New advances in intra-operative imaging in trauma

The invention of flat-panel detectors led to a revolution in medical imaging. The major benefits of this technology are a higher image quality and dose reduction. Flat-panel detectors have proved to be superior to standard C-arms (= C-arm with radiograph source and image intensifier). Cone-beam computed tomography (cone-beam CT) is a 3D data set, which can be acquired with a flat-panel detector. The cone-shaped beam is used for 3D data generation. For cone-beam CT acquisition, the flat-panel detector rotates around the patient lying on the operating table. Intra-operative cone-beam CT can be a very helpful tool in orthopaedic surgery. Immediate control of fracture reduction and implant positioning in high image quality can reduce the need for secondary revision surgery due to implant malposition. In recent years there has been a revival of standard fan beam CT technology in operating rooms. Fixed and mobile systems are available. Fixed systems are typically placed on a sliding gantry. Different mobile intra-operative CT scanners were recently introduced. Due to their mobility, they are not bound to a specific operating room. The use of standard intra-operative CT scanners results in high 3D image quality but, in comparison with a cone-beam CT scanner, fluoroscopy is not possible. The introduction of flat-panel detectors has led to improvements in intra-operative image quality combined with dose reduction. The possibility of high-quality 3D imaging in combination with navigation can assure optimal implant placement. Due to immediate control of the osteosynthesis, revision surgery at a later time can be prevented. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170055