Image quality and radiation dose of cone-beam CT versus multidetector CT for upper extremity osteosynthesis

This study compared image quality and radiation dose between cone-beam computed tomography (CBCT) and multidetector computed tomography (MDCT) under equivalent scanning settings, focusing on postoperative imaging after upper extremity osteosynthesis. A distal radius plate was implanted in a cadaveric forearm to simulate postoperative conditions. A total of twenty-four scans were performed using both modalities. Radiation dose was quantified with seven dosimeters placed at various anatomical locations and scan parameters were adjusted to ensure comparability. Subjective image quality was evaluated by five independent radiologists, while objective image quality was assessed using signal-to-noise ratio and contrast-to-noise ratio. Significant differences were found in radiation exposure and image quality. CBCT showed a slightly higher radiation dose (dose-length product: CBCT, 56.97 mGy*cm; MDCT, 46.19 mGy*cm; p < 0.0001). No significant difference was observed in cortical bone assessment (p = 0.28), but CBCT was rated higher for cancellous bone visualization (p = 0.005), artifact reduction (p = 0.003), and overall image quality (p = 0.009). Objectively, CBCT demonstrated lower image noise with superior signal-to-noise ratio (p = 0.0004) and contrast-to-noise ratio (p < 0.0001). This research offers a direct comparison of CBCT and MDCT using matched scan parameters on the same anatomical specimen, providing practical insights into image quality and radiation dose for optimizing postoperative orthopedic imaging protocols. CBCT demonstrates advantages in bone imaging and artifact management, while MDCT has superior potential for radiation dose reduction without compromising image quality.