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Objective <p>This prospective study aimed to evaluate the capabilities of two novel vertex-toes CT protocols (ultra-low and low-dose) compared to a standard high-dose CT protocol plus radiographic skeletal survey (SS) in a post-mortem setting. The study sought to assess perceived image quality (IQ)&#xa0;and the fracture detection capabilities of each CT protocol.</p> Materials and methods <p>Participants aged 2&#xa0;years and under received three whole-body CT scans, followed by a SS. Radiologists reviewed images in the sequence of ultra-low, low-dose, to standard-dose CT, then SS. The reviewers graded perceived IQ on a Likert scale. Gwet’s agreement coefficient (AC)-2 and cumulative link mixed models quantified interobserver agreement and IQ differences, respectively. Fractures detected by each modality were compared across anatomical regions, with positive specific agreement (PSA) assessing interobserver agreement. Radiation doses were calculated for each CT protocol.</p> Results <p>Significant differences in IQ ratings were observed across CT protocols for all anatomical regions (ribs [ultra-low–low], <i>p</i> = 0.0001; femur [ultra-low–low], <i>p</i> = 0.0001; all others, <i>p</i> &lt; 0.001), alongside low interobserver agreement in IQ (lumbar spine [low-dose]-AC = 0.78; humerus [low-dose]-AC = 0.77; all others, AC &lt; 0.7). Among 29 participants, 69 fractures were identified across modalities, all being detected by the standard-dose CT. Ultra-low and low-dose CT identified 62 (90%) of fractures detected using standard-dose CT. SS detected the fewest (17 (25%)), with the highest false-positive rate. Higher CT doses were associated with higher PSA values for fracture detection. Doses for UL and low-dose CTs were 1.3–2.3&#xa0;mSv.</p> Conclusion <p>Low-dose CT improved fracture detection, reduced false positives, and delivered less radiation than a bone scan, highlighting its potential for use in clinical suspected non-accidental injury.</p>

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Evaluation of ultra-low and low-dose CT skeletal survey for fracture detection in assessments for suspected non-accidental injury: a prospective post-mortem study

  • 期刊论文

  • 发表日期：

    2025年7月29日

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  • Michael Lawson,
  • Siew Yeong,
  • Shu Yi Tan,
  • Catherine Vincent,
  • Joanna Tully,
  • Mohamed Badawy,
  • Ahilan Kuganesan,
  • Richard Bassed,
  • Michael Ditchfield

摘要

Objective

This prospective study aimed to evaluate the capabilities of two novel vertex-toes CT protocols (ultra-low and low-dose) compared to a standard high-dose CT protocol plus radiographic skeletal survey (SS) in a post-mortem setting. The study sought to assess perceived image quality (IQ) and the fracture detection capabilities of each CT protocol.

Materials and methods

Participants aged 2 years and under received three whole-body CT scans, followed by a SS. Radiologists reviewed images in the sequence of ultra-low, low-dose, to standard-dose CT, then SS. The reviewers graded perceived IQ on a Likert scale. Gwet’s agreement coefficient (AC)-2 and cumulative link mixed models quantified interobserver agreement and IQ differences, respectively. Fractures detected by each modality were compared across anatomical regions, with positive specific agreement (PSA) assessing interobserver agreement. Radiation doses were calculated for each CT protocol.

Results

Significant differences in IQ ratings were observed across CT protocols for all anatomical regions (ribs [ultra-low–low], p = 0.0001; femur [ultra-low–low], p = 0.0001; all others, p < 0.001), alongside low interobserver agreement in IQ (lumbar spine [low-dose]-AC = 0.78; humerus [low-dose]-AC = 0.77; all others, AC < 0.7). Among 29 participants, 69 fractures were identified across modalities, all being detected by the standard-dose CT. Ultra-low and low-dose CT identified 62 (90%) of fractures detected using standard-dose CT. SS detected the fewest (17 (25%)), with the highest false-positive rate. Higher CT doses were associated with higher PSA values for fracture detection. Doses for UL and low-dose CTs were 1.3–2.3 mSv.

Conclusion

Low-dose CT improved fracture detection, reduced false positives, and delivered less radiation than a bone scan, highlighting its potential for use in clinical suspected non-accidental injury.