Radiation dose in non-dental cone beam CT applications: a systematic review

Nardi, Cosimo; Salerno, Sergio; Molteni, Roberto; Occhipinti, Mariaelena; Grazzini, Giulia; Norberti, Niccolò; Cordopatri, Cesare; Colagrande, Stefano

doi:10.1007/s11547-018-0910-7

Cited by 34 publications

(29 citation statements)

References 62 publications

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“…Clinical studies have shown that implementation of ASIR-V can decrease the mean RD between 34 and 35% while maintaining image quality [13,14]. Previously reported mean RD for low-dose CT evaluation of fractures of the peripheral skeleton has been in the range of 10-800 μSv [12,[15][16][17][18] and for cone-beam CT (CBCT) in the range of 0.9-14.3 μSv [19]. Our ULD-CT protocol has, to our knowledge, the lowest reported mean RD (0.59 μSv) for the peripheral skeleton in the literature, corresponding to around 1.7 h of exposure to background radiation [20].…”

Section: Discussionmentioning

confidence: 99%

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

et al. 2019

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Objective The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. Materials and methods An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. Results In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4–3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47–0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54–0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1–8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8–10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. Conclusions Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.

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Section: Discussionmentioning

confidence: 99%

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

et al. 2019

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“…Recently, a new three-dimensional imaging technique called cone beam computed tomography (CBCT) has proved to supply an excellent volumetric study of maxillofacial bone structures [10] and satisfactorily recognise mandibular fractures [11]. Moreover, it has a high spatial resolution (0.075-0.4 mm isotropic voxel) [12], delivers relatively low radiation doses compared to MSCT [13], and is only slightly affected by metal artefacts, which often occur in patients stabilised by immobilisation techniques that use metallic materials during post-treatment follow-up [14]. Long scan times (5.4-40 s) [15] advise against the use of CBCT in patients who experience pain and have functional disability for the increased risk of motion artefacts [16].…”

Section: Imaging Techniquesmentioning

confidence: 99%

Imaging of mandibular fractures: a pictorial review

et al. 2020

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Mandibular fractures are among the most common maxillofacial fractures observed in emergency rooms and are mainly caused by road accidents. The clinical features of mandibular fractures include malocclusion and loss of mandibular function. Panoramic radiography is usually limited to isolated lesions, whereas computed tomography is the tool of choice for all other facial traumatic events. No reference standard classification system for the different types of mandibular fractures is defined. Therapeutic options include a conservative approach or surgical treatment based on the anatomic area and the severity of fracture. The main purpose of this pictorial review is to illustrate a practical description of the pathophysiology of mandibular fractures and describe both the imaging techniques to recognise them and the therapeutic indications.

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“…Detection of fractures and fracture-related findings in CBCT and radiography is summarized in Table 2 (upper extremity) and Table 3 (lower extremity). Fifty-two patients (56.5%) received surgical therapy after imaging (44 upper/8 lower extremities), with the majority of surgical procedures (34) comprising open reduction and internal fixation of distal forearm fractures. Thirty-four patients (37.0%) were treated solely with immobilization or functional therapy (27/7).…”

Section: Resultsmentioning

confidence: 99%

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

et al. 2020

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Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.

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Radiation dose in non-dental cone beam CT applications: a systematic review

Abstract: CBCT of extremities, cervical spine, ears and paranasal sinuses was found to be a low-dose volumetric imaging technique. Effective doses varied significantly because of different exposure settings of CBCT-units and different dosimetry systems used to estimate dose.

Cited by 34 publications

References 62 publications

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects

Imaging of mandibular fractures: a pictorial review

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

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