MedicalResearch.com Interview with:
Sanjit Konda, MD
Assistant professor of Orthopaedic surgery
NYU Langone Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Konda: We serendipitously found that we could identify periarticular fractures associated with deep knee wounds with the use of a CT-scan. We published a study in the Journal of Orthopaedic Trauma showing that a CT scan could identify a traumatic arthrotomy of a joint better than a saline load test, which at the time was considered the diagnostic gold standard. When we presented that work, we received criticism that we were subjecting patients to a high dose of radiation for a diagnostic test; however, our rationale at the time was that the saline load test was a painful, invasive procedure using a needle, and that we would trade a bit of radiation for lack of invasive procedure.
This got us thinking of ways we could decrease the amount of radiation in the CT yet maintain the same diagnostic accuracy of identifying penetrating joint injuries. Collaborating with Dr. Soterios Gyftopoulos, an assistant professor in the Department of Radiology at NYU Langone, we were able to successfully reduce the amount of radiation in these CT scans and still get good bony images. We then thought, if we can get a CT scan that shows us good bony detail and is safer, then why shouldn’t we be doing it on every joint fracture, not just these arthrotomy cases? We then applied this to our current research protocol, REDUCTION(Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury) in which we reduced the average amount of radiation from 0.43 msV to 0.03 msV, or down to the average dose given in a routine chest X-ray. After running a comparison study with our ultra-low dose radiation protocol compared to conventional CT scans, we found we were able to obtain nearly the exact same types of images for various joint fractures and locations without sacrificing any diagnostic accuracy in most cases. We gave sets of these CT scans to orthopaedic surgeons to analyze, and found we achieved 98 percent sensitivity and 89 percent specificity with the ultra-low dose CT scans when occult fractures, or those that could not be seen on an X-ray, were removed from our analysis.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Konda: If implemented on a widespread basis for orthopaedic trauma care, ultra-low dose radiation CT scans could become the standard of care for patients with fractures that involve the joint’s surface. These imaging tests are medically necessary in such cases, so if we are able to reduce the radiation exposure amount by 14 times, there could be public health benefits for patient safety.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Konda: In future research, we will continue to follow-up patients who underwent the ultra-low dose radiation CT scans to ensure patient outcomes haven’t changed in the hopes of expanding the protocol to other departments within our Medical Center. We also want to learn more about how this protocol would work in evaluating tumors or other lesions, and applications such as those that might be used in spinal surgery.
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Citation: Presented at the 2016 AAOS meeting
In addition to Drs. Konda, Egol and Gyftopoulos, NYU Langone researchers included Abraham Goch, BS;Philipp Leucht, MD, PhD; Anthony Christiano, BA, and Gideon Yoeli, MD provided support from Jamaica Hospital Medical Center.
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Dr. Sanjit Konda (2016). Very Low Dose CT Scans Successfully Detect Bone Fractures MedicalResearch.com