Direct comparison of conventional radiography and cone-beam CT in small bone and joint XXXX .

@entity1 @entity174 @entity130
OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint @entity130 . MATERIALS AND METHODS: Between March 2013 and January 2014, 231 @entity1 with recent small bone or joint @entity130 underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of @entity174 as well as the number of complex @entity174 were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared. RESULTS: Fracture detection on CBCT increased by 35  % and 37  % for reader 1 and reader 2, respectively, and identification of complex @entity174 increased by 236  % and 185  %. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT. CONCLUSION: CBCT detects significantly more small bone and joint @entity174 , in particular complex @entity174 , than CR. In the majority of cases, the clinical implication of the additionally detected @entity174 is limited, but in some @entity1 (e.g., @entity174 ), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint @entity130 and keeping CBCT for @entity1 with clinical-radiographic discordance or suspected complex @entity174 in need of further (preoperative) assessment.
