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• Availability dose not mean safety
  Mahamoud M Gabal
  Published on: 29 April 2016

• Published on: 29 April 2016

  Availability dose not mean safety

  • Mahamoud M Gabal, radiologist

  Dear Editor

  Scaphoid fracture is considered the most frequent fracture among the carpal bone fractures . it has a high rate of complication .early detection and proper management prevent this complication . conventional and helical CT can detect this type of fracture . multiplanar examination require coronal and axial reconstruction whish is not as the same quality as the axial cuts . real coronal and sagit...

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  Dear Editor

  Scaphoid fracture is considered the most frequent fracture among the carpal bone fractures . it has a high rate of complication .early detection and proper management prevent this complication . conventional and helical CT can detect this type of fracture . multiplanar examination require coronal and axial reconstruction whish is not as the same quality as the axial cuts . real coronal and sagittal cuts are required .to overcome this problem we used special techniques . for sagittal cuts the patient lie in prone position with abducted shoulder , flexed elbow and extended wrist the scanogram is done . and the cuts are taken at the same technique as the axial cuts .for the coronal cuts abduction of the shoulder and flexion of the elbow and external rotation of the wrist with the palm of the hand is supported on the head is the ideal technique . the scanogram is taken and the examination is continued as the axial technique . the coronal examination is more familiar to the physician but the sagittal cuts are more accurate in detection of cortical disruption . the speed of multidetector CT is more beneficial for moving organs to complete the examination in one breath. but with static examination of the wrist it has only one advantage to reduce radiation dose .The radiation dose in spite this high speed is fivefolds the radiation dose of the helical CT. with multidetector examination as the reconstruction of the images have the same quality as the original examination so we recommend to examine the affected hand in coronal cuts with small width and shorter time of examination with focused rays on the hand to decrease the pitch so the total dose is markedly reduced . however if we examine the patient in real axial ,coronal and sagittal technique the total dose is 60% of single examination of the multidetector CT .the high dose of radiation with the high incidence of carpal bone fractures at young adult will increase the risk of cancer as they have long life expectancy than elderly peoples .so CT examination should be done with failure of other modalities to catch the carpal fractures . the ultrasonography can diagnose any cortical bone discontinuity in any of carpal bones .but due to high rate of scaphoid fracture the ultrasonography research is directed to this bone . the radio-luno-capitate axis is considered the main landmark in sagittal plain . to catch the other carpal bones we advise to begin with the base of the metacarpal bones and follow the know anatomy .in sagittal view bony discontinuity is detected and any related hematona is seen . in axial view the double contour of the fractured bone is seen . increase the gain and zooming will focus the attention to the bony surfaces .soft tissue examination is another advantage of ultrasonography . so ultrasonography should be the first modality of imaging that used in wrist injuries we should remember that multidetector CT availability dose not mean safety........

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  Conflict of Interest:
  None declared.

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