{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:49:51Z","timestamp":1781916591208,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T00:00:00Z","timestamp":1539129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Radiation dose is a general concern in diagnostic imaging and a special concern for children who are at greater risk from radiation effects. This study evaluates effective doses (E) produced during 2D and volume imaging with a novel cone beam computed tomography (<jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content>) based extremity imaging device. The device's compact size and protocol options offer image choices that enhance the potential for reduced dose and improved diagnostics when evaluating sports injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Hand\u2010wrist, foot\u2010ankle, and knee phantoms were developed for use with optically stimulated luminescent dosimeters (<jats:styled-content style=\"fixed-case\">OSL<\/jats:styled-content>). Dosimetry of transmission radiographs (2D) and <jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content> volumes (3D) was assessed for Standard and lowered dose (Lite) exposure protocols. Effective dose was calculated for child and adult age groups. Image quality was assessed with contrast\u2010to\u2010noise ratio (<jats:styled-content style=\"fixed-case\">CNR<\/jats:styled-content>) and modulation transfer function (<jats:styled-content style=\"fixed-case\">MTF<\/jats:styled-content>). A figure of merit was calculated as the square of <jats:styled-content style=\"fixed-case\">CNR<\/jats:styled-content> divided by E.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Standard 2D doses ranged from 0.001\u20130.06 \u03bcSv for adults, 0.001\u20130.05 \u03bcSv for 15\u2010yr olds, 0.003\u20130.13 \u03bcSv for 10\u2010yr olds, and 0.005\u20130.20 for 5\u2010yr olds. Dose reductions with Lite protocols ranged from 26 to 51%. Standard <jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content> doses ranged from 0.3\u20134.6 \u03bcSv for adults, 0.3\u20134.4 \u03bcSv for 15\u2010yr olds, 0.6\u20139.8 \u03bcSv for 10\u2010yr olds, and 1\u201322.6 \u03bcSv for 5\u2010yr olds. For both 2D and 3D a trend of increasing imaging dose with reduced age was present and was statistically significant for children below the age of 10 (<jats:italic>P<\/jats:italic> = 0.0009). Lite dose reductions averaged 47%. <jats:styled-content style=\"fixed-case\">CNR<\/jats:styled-content> was statistically reduced in Lite dose scans (<jats:italic>P<\/jats:italic> = 0.0384) but was not statistically different using <jats:styled-content style=\"fixed-case\">FOM<\/jats:styled-content> analysis (<jats:italic>P<\/jats:italic> = 0.3089). <jats:styled-content style=\"fixed-case\">MTF<\/jats:styled-content> was not significantly affected by the two dose protocols (<jats:italic>P<\/jats:italic> = 0.8104).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content> effective doses calculated from anthropomorphic phantom exposures following manufacturer suggested protocols appear to be substantially less than previously reported doses for similar <jats:styled-content style=\"fixed-case\">MDCT<\/jats:styled-content> extremity examinations. In this study, effective dose from 2D radiographic imaging was approximately two orders of magnitude less than <jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content> imaging. Doses were on the order of a few minutes to hours of ubiquitous per\u2010capita background dose for 2D imaging and a few hours to days for 3D imaging. Dose significantly increased for children younger than age 10. Lite protocols resulted in substantial dose reductions and can be recommended for children and those examinations where reduced <jats:styled-content style=\"fixed-case\">CNR<\/jats:styled-content> will not affect diagnosis. Flexibility of 2D and 3D imaging options with low\u2010dose protocols make this technology a promising option for radiographic evaluation of the extremities. Efficacy studies are needed to determine when <jats:styled-content style=\"fixed-case\">MDCT<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> CBCT<\/jats:styled-content> or Digital Radiography are best used for particular diagnostic tasks.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.13198","type":"journal-article","created":{"date-parts":[[2018,9,19]],"date-time":"2018-09-19T10:37:11Z","timestamp":1537353431000},"page":"4955-4963","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Hand\u2010wrist, knee, and foot\u2010ankle dosimetry and image quality measurements of a novel extremity imaging unit providing <scp>CBCT<\/scp> and 2D imaging options"],"prefix":"10.1002","volume":"45","author":[{"given":"John B.","family":"Ludlow","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Radiology University of North Carolina School of Dentistry Chapel Hill NC 27599\u20107455 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,10]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"National Council on Radiation Protection and Measurements.Ionizing Radiation Exposure of the Population of the United States (Report No. 160) Bethesda MDl2009."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.2.1760289"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.427"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60815-0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2360"},{"key":"e_1_2_7_7_1","first-page":"424","volume-title":"Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII\u2014 Phase 2","author":"National Research Council, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation","year":"2006"},{"key":"e_1_2_7_8_1","unstructured":"Michelle Healy Safe Kids Worldwide survey of emergency room visits shows more than a million times a year or about every 25 seconds a young athlete visits a hospital emergency room for a sports\u2010related injury USA TODAY Published 12:03 a.m. ET Aug. 6 2013 | Updated 11:54 a.m. ET Aug. 6 2013."},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1259\/dmfr.20140197"},{"key":"e_1_2_7_10_1","volume-title":"Radiation Protection No. 172. Cone Beam CT for Dental and Maxillofacial Radiology Evidence\u2010Based Guidelines","author":"European Commission","year":"2012"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.5430\/ijdi.v1n2p1"},{"key":"e_1_2_7_12_1","first-page":"1","article-title":"The 2007 recommendations of the international commission on radiological protection","volume":"37","author":"Valentin J","year":"2007","journal-title":"Ann ICRP"},{"key":"e_1_2_7_13_1","unstructured":"Physical Aspects of Irradiation NBS Handbook No. 85. Washington DC: US Government"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/26\/3\/003"},{"key":"e_1_2_7_15_1","volume-title":"Developmental Juvenile Osteology","author":"Scheuer L","year":"2000"},{"key":"e_1_2_7_16_1","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics.Growth charts.http:\/\/www.cdc.gov\/growthchartsaccessed January 20 2018."},{"key":"e_1_2_7_17_1","first-page":"317","article-title":"Simplified calculation of body\u2010surface area: [letter]","volume":"1987","author":"Mosteller RD","journal-title":"NEJM"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-4179(99)00047-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.10257"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2349\/biij.3.2.e38"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/rpd\/nct162"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2008.03.018"},{"key":"e_1_2_7_23_1","first-page":"1","article-title":"Effective radiation dose in wrist resulting from a radiographic device, two CBCT devices and one MSCT device: a comparative study","volume":"13","author":"Koivisto J","year":"2017","journal-title":"Radiat Protect Dosimetry"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-015-0067-8"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-0266(01)00143-7"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4321-7"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-101251"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-015-2105-9"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4736212"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmp.13198","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.13198","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.13198","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.13198","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T01:38:49Z","timestamp":1693964329000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.13198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,10]]},"references-count":28,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1002\/mp.13198"],"URL":"https:\/\/doi.org\/10.1002\/mp.13198","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,10]]},"assertion":[{"value":"2018-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}