A Standardized Protocol for Cone-Beam Computed Tomography of the Hand and Wrist in Rheumatoid Arthritis

The aim of the investigation was to develop a standardized protocol for description of the results of cone-beam computed tomography (CBCT) of the hand and wrist in rheumatoid arthritis.

Materials and Methods. The results of 112 hand and wrist CBCT examinations (n=56) were analyzed in patients aged from 36 to 67 with medium-active seropositive rheumatoid arthritis in anamnesis. The hand and wrist CBCT was carried out using a NewTom 5G cone-beam computed unit (QR s.r.l., Italy) having a 200×250 mm flat-panel detector, 180×160 mm field of view (maximum), and a 360° gantry rotation around the region of interest. The hand and wrist scanning was carried out from the distal metaphysis of the forearm bones to the nail ends of the distal phalanges of the fingers. Scan mode — patient scan (exposure time — 3.6 s, X-ray tube boosting voltage — 110 kW, current — 0.6‒0.8 mA), scan pattern — regular scan, scan time — 18 s. The CBCT examinations of the wrists and hands were performed using special-purpose setups allowing complete coverage of the region of interest.

Results. A standardized protocol was designed for the description of hand and wrist cone-beam examination that documents all the major changes resulting from rheumatoid arthritis: soft tissue thickening, erosions and cystic-like changes, osteoporosis, narrowing of the joint spaces, incomplete dislocations, bone deformities and areas of osteolysis. Significant changes are recorded in point form, according to the Sharp or SENS methods. Application of the standardized protocol allows unification of the structuring of the examination description, and facilitates X-ray assessment of changes in the hand and wrist during CBCT in patients with rheumatoid arthritis.

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Makarova D.V., Kushnyr K.V. A Standardized Protocol for Cone-Beam Computed Tomography of the Hand and Wrist in Rheumatoid Arthritis. Sovremennye tehnologii v medicine 2015; 7(4): 135, https://doi.org/10.17691/stm2015.7.4.18