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Advancing Hand and Wrist Imaging with Tomosynthesis
Tyler S. Pidgeon, MD1 and Samuel Adams, MD2, (1)Duke University Medical Center, Durham, NC, (2)Duke Univeristy Medical Center, Morrisville, NC


Tomosynthesis is an imaging modality that falls between traditional radiography and computed tomography (CT). It has been used in breast, chest, head and neck, spine, total joint, and emergency imaging to produce better visualization of complex anatomic structures compared to conventional imaging with less radiation, metallic artifact, cost, and acquisition time compared to traditional CT. Modern systems are the size of a mini c-arm, can produce standard fluoroscopic images, and allow for capture of high-quality tomosynthesis studies in approximately 10 seconds. The tomosynthesis images are scrollable with three-dimensional content that approach the detail of coronal and sagittal CT scans. We hypothesize that mini c-arms with tomosynthesis capability will have several useful applications in hand and wrist surgery and outperform traditional fluoroscopy.


A cadaveric study was designed to determine the usefulness of a mini c-arm with tomosynthesis capability in several hand and wrist procedures including scaphoid fixation with headless compression screw (SHCS), distal radius fixation with volar locked plate (DRVLP), metacarpal fixation with intramedullary nail (MCIMN), and 5th CMC reduction and pinning (5CMC). Each procedure was performed using traditional fluoroscopy. Tomosynthesis images were then obtained in the coronal and sagittal planes to compare to the standard images. For SHCS, DRVLP, and MCIMN, hardware was then purposefully and subtly advanced into the joints. For 5CMC, the CMC joint was then purposely malreduced. Traditional fluoroscopy and tomosynthesis ijmages were again obtained and compared with respect to efficacy of discovery of these errors. The Qpix Solutions mini c-arm was used for all image acquisitions.


Tomosynthesis was superior to standard fluoroscopy in determining intra-articular hardware placement (Figure 1). Tomosynthesis confirmed intra-articular hardware placement in all cases. Fluoroscopy missed intra-articular hardware placement in the SHCS case, could not confirm it in the DRVLP case, and missed it in one of two instances in the MCIMN case. Tomosynthesis was also superior to traditional fluoroscopy in determining CMC joint malreduction (Figure 2). Sagittal tomosynthesis images absolutely confirmed malreduction of the CMC joint while AP and lateral fluoroscopy images appeared to demonstrate a reduced joint.

• Tomosynthesis produces a superior image in the hand and wrist compared to standard fluoroscopy
• Tomosynthesis has several potential uses in hand and wrist surgery including but not limited to avoidance of intra-articular hardware placement and confirmation of joint reduction
• Future research in the hand and wrist may include the use of tomosynthesis for intra-articular fracture reduction and for joint aspiration

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