Use of advanced CT scanners can improve diagnosing of wrist fracture
Impactful private-public collaboration improves patient workflow in the Emergency department.

Author Felix Müller, MD

There are around 30.000 patients with wrist traumas at the emergency departments in Denmark each year. Half of those patients have a fracture. While a conventional x-ray can display many of the fractures, some of the most severe fractures remain hidden, because they occur within the bone. Magnetic Resonance Imaging scanners are then used to display the bleeding inside the bone. But the technology is slow, patients have to be in the scanner for a long time and some patients cannot be scanned. CT scans, which only takes a few seconds, are standard in a modern emergency department. These scanners usually cannot detect the bleeding inside the bone. But a new type of CT scanner, a Dual Energy CT scanner, can detect the bleeding - at least in larger bones.

One of the main challenges we had to overcome was detecting bleeding in bones which are smaller than 1 cm. Felix Müller, MD

Testing the setup

In order to use Dual Energy technology for patients with wrist fracture the CT scan settings had to be determined and optimized. This was done with a phantom study, where an artificial bone was build and imaged. The results from this study were encouraging and showed that the bleeding could be detecting also in small bones. The team then investigated how good the performance of this scan technique was by comparing it to the MRI scans it was hoping to replace. "Optimising dual-energy CT scan parameters for virtual non-calcium imaging of the bone marrow: a phantom study"


Patients in whom a fracture could not be seen on a conventional x-ray where imaged with both MRI and the new Dual Energy CT scanner. Results which have just been published in the journal Radiology show that the new scan technique is as good as its MRI counterpart. (LINK: https://pubs.rsna.org/doi/10.1148/radiol.2020192701) In the study almost 7 out of 10 patients, who had pain in the wrist without any visible fracture on the original x-ray, did have a fracture. "Dual-Energy CT for Suspected Radiographically Negative Wrist Fractures: A Prospective Diagnostic Test Accuracy Study"

From fundamental research to relevance for patients

Felix Müllers work is part of an industrial PhD project, cofounded by the Innovation Fund Denmark and Siemens Healthineers. The project links three critical partners for technological advancements in healthcare: the industry, the University represented by Professor Mikael Boesen from the University of Copenhagen , and the healthcare sector in the capital region of Denmark. The project builds further on a well-established research and innovation partnership, which Siemens Healthineers has with the department of Radiology at Herlev and Gentofte Hospital. Working both within the industry and at the hospital gave Felix Müller the unique opportunity to directly link the patient interest with product development and improvement.

This technology will revolutionize the traumalotogy in the Emegency department! Mikael Boesen, MD, phD

More hospitals are interested

The team now wants to continue their work and try to implement this new technology at multiple sites. A number of hospitals in Denmark have already shown an interest in a collaboration, to try and offer patients a faster, more comfortable and better service.