Faculty mentor/PI email address
abedin@rowan.edu
Keywords
Femoral bone landmarks, X-ray, Computed tomography (CT), Orthopedic imaging
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Background Accurate femoral bone landmark identification is essential for orthopedic surgical planning, deformity correction, and fracture risk assessment. Radiography offers accessibility and low cost, while CT provides superior spatial resolution and three-dimensional visualization. Despite technological advances, no quantitative synthesis has compared these modalities specifically for femoral landmark identification.
Hypothesis CT provides superior measurement accuracy and interobserver reliability compared to radiography for femoral bone landmark identification.
Methods Following PRISMA 2020 guidelines, Embase, Scopus, and PubMed were searched from 2015-2025. Studies comparing radiography and CT for femoral landmark identification with quantitative outcomes were included. Dual-reviewer screening of 604 records yielded 27 studies for systematic review. Random effects meta-analysis was performed on 11 datasets from 8 records, assessing measurement differences in hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA), and interobserver reliability via intraclass correlation coefficients (ICCs). Risk of bias was assessed using QUADAS-2 and publication bias via Egger’s test.
Results Across 3,147 knees and lower limbs, CT measurements showed 0.86° less deformity than radiography (95% CI: -1.83 to 0.12; p = 0.09), with substantial heterogeneity (I² = 98.3%). CT achieved superior interobserver reliability (ICC 0.951, 95% CI: 0.923-0.972) versus radiography (ICC 0.923, 95% CI: 0.887- 0.951; p = 0.03). MPTA and LDFA showed the most consistent inter-modality differences (I² = 0%), while HKA demonstrated high variability (I² = 89.1%). No publication bias was detected (Egger’s test, p = 0.97).
Conclusions Both radiography and CT provide excellent interobserver reliability for femoral landmark identification. The 0.86° systematic difference favoring CT falls within clinically acceptable ranges for most orthopedic applications, supporting radiography for routine assessments and CT for precision-critical procedures.
Disciplines
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Medicine and Health Sciences | Radiology
Included in
Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Radiology Commons
X-ray versus CT for Femoral Landmark Identification: A Systematic Review and Meta-Analysis
Background Accurate femoral bone landmark identification is essential for orthopedic surgical planning, deformity correction, and fracture risk assessment. Radiography offers accessibility and low cost, while CT provides superior spatial resolution and three-dimensional visualization. Despite technological advances, no quantitative synthesis has compared these modalities specifically for femoral landmark identification.
Hypothesis CT provides superior measurement accuracy and interobserver reliability compared to radiography for femoral bone landmark identification.
Methods Following PRISMA 2020 guidelines, Embase, Scopus, and PubMed were searched from 2015-2025. Studies comparing radiography and CT for femoral landmark identification with quantitative outcomes were included. Dual-reviewer screening of 604 records yielded 27 studies for systematic review. Random effects meta-analysis was performed on 11 datasets from 8 records, assessing measurement differences in hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA), and interobserver reliability via intraclass correlation coefficients (ICCs). Risk of bias was assessed using QUADAS-2 and publication bias via Egger’s test.
Results Across 3,147 knees and lower limbs, CT measurements showed 0.86° less deformity than radiography (95% CI: -1.83 to 0.12; p = 0.09), with substantial heterogeneity (I² = 98.3%). CT achieved superior interobserver reliability (ICC 0.951, 95% CI: 0.923-0.972) versus radiography (ICC 0.923, 95% CI: 0.887- 0.951; p = 0.03). MPTA and LDFA showed the most consistent inter-modality differences (I² = 0%), while HKA demonstrated high variability (I² = 89.1%). No publication bias was detected (Egger’s test, p = 0.97).
Conclusions Both radiography and CT provide excellent interobserver reliability for femoral landmark identification. The 0.86° systematic difference favoring CT falls within clinically acceptable ranges for most orthopedic applications, supporting radiography for routine assessments and CT for precision-critical procedures.