OBJECTIVES: We aimed to identify a protocol with the lowest possible radiation dose for CT imaging of post-operative acetabular fractures without compromising intra- and inter-observer reliability.
DESIGN: Ten fresh frozen cadavers with 20 acetabuli were used. Four common fracture patterns were created, and typical fixation constructs were placed. Intentional malreduction and joint penetration were performed in some of the specimens. Each specimen was scanned with decreasing radiation dose by varying a number of protocol factors such as current and exposure time (mAs), window filters, and others. The scans were then reviewed by five fellowship trained orthopaedic traumatologists comparing against the standard, full dose CT scan of each specimen. The following parameters were assessed for each specimen: 1) articular step-off 2) articular gap 3) intra-articular implant penetration and 4) surgeon confidence. Readings were noted to be in agreement if measurement was < 2 mm.
RESULTS: Intra-observer reliability for step-off, gap, and intra-articular implants ranged from 80 to 100% (p < 0.001) across all raters. Inter-observer evaluation of a single, pre-determined slice was 100% (average difference in rater measurements between the full dose protocol and lowest radiation protocol was 0.42 mm). The lowest radiation dose with > 80% inter-observer reliability was a soft tissue algorithm viewed in a bone window with 1.25 mm slices at 0.0625 mm pixels, 40mAs and 516 pitch (ultra-low dose CT protocol), which represents 1/10th the radiation of a full dose pelvic CT scan.
CONCLUSION: Utilizing the ultra-low dose CT protocol represents 1/10th of the radiation of a full dose CT scan, while still providing excellent intra- and inter-observer reliability.