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Gantry-Free Cone-Beam CT Offers More Flexibility for Elbow Imaging

By MedImaging International staff writers
Posted on 15 Dec 2023

Image: Photographs show patients with severely limited range of motion (Photo courtesy of University Hospital Würzburg)

Elbow injuries are frequently seen in emergency rooms, yet capturing high-quality images of such injuries can be challenging. Traditional CT systems typically have a gantry diameter of 70 to 80 cm, requiring patients to adopt a prone position with the injured arm extended, often referred to as a "superman" pose. This position, with the injured arm either beside the body or on the abdomen, can affect image quality as well as require increased radiation doses. An effective alternative has emerged in the form of gantry-free cone-beam CT (CBCT) combined with large flat-panel detectors. This approach has been shown to significantly reduce the radiation dose compared to traditional gantry-based multidetector CT (MDCT), without compromising image quality. Researchers recently undertook a study to evaluate the effectiveness of gantry-free CBCT compared to two-dimensional radiography in diagnosing acute elbow trauma in both adults and children.

In the study, conducted at University Hospital Würzburg (Würzburg, Germany), researchers used a high-resolution CBCT scanning mode based on a radiographic system equipped with two telescopic arms mounted on ceiling rails. These arms carry the X-ray tube and a large flat panel detector, respectively. Their coordinated movement along set trajectories facilitates the collection of three-dimensional projection data. The retrospective study revealed that, in 23 patients who had difficulty being positioned for gantry-based CT, elbow fractures were more sensitively diagnosed using gantry-free CBCT than with traditional two-dimensional radiography.

The CBCT system effectively overcomes the positioning challenges of gantry-based CT and yields remarkably high-quality images. Moreover, gantry-free CBCT offers enhanced dose efficiency due to the unique acquisition geometry of its twin robotic arms. Although the CBCT's acquisition time of 14 seconds is longer than the five seconds typical of gantry CT, leading to concerns about potential motion artifacts and reduced image quality, this issue was mitigated by allowing scanning of the elbow in a comfortable, flexed 90° position, minimizing patient movement. In related research, it was also demonstrated that imaging the appendicular skeleton with the gantry-free CBCT system is viable even in the presence of metal implants that can potentially impair image quality.

“Cross-sectional elbow imaging in the context of trauma can be quite challenging,” said Andreas Kunz, MD, a radiologist at the University Hospital Würzburg. “Not only did this CBCT system eliminate the positioning challenges associated with gantry-based CT, it also provided remarkably high-quality images.”

“The investigated gantry-free cone-beam CT promises to alleviate the most common challenges to imaging the appendicular skeleton without compromising image quality, radiation dose or patient comfort,” Dr. Kunz added.

Related Links:
University Hospital Würzburg

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69 (32.901763916016): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

70 (230.07392883301): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (200.03318786621): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (41.961669921875): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (57.220458984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (23.841857910156): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (53.882598876953): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (36.954879760742): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

105 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

106 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

109 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

110 (60.081481933594): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (395.05958557129): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (599.14588928223): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (311.85150146484): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

115 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

116 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

117 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

118 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

120 (277.04238891602): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 20201.206207275): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

123 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

124 (464.91622924805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294799600 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294799600 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 397233.00933838): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (82.015991210938): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (351.90582275391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (56.028366088867): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (240.08750915527): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (185.96649169922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (66.995620727539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (455.14106750488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (329.01763916016): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (304.9373626709): SELECT name FROM jos_deeppockets WHERE id=215

136 (37.908554077148): SELECT name FROM jos_deeppockets WHERE id=215

137 (426.05400085449): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (334.02442932129): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

140 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

141 (!!!!! 7848.0243682861): TRUNCATE TABLE jos_trademed_module

142 (76.055526733398): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (51.975250244141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294799600 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (766.99256896973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

147 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

148 (!!!!! 1075.9830474854): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

150 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

151 (80.82389831543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294799600 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294799600 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

153 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

154 (28.848648071289): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

156 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294799600 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294799600 AND published='1' LIMIT 1

157 (104.90417480469): select jos_twitters.link from jos_twitters where cat=10

158 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

159 (25.98762512207): select jos_google_plus.link from jos_google_plus where cat=10

160 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

161 (366.9261932373): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1120.8057403564): insert into jos_banners_delta values (14615,'2025-04-29 21:24:27','3.144.134.101','view'),(14202,'2025-04-29 21:24:27','3.144.134.101','view'),(14203,'2025-04-29 21:24:27','3.144.134.101','view')

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