step-wise removal of overlying soft tissue and muscle to reveal underlying vascular and bony anatomy, providing a thorough assessment of the injury. For example, the “peeling away” of the skin in Fig. 1 allows accurate visualization of the underlying vastus intermedius muscle hematoma as a result of an injured branch of the SFA. On further examination and “peeling away” of soft tissues and muscle, the radiologist can confdently rule out any subtle fractures underlying the vascular injury.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x - “CR is a novel, promising 3D post-processing technique that provides photorealistic visualizations of lower extremity traumatic injuries, depicting clinically important aspects of those injuries, aiding in patient workup and surgical planning, and ultimately potentially improving patient outcomes. Current limitations of CR include post-processing time, approximately 5 additional minutes, compared to other methods given the higher computational power required to generate the 3D images. Also, the quality of the final image depends on the quality of the original dataset. Any reduction in image quality including patient or scanner-based artifacts will be translated into the 3D visualization. As mentioned by Rowe et al., application of these visualizations into routine clinical practice, as well as their advantages and disadvantages relative to traditional 3D techniques, will need to be further investigated through a series of quantitative and qualitative studies.”
Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.
Lugo-Fagundo, C., Lugo-Fagundo, E., Chu, L.C., Fishman EK, Rowe SP
Emerg Radiol (2023). https://doi.org/10.1007/s10140-023-02178-x
- Cinematic rendering (CR) is a novel post-processing technique similar to volume rendering (VR), which allows for a more photorealistic imaging reconstruction by using a complex light modelling algorithm, incorporating information from multiple light paths and predicted photon scattering patterns. Several recent publications relating to adult imaging have argued that CR gives a better “realism” and “expressiveness” experience over VR techniques. CR has also been shown to improve visualisation of musculoskeletal and vascular anatomy compared with conventional CT viewing, and may help non-radiologists to understand complex patient anatomy. In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes.We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “CR uses a Monte Carlo path-tracing method to simulate howphotons have passed through the imaged tissue fromall directions. As there are theoretically an infinite number of directions fromwhich a photon could travel, theMonte Carlo simulation generates a randomnumber of light paths, which are averaged over time to create an image, approximating photon travel from all directions. This complex interaction of light rays better imitates how we visualise objects in real life, resulting in the so-called “photorealistic” image. The path tracing method also takes into account any overlying structures, generating shadows to help improve depth perception of the final digital 3D model.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - "In addition to musculoskeletal pathology, CR has been shown to provide improved visualisation of underlying vascular anatomy (over 2D CT images) for undergraduate medical education and several studies have published examples of CR use in depicting cerebrovascular, mesenteric, and aortic vascular pathology. In relation to trauma, we have found that traumatic pseudoaneurysms can be well depicted in relation to surrounding bony anatomy and may help in explaining treatment plans during patient consent for interventional procedures.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “Despite the improved aesthetic appearances of CR, there are clear potential drawbacks in relying on this technique alone, some of which are similar to the VR technique. These include the potential to “mask” important findings, either by incorrect windowing or the superimposition of overlying structures. Furthermore, where the pathology is subtle or injuries (e.g., fractures) are present without significant displacement or angulation, they may be easily overlooked and “smoothened out” by the reconstruction algorithm. As such, any 3D reconstruction (CR and VR) should thus always be reviewed with the original source material (e.g., axial CT sections), as is conventional radiology practice. Care should also be taken in these circumstances to determine whether the 3D model should be shown at all, as it could provide false reassurance if the findings are too subtle to demonstrate.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282 - “As with all post-processing software, the quality of the CR reconstruction also depends on the original CT image quality. Image reconstructions require thin, isovolumetric sections in order to create accurate, non-pixelated, and aesthetically pleasing 3D models. This can result in a longer post-processing times and the higher computational demand is one main drawbacks of CR (compared to VR). Realtime display of a rotating CR image is at present limited by the need for repetitive recalculation of complex light paths, which can take the reconstruction software anywhere from 5-30 seconds per rotation.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology 77 (2022) 274-282
- “In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes. We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “In addition to musculoskeletal pathology, CR has been shown to provide improved visualisation of underlying vascular anatomy (over 2D CT images) for undergraduate medical education and several studies have published examples of CR use in depicting cerebrovascular, mesenteric, and aortic vascular pathology. In relation to trauma, we have found that traumatic pseudoaneurysms can be well depicted in relation to surrounding bony anatomy and may help in explaining treatment plans during patient consent for interventional procedures.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “As with all post-processing software, the quality of the CR reconstruction also depends on the original CT image quality. Image reconstructions require thin, isovolumetric sections in order to create accurate, non-pixelated, and aesthetically pleasing 3D models. This can result in a longer post-processing times and the higher computational demand is one main drawbacks of CR (compared to VR). Real-time display of a rotating CR image is at present limited by the need for repetitive recalculation of complex light paths, which can take the reconstruction software anywhere from 5-30 seconds per rotation.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033 - “In conclusion, CR may provide useful 3D reconstructions for a broad range of paediatric musculoskeletal pathologies, and could complement or replace other useful but more costly visualisation techniques, such as 3D printing and augmented/virtual reality. Potential benefits of improved visualisation for the patient includes better understanding of complex anatomy and proposed surgical therapies, and for the clinician, to help surgical planning and improved patient communication around consent and during multidisciplinary team settings. Although the diagnostic value offered by CR may not necessarily be superior to VR for the radiologist, better anatomical understanding and visualisation by non-radiologists could translate into improved patient outcomes.”
Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT
A. Fagan et al.
Clinical Radiology, https://doi.org/10.1016/j.crad.2022.01.033
- “CR reconstructions are superior to VRT due to higher image quality and higher anatomical accuracy. Traumatologists find CR reconstructions to improve visualization of lower extremity fractures which should thus be used for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lowerextremity fractures?
Lena M. Wollschlaegera et al.
Eur J Radiol. 2020;126:108911. doi:10.1016/j.ejrad.2020.108911 - "CR provides a more detailed visualization of multifragmentary intraarticular lower extremity fractures with improved image quality and higher anatomical accuracy compared to VRT, thus facilitating the understanding of fracture morphology in multifragmentary intraarticular fractures. Therefore, CR improves traumatological preoperative fracture visualization in patients with multifragmentary in- traarticular lower extremity fractures and thus can be recommended for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lowerextremity fractures?
Lena M. Wollschlaegera et al.
Eur J Radiol. 2020;126:108911. doi:10.1016/j.ejrad.2020.108911 - “In summary, CR is a promising new technique for the display of reconstructed 3D MDCT data and the images provide a level of photorealistic detail that has never before been available from non-invasive medical imaging. However, the utility of these reconstructions has yet to be assessed in large clinical studies. The potential translation of these remarkably detailed reconstructions into routine clinical practice and an understanding of their advantages and disadvantages relative to traditional 3D techniques will require a systematic series of quantitative and qualitative studies.”
CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering.
Rowe, S.P., Fritz, J. & Fishman, E.K.
Emerg Radiol 25, 93–101 (2018).
- “Although 3D imaging can be applied to all anatomical regions and used with all imaging techniques, its most varied and rel- evant applications are found with computed tomography (CT) data in musculoskeletal imaging. These new applications include global illumination rendering (GIR), unfolded rib reformations, subtracted CT angiography for bone analysis, dynamic studies, temporal subtraction and image fusion. In all of these tasks, registration and segmentation are two basic processes that affect the quality of the results. GIR simulates the complete interaction of photons with the scanned object, providing photorealistic volume rendering. Reformations to unfold the rib cage allow more accurate and faster diagnosis of rib lesions. Dynamic CT can be applied to cinematic joint evaluations a well as to perfusion and angiographic studies.”
3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future
A. Blum et al.
Diagnostic and Interventional Imaging 2020 (in press) - "Maximum intensity projection (MIP) is a volume-rendering technique that generates a projection of the volume of interest into a viewing plane by displaying the maximum CT numbers encountered along the projection direction. The thickness of the volume of interest can be modified to include or exclude various objects from the projection. MIP images are used primarily with CT angiography and they usually require bone segmentation to be applied.”
3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future
A. Blum et al.
Diagnostic and Interventional Imaging 2020 (in press) - "GIR has been used in multiple domains, including the film and design industries, for many years, but it has only relatively recently been adopted in medical imaging. GIR simulates the complete inter- action of photons with the scanned object, providing photorealistic volume rendering. This technique is also known as cinematic rendering (Siemens Healthineers), global illumination rendering (Canon Medical Systems) or volume illumination (GE Healthcare).”
3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future
A. Blum et al.
Diagnostic and Interventional Imaging 2020 (in press) - “As a result, this technique is able to computes the complex physics of lighting effects in real-time, leading to a natural illumination of the rendered data (in contrast to the synthetic light sources used in VRT). GIR mod- els light propagation, absorption, scattering and eventually color transmission under multiple light sources. As with VRT, the transfer function assigns a color and an opacity property to each voxel. In addition, segmentation processes can also be used.”
3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future
A. Blum et al.
Diagnostic and Interventional Imaging 2020 (in press)
- Purpose: Cinematic rendering (CR), a recently launched, FDA-approved rendering technique converts CT image datasets into nearly photorealistic 3D reconstructions by using a unique lighting model. The purpose of this study was to compare CR to volume rendering technique (VRT) images in the preoperative visualization of multifragmentary intraarticular lower extremity fractures.
Conclusions: CR reconstructions are superior to VRT due to higher image quality and higher anatomical accuracy. Traumatologists find CR reconstructions to improve visualization of lower extremity fractures which should thus be used for fracture demonstration during interdisciplinary conferences.
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - "CR uses a unique lighting model which is far more complex than the ray casting methods used in VR [5]. In CR, the algorithm is based on the global illumination model. This model incorporates information of billions of photons traveling through the volumetric dataset, and the interactions of these rays of light with a joining voxels. Complex lighting effects such as refraction, absorption, depth of field, soft shadows and ambient occlusion can be created.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - “Recently, Dappa et al. published a review comparing the potential value of CR to conventional VRT images and illustrated potential clinical applications of CR such as preoperative treatment planning. In their experience, CR is especially striking for visualizing structures with high density and high contrast such as bones. Further- more, they highlighted the high quality of CR images and their ability for the perception of depth and the photorealistic representation of human anatomy.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911 - “CR provides a more detailed visualization of multifragmentary intraarticular lower extremity fractures with improved image quality and higher anatomical accuracy compared to VRT, thus facilitating the understanding of fracture morphology in multifragmentary intraarticular fractures. Therefore, CR improves traumatological pre-operative fracture visualization in patients with multifragmentary in- traarticular lower extremity fractures and thus can be recommended for fracture demonstration during interdisciplinary conferences.”
Is CT-based cinematic rendering superior to volume rendering technique in T the preoperative evaluation of multifragmentary intraarticular lower extremity fractures?
Lena M. Wollschlaegera et al.
European Journal of Radiology 126 (2020) 108911
- Purpose This study compared the accuracy and timeliness of two-dimensional computed tomography (2DCT) and three- dimensional computed tomography (3DCT) in the diagnosis of different types of acetabular fractures and by different groups of interpreters using the Letournel and Judet classification system.
Conclusions Standardized 3DCT provides greater reliability and faster diagnosis of acetabular fractures and helps improve the accuracy in transverse- and posterior wall-type fractures. In addition, it helps improve the accuracy of less experienced interpreters.
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “Overall, correct classifications with 3D required just over half the time of 2D images (60 vs. 32 s, a reduction of 28 s). Significant time reductions with 3D were observed for both study groups and for all types of fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “At all levels of experience among orthope- dic surgeons, accuracy is greater with 3D than 2D, but the difference is more noticeable among less experienced surgeons. A study by Sebaaly et al. found 35% improvement in correct classification (from 28 to 63%) with trainees when 3D images were added but only 7% (from 85 to 92%) among the experts. Our results also noted improvement in both ac- curacy and inter-observer reliability among graduate trainees when the interpretation was performed with 3D images versus 2D.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “A 3D image set should contain a set of elec- tronic hip disarticulation images with adequate representative views using appropriate rendering techniques. Reported accuracies are higher among studies with images of hip disarticulation compared with non-hip disarticulation. A study by Boudissa et al. reported an improvement in accuracy from 52 to 83%, with the addition of hip disarticulation images, a 31% increase.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6 - “In summary, using 3D images results in increased inter- observer reliability and faster interpretation. It helps improve accuracy in cases where classification involves simple types of fractures and also helps improve the overall accuracy of less experienced interpreters. Standardized 3D images can be produced without extensive knowledge of the Letournal classification system and are therefore appropriate for use in an emer- gency unit. We recommend routinely producing this set of 3D images for trauma patients with pelvic bone fractures.”
Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures
Thanat Kanthawang et al.
Emergency Radiology https://doi.org/10.1007/s10140-019-01744-6
- “With emerging virtual reality technologies, application of new tools in forensic medicine and anthropology will require adjustments, technical optimization, and validation. This study serves as an example of the anticipated level of efficacy and some of the limitations of virtual skeletons using current technology. Technical improvements should focus on searching for appropriate 3D-rendering parameters and minimization of stair-step artifacts. When virtual pelvic bones are used in an assessment, the cinematic volume rendering 3D CT has a high level of efficacy in revealing relevant details on the pubic bone, but remains unsuitable for evaluation of the auricular surface because of the poor demonstration of transverse organization and porosity.”
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al.
Forensic Science International (in press) - - Virtual skeletons created from 3D CT images have the potential to be used as a substitute for real bones.
- For age estimation, 3D CT can reveal relevant details on the pubic symphyses.
- 3D CT cannot effectively display the transverse organization or the porosity of the auricular surface.
- Appropriate rendering parameters and reduction of artifacts in 3D CT are required.
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al.
Forensic Science International (in press) - “Cinematic volume rendering is a newly introduced technique inspired by the photorealistic appearance of some animation movies. Owing to advances in computer technology, cinematic volume rendering resembles casting billons light rays from all possible directions to create an image. This technique integrates natural light effects which improves the rendering of shape, depth, and shading on the surface of 3D images.”
Technical note: Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones
Nuttaya Pattamapaspong et al.
Forensic Science International (in press) 
- ”In the following pictorial essay, we provide a number of clinical examples of the use of CR in musculoskeletal imaging, including the evaluation of complex fractures, the delineation of the relationship of fractures to adjacent vasculature and overlying soft tissues, and the visualization of vascular and soft tissue injuries.” CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering. Rowe SP, Fritz J , Fishman EK Emerg Radiol. 2017 Sep 12. [Epub ahead of print]
- BACKGROUND: Surgical stabilization of flail chest is increasingly recognized as a valid approach to improve pulmonary mechanics in selected trauma patients. The use of two-dimensional (2D) computed tomography (CT) has become almost universal in the assessment of blunt chest trauma and multiple rib fractures. We hypothesized that three-dimensional (3D) CT adds valuable information to the preoperative plan for fixation of rib fractures.
RESULTS: Intraobserver and interobserver reliability was excellent for both 2D CT and 3D CT and was the highest for 2D CT. Overall, 2D CT had the highest diagnostic accuracy for detecting rib fractures as compared with plain radiographs and 3D CT. However, 3D CT changed the surgical tactic in 65.7% of the cases.
CONCLUSION: We conclude that 3D CT is not as accurate as 2D CT for rib fracture diagnostic purposes; it seems to be an important tool for the preoperative planning of rib fracture fixation.
Utility of three-dimensional computed tomography for the surgical management of rib fractures. Pulley BR et al. J Trauma Acute Care Surg. 2015 Mar;78(3):530-4 - “We conclude that 3D CT is not as accurate as 2D CT for rib fracture diagnostic purposes; it seems to be an important tool for the preoperative planning of rib fracture fixation.”
Utility of three-dimensional computed tomography for the surgical management of rib fractures. Pulley BR et al. J Trauma Acute Care Surg. 2015 Mar;78(3):530-4 - “We propose that 3DV images should be part of routine head trauma imaging, especially in the pediatric age group. It requires minimal post-processing time and no additional radiation. Furthermore, 3DV images help in reducing the interpretation time and also enhance the ability of the radiologist to characterize the calvarial fractures.”
Skull fractures in pediatric patients on computerized tomogram: comparison between routing bone window images and 3D volume-rendered images. Dundamadappa SK et al. Emerg Radiol. 2015 Aug;22(4):367-72. - “Skull fracture is a common finding following head trauma. It has a prognostic significance and its presence points to severe trauma. Additionally, there is a greater possibility of detecting associated small underlying extra-axial hematomas and subtle injuries to the brain parenchyma. In pediatric patients, the presence of multiple open sutures often makes fracture evaluation challenging. In our experience, 3D volume (3DV)-rendered CT images complement routine axial bone window (RBW) images in detection and characterization of fractures.”
Skull fractures in pediatric patients on computerized tomogram: comparison between routing bone window images and 3D volume-rendered images. Dundamadappa SK et al. Emerg Radiol. 2015 Aug;22(4):367-72. - “Perilunate dislocations, perilunate fracture-dislocations (PLFDs), and lunate dislocations are high-energy wrist injuries that can and should be recognized on radiographs. These injuries are a result of important sequential osseous and ligamentous injuries or failures. Prompt and accurate radiographic diagnosis aids in the management of patients with perilunate dislocations, PLFDs, and lunate dislocations while assisting orthopedic surgeons with subsequent surgical planning. CT may better show the extent of the injury and help in treatment planning particularly in cases of delayed treatment or chronic perilunate dislocation. A CT examination with coronal, sagittal, and 3D reformatted images is ordered at our institution in cases in which the extent of the carpal injuries is poorly shown on radiographic examination.”
Spectrum of carpal dislocations and fracture-dislocations: imaging and management. Scalcione LR et al. AJR Am J Roentgenol. 2014 Sep;203(3):541-50. - “Prompt and accurate radiographic diagnosis aids in the management of patients with perilunate dislocations, PLFDs, and lunate dislocations while assisting orthopedic surgeons with subsequent surgical planning. CT may better show the extent of the injury and help in treatment planning particularly in cases of delayed treatment or chronic perilunate dislocation. A CT examination with coronal, sagittal, and 3D reformatted images is ordered at our institution in cases in which the extent of the carpal injuries is poorly shown on radiographic examination.”
Spectrum of carpal dislocations and fracture-dislocations: imaging and management. Scalcione LR et al. AJR Am J Roentgenol. 2014 Sep;203(3):541-50. - BACKGROUND: Distal humerus fractures are difficult to characterise and to classify according to the AO system. In this multicentre study, our objectives were to assess the usefulness of computed tomography (CT) and to measure intra-observer and inter-observer reliability according to observer experience.
CONCLUSION: CT improves diagnostic accuracy and, in some cases, changes the surgical strategy. In our study of a large number of observers, CT did not improve inter-observer agreement about the study variables. Intra-observer agreement was improved by 3D CT but not by 2D CT. Accuracy was not influenced by years of observer experience but was dependent on image quality, proficiency with computer-based tools and, above all, image observation and interpretation.
Usefulness and reliability of two- and three-dimensional computed tomography in patients older than 65 years with distal humerus fractures. Jacquot A et al. Orthop Traumatol Surg Res. 2014 May;100(3):275-80 - “CT improves diagnostic accuracy and, in some cases, changes the surgical strategy. In our study of a large number of observers, CT did not improve inter-observer agreement about the study variables. Intra-observer agreement was improved by 3D CT but not by 2D CT. Accuracy was not influenced by years of observer experience but was dependent on image quality, proficiency with computer-based tools and, above all, image observation and interpretation.”
Usefulness and reliability of two- and three-dimensional computed tomography in patients older than 65 years with distal humerus fractures. Jacquot A et al. Orthop Traumatol Surg Res. 2014 May;100(3):275-80 - “The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures.”
Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures. Veltman ES et al. Injury. 2014 Jul;45(7):1117-20. - PURPOSE: Three-dimensional (3D) reformatted images provide a more inclusive representation of abnormalities than transverse images in cranial computed tomography (CT). The purpose of this study was to assess the value of 3D reformations for radiology residents in the interpretation of emergency cranial CTs.
MATERIALS AND METHODS: In total, 218 consecutive patients who underwent emergency cranial CT scans with 3D reformation were included in this retrospective study. Four blinded readers (three radiology residents and a neuroradiologist) interpreted the transverse and 3D images in two separate sessions. Each reader assessed 1) abnormal finding(s) and the confidence score(s) (5-point scale) for transverse and 3D images, 2) added value score of 3D images (5-point scale), and 3) interpretation time for both transverse and 3D images. We analyzed discordance between each radiology resident and the neuroradiologist on a lesion-by-lesion basis. - RESULTS: In total, 509 lesions were detected in 218 patients. Discordance rates between the three residents and the neuroradiologist were 11.4%-20.2% (mean, 15.0%) and 8.8%-16.9% (mean, 12.1%) in the interpretation of transverse and 3D images, respectively. Confidence scores were higher for 3D images than for transverse images for all readers. The added value scores for the 3D images were relatively higher for the inexperienced residents. Interpretation times for 3D images were significantly higher than for transverse images for all readers.
CONCLUSION: The 3D reformations assist radiology residents in the interpretation of emergency cranial CT examinations Comparison of emergency cranial CT interpretation between radiology residents and neuroradiologists: transverse versus three-dimensional images.
Kim ES et al. Diagn Interv Radiol. 2014 May-Jun;20(3):277-84 - PURPOSE: Three-dimensional (3D) reformatted images provide a more inclusive representation of abnormalities than transverse images in cranial computed tomography (CT). The purpose of this study was to assess the value of 3D reformations for radiology residents in the interpretation of emergency cranial CTs..
RESULTS: In total, 509 lesions were detected in 218 patients. Discordance rates between the three residents and the neuroradiologist were 11.4%-20.2% (mean, 15.0%) and 8.8%-16.9% (mean, 12.1%) in the interpretation of transverse and 3D images, respectively. Confidence scores were higher for 3D images than for transverse images for all readers. The added value scores for the 3D images were relatively higher for the inexperienced residents. Interpretation times for 3D images were significantly higher than for transverse images for all readers.
CONCLUSION: The 3D reformations assist radiology residents in the interpretation of emergency cranial CT examinations Comparison of emergency cranial CT interpretation between radiology residents and neuroradiologists: transverse versus three-dimensional images.
Kim ES et al. Diagn Interv Radiol. 2014 May-Jun;20(3):277-84 - “The 3D reformations assist radiology residents in the interpretation of emergency cranial CT examinations.”
Comparison of emergency cranial CT interpretation between radiology residents and neuroradiologists: transverse versus three-dimensional images. Kim ES et al. Diagn Interv Radiol. 2014 May-Jun;20(3):277-84 - What does 3D CT add to 2D CT based on the literature?
- High impact on surgical planning and decision making
- Increased concensus on decision making
- Roadmaps for pre-operative planning with CT
I- mproved lesion detection with increased accuracy - Does the use of 3D differ depending on imaging experience?
- Resident vs. faculty
- Experience of the faculty
- “hands on” vs select images - INTRODUCTION: The insertion of thoracic pedicle screws (T1-T10) is subject to a relevant rate of malplacement. The optimum implantation procedure is still a topic of controversial debate. Currently, a postoperative computed tomography is required to evaluate the screw positions. The present study was undertaken to clarify whether intraoperative 3D imaging is a reliable method of determining the position of thoracic pedicle screws.
CONCLUSIONS: Performing an intraoperative 3D scan enables the position of thoracic pedicle screws to be determined with sufficient accuracy. The rate of revision surgery was reduced to 0 %. Reliability and consequences of intraoperative 3D imaging to control positions of thoracic pedicle screws. Beck M et al. Arch Orthop Trauma Surg. 2012 Oct;132(10):1371-7 - “For the post-operative patient, conventional axial computed tomography (CT) imaging and 2D multiplanar reconstruction are of limited value because of the beam-hardening artifact. However, three-dimensional (3D) CT imaging is an effective means of detecting subtle fracture healing, or confirming non-union, and for evaluating the integrity of metal hardware. In this article we emphasize the advantages of 3D CT imaging in the assessment and preoperative planning of non-union for patients who have been surgically treated for fractures.”
Recognition, assessment, and treatment of non-union after surgical fixation of fractures: emphasis on 3D CT. Calisir C, Fayad LM, Carrino JA, Fishman EK Jpn J Radiol. 2012 Jan;30(1):1-9. - “Pediatric trauma is a significant source of morbidity and mortality in pediatric patients. Prompt and accurate assessment of injuries is necessary for the best outcome. Computed tomography (CT) has become a well-accepted, rapid, relatively noninvasive way to assess the trauma patient. In certain cases of pelvic trauma, two- and three-dimensional CT (2D/3D CT) adds detail not otherwise obtainable or appreciated. Although the benefits must be balanced against the slight increase in delivered radiation dose, we believe that 2D/3D CT is often an important part of patient management.”
Acetabular and pelvic fractures in the pediatric patient: value of two- and three-dimensional imaging. Magid D, Fishman EK, Ney DR, Kuhlman JE, Frantz KM, Sponseller PD. J Pediatr Orthop. 1992 Sep-Oct;12(5):621-5.