Rodriguez Kaitlyn, Levin Jay, Solomon Justin, Hurley Eoghan T, Lorenzana Daniel, Samei Ehsan, Boachie-Adjie Yaw, French Robert, Anakwenze Oke, Klifto Christopher
Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
J Shoulder Elbow Surg. 2025 May;34(5):1185-1193. doi: 10.1016/j.jse.2024.08.038. Epub 2024 Oct 21.
Computed tomography (CT) offers a detailed assessment of the shoulder for preoperative shoulder arthroplasty planning; however, this technique exposes the patient to ionizing radiation. The purpose of this study was to prospectively evaluate the practicality of reducing the CT radiation dose compared to conventional dose levels for manual and preoperative planning software measurements for shoulder arthroplasty.
A total of 10 shoulder CT examinations were performed for preoperative planning purposes on a dual x-ray source CT scanner. A specialized dose-split scan technique was utilized to reconstruct CT images corresponding to 100%, 70%, and 30% radiation dose relative to our institution's standard of care imaging protocol. Glenoid version, inclination, and humeral head subluxation were measured manually by 3 authors and by commercially available software platforms. These measurements were analyzed for agreement among the 100%, 70%, and 30% dose levels for each patient. Tolerances of 5° of glenoid version, 5° of glenoid inclination, and 10% humeral head subluxation were used as equivalent for preoperative planning.
Automated measurements of 70% dose images were within 5° of version, 5° of inclination, and 10% subluxation in 95.0% of cases. Manual measurements of 70% RD images were within 5° of version for 90.0% of cases, 5° of inclination in 86.7% of cases, and 10% subluxation in 100% of cases. Automated measurements from the 30% dose images were within 5° of version, 5° of inclination, and 10% subluxation for 100% of cases. Manual measurements from the 30% dose images were within 5° of version for 86.7% of cases, 5° of inclination in 76.7% of cases, and 10% subluxation in 100% of cases. The mean absolute difference in software measurement of glenoid version (P = .96), glenoid inclination (P = .64), or humeral head subluxation (P = .09) or in aggregated manual mean absolute difference of version (P = .22), inclination (P = .31), or humeral head subluxation (P = .56) was not significant. Good to excellent reliability was determined by interclass correlation coefficients among the manual observers and automatic software platforms for measurements at all doses (P < .001) CONCLUSIONS: The results indicate that both preoperative planning software platforms and human observers produced similar measurements of glenoid version, inclination, and humeral head subluxation from reduced-dose images compared to standard of care doses. By implementing reduced dose techniques in preoperative shoulder CT, the potential risks associated with radiation exposure could be reduced for patients undergoing shoulder arthroplasty.
计算机断层扫描（CT）可为术前肩关节置换术规划提供肩部的详细评估；然而，该技术会使患者暴露于电离辐射中。本研究的目的是前瞻性评估与传统剂量水平相比，降低CT辐射剂量用于肩关节置换术的手动测量和术前规划软件测量的实用性。
为了进行术前规划，在双X射线源CT扫描仪上共进行了10次肩部CT检查。采用一种专门的剂量分割扫描技术来重建与相对于我们机构标准护理成像方案的100%、70%和30%辐射剂量相对应的CT图像。由3名作者以及通过市售软件平台手动测量肩胛盂的版本、倾斜度和肱骨头半脱位情况。分析每位患者在100%、70%和30%剂量水平下这些测量值的一致性。将肩胛盂版本5°、肩胛盂倾斜度5°和肱骨头半脱位10%的公差用作术前规划的等效值。
70%剂量图像的自动测量值在95.0%的病例中版本偏差在5°以内、倾斜度偏差在5°以内、半脱位偏差在10%以内。70%辐射剂量（RD）图像的手动测量值在90.0%的病例中版本偏差在5°以内，86.7%的病例中倾斜度偏差在5°以内，100%的病例中半脱位偏差在10%以内。30%剂量图像的自动测量值在100%的病例中版本偏差在5°以内、倾斜度偏差在5°以内、半脱位偏差在10%以内。30%剂量图像的手动测量值在86.7%的病例中版本偏差在5°以内，76.7%的病例中倾斜度偏差在5°以内，100%的病例中半脱位偏差在10%以内。肩胛盂版本（P = 0.96）、肩胛盂倾斜度（P = 0.64）或肱骨头半脱位（P = 0.09）的软件测量值的平均绝对差异，或版本（P = 0.22）、倾斜度（P = 0.31）或肱骨头半脱位（P = 0.56）的汇总手动平均绝对差异均无统计学意义。通过所有剂量下手动观察者和自动软件平台之间的组内相关系数确定了良好至极好的可靠性（P < 0.001）。结论：结果表明，与标准护理剂量相比，术前规划软件平台和人工观察者从低剂量图像中获得的肩胛盂版本、倾斜度和肱骨头半脱位测量值相似。通过在术前肩部CT中采用低剂量技术，可以降低接受肩关节置换术患者与辐射暴露相关的潜在风险。
