Incidental Findings in Low-Dose Full-Body Imaging Taken for Total Hip and Knee Arthroplasty

Abstract

Detection of incidental findings (IFs) in preoperative imaging for total joint arthroplasty (TJA) patients may lead to additional testing, cost, and surgical delay. The purpose of this study is to identify the incidence and clinical significance of IFs on preoperative low-dose full-body imaging (LFI) in the total joint population. Furthermore, we aim to determine whether these findings lead to additional imaging, delay, or cancelation in TJA cases. A retrospective review of 2,183 patients planned for total hip arthroplasty or total knee arthroplasty, who had preoperative LFI imaging obtained from 2013 to 2020 was conducted. LFI radiographic reports were reviewed to identify any flagged radiographs. Flagged IFs were divided into thoracic, spinal, lower limb, and abdominal IFs. Charts were reviewed to identify if any additional imaging was completed, the case was delayed or canceled, or a new pathology requiring continued follow-up or treatment was discovered. Of the 2,183 LFI images taken prior to TJA, 41 cases qualified as having IF (1.9%, 41/2,183), 18 thoracic, 11 spinal, 11 lower limb, and 1 abdominal. Overall, 15 (0.7%, 15/2,183) IF cases were clinically determined to require at least one additional form of imaging. Two had a significant finding; a schwannoma near the distal femoral shaft and a squamous cell carcinoma of the lung. Three TJA cases were delayed, and no cases were cancelled due to the IFs. The possible increase in IF detection by preoperative LFI does not greatly impact TJA case completion. Though rare, providers should pay close attention as clinically significant IFs can be discovered and lead to early treatment. This was a retrospective cohort study with level III evidence.

Keywords

EOS - incidental findings - total joint arthroplasty - radiographic findings - low dose full body imaging

Publikationsverlauf

Eingereicht: 30. März 2022

Angenommen: 08. Juli 2022

Artikel online veröffentlicht:
07. September 2022

• References

• 1 O'Sullivan JW, Muntinga T, Grigg S, Ioannidis JPA. Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ 2018; 361: k2387
• 2 Morris Z, Whiteley WN, Longstreth Jr WT. et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009; 339 (7720): b3016
• 3 Flor N, Di Leo G, Squarza SAC. et al. Malignant incidental extracardiac findings on cardiac CT: systematic review and meta-analysis. AJR Am J Roentgenol 2013; 201 (03) 555-564
• 4 Smith-Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 2008; 27 (06) 1491-1502
• 5 Berland LL, Silverman SG, Gore RM. et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010; 7 (10) 754-773
• 6 Tran G, Khalil LS, Wrubel A, Klochko CL, Davis JJ, Soliman SB. Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty. Skeletal Radiol 2021; 50 (06) 1151-1161
• 7 Hassebrock JD, Makovicka JL, Clarke HD, Spangehl MJ, Beauchamp CP, Schwartz AJ. Frequency, cost, and clinical significance of incidental findings on preoperative planning images for computer-assisted total joint arthroplasty. J Arthroplasty 2020; 35 (04) 945-949.e1
• 8 Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med 2007; 357 (22) 2277-2284
• 9 Deschênes S, Charron G, Beaudoin G. et al. Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine 2010; 35 (09) 989-994
• 10 Dietrich TJ, Pfirrmann CWA, Schwab A, Pankalla K, Buck FM. Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography. Skeletal Radiol 2013; 42 (07) 959-967
• 11 Wade R, Yang H, McKenna C, Faria R, Gummerson N, Woolacott N. A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 2013; 22 (02) 296-304
• 12 Dubousset J, Charpak G, Dorion I. et al. A new 2D and 3D imaging approach to musculo-skeletal physiology and pathology with low-dose radiation and the standing position: the EOS system [in French]. Bull Acad Natl Med 2005; 189 (02) 287-297
• 13 McKenna C, Wade R, Faria R. et al. EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation. Health Technol Assess 2012; 16 (14) 1-188
• 14 Semaan HB, Bieszczad JE, Obri T. et al. Incidental extraspinal findings at lumbar spine magnetic resonance imaging: a retrospective study. Spine 2015; 40 (18) 1436-1443
• 15 Quattrocchi CC, Giona A, Di Martino AC. et al. Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study. Insights Imaging 2013; 4 (03) 301-308
• 16 Lee SY, Landis MS, Ross IG, Goela A, Leung AE. Extraspinal findings at lumbar spine CT examinations: prevalence and clinical importance. Radiology 2012; 263 (02) 502-509