Abstract
Imaging pediatric elbow trauma in the acute setting remains diagnostically challenging given difficult patient positioning, multiple ossification centers of the pediatric elbow, overlapping structures, and complex joint anatomy. Digital tomosynthesis is a technique where the X-ray source travels across a limited arc angle, obtaining a series of low-dose exposures that are in turn digitally reconstructed to produce high in-plane resolution at a relatively low overall radiation dose. Digital tomosynthesis is now more commonly integrated into standard radiographic machines and offers a new and exciting way to assess the pediatric elbow. In this review article we discuss the clinical applications of digital tomosynthesis in pediatric elbow trauma along with challenges related to technique, patient positioning and artifacts.
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Iyer RS, Thapa MM, Khanna PC, Chew FS (2012) Pediatric bone imaging: imaging elbow trauma in children — a review of acute and chronic injuries. AJR Am J Roentgenol 198:1053–1068
Landin LA (1983) Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand Suppl 202:100–109
Emery KH, Zingula SN, Anton CG et al (2016) Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 46:61–66
DeFroda SF, Hansen H, Gil JA et al (2017) Radiographic evaluation of common pediatric elbow injuries. Orthop Rev 9:7030
Cheng JC, Wing-Man K, Shen WY et al (1998) A new look at the sequential development of elbow ossification centers in children. J Pediatr Orthop 18:161–167
Patel B, Reed M, Patel S (2009) Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol 39:226–231
Donnelly LF, Klostermeier TT, Klosterman LA (1998) Traumatic elbow effusions in pediatric patients: are occult fractures the rule? AJR Am J Roentgenol 171:243–245
Skaggs DL, Mirzayan R (1999) The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 81:1429–1433
Major NM, Crawford ST (2002) Elbow effusions in trauma in adults and children: is there an occult fracture? AJR Am J Roentgenol 178:413–418
Al-Aubaidi Z, Torfing T (2012) The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient: a prospective magnetic resonance imaging study. J Pediatr Orthop B 21:514–519
Lins RE, Simovitch RW, Waters PM (1999) Pediatric elbow trauma. Orthop Clin North Am 30:119–132
Chapman V, Grottkau B, Albright M et al (2006) MDCT of the elbow in pediatric patients with posttraumatic elbow effusions. AJR Am J Roentgenol 187:812–817
Chapman VM, Grottkau BE, Albright M et al (2005) Multidetector computed tomography of pediatric lateral condylar fractures. J Comput Assist Tomogr 29:842–846
Maravilla KR, Murry RC Jr, Horner S (1983) Digital tomosynthesis: technique for electronic reconstructive tomography. AJR Am J Roentgenol 41:497–502
Compton N, Murphy L, Lyons F et al (2018) Tomosynthesis: a new radiologic technique for rapid diagnosis of scaphoid fractures. Surgeon 16:131–136
Ottenin MA, Jacquot A, Grospretre O et al (2012) Evaluation of the diagnostic performance of tomosynthesis in fractures of the wrist. AJR Am J Roentgenol 198:180–186
Geijer M, Börjesson AM, Göthlin JH (2011) Clinical utility of tomosynthesis in suspected scaphoid fracture. A pilot study. Skelet Radiol 40:863–867
Nelson F, Bokhari O, Oravec D et al (2017) The use of tomosynthesis in the global study of knee subchondral insufficiency fractures. Acad Radiol 24:175–183
Ha AS, Lee AY, Hippe DS et al (2015) Digital tomosynthesis to evaluate fracture healing: prospective comparison with radiography and CT. AJR Am J Roentgenol 205:136–141
De Silvestro A, Martini K, Becker AS et al (2018) Postoperative imaging of orthopaedic hardware in the hand and wrist: is there an added value for tomosynthesis? Clin Radiol 73:214.e1–214.e9
Dobbins JT, Godfrey DJ (2003) Digital X-ray tomosynthesis: current state of the art and clinical potential. Phys Med Biol 48:R65–R106
Gislason A, Elbakri IA, Reed M (2009) Dose assessment of digital tomosynthesis in pediatric imaging. Proc SPIE 7258:72585
Geiser WR, Einstein SA, Yang WT (2018) Artifacts in digital breast Tomosynthesis. AJR Am J Roentgenol 21:926–932
Tirada N, Li G, Dreizin D et al (2019) Digital breast tomosynthesis: physics, artifacts, and quality control considerations. Radiographics 39:413–426
Deller T, Jabri KN, Sabol JM et al (2007) Effect of acquisition parameters on image quality in digital tomosynthesis. Proc SPIE 6510:650101
Acciavatti RJ, Maidment AD (2012) Optimization of continuous tube motion and step-and-shoot motion in digital breast tomosynthesis systems with patient motion. Phys Med Imaging 8313:831306
Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109:145–154
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Zapala, M.A., Livingston, K., Phelps, A.S. et al. Digital tomosynthesis of the pediatric elbow. Pediatr Radiol 49, 1643–1651 (2019). https://doi.org/10.1007/s00247-019-04444-y
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DOI: https://doi.org/10.1007/s00247-019-04444-y