Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications
Introduction
During the last decade, there has been a tendency of using three-dimensional (3D) information to aid in dentomaxillofacial diagnostics and surgery planning [1], [2]. Conventional CT protocols are generally associated with relatively high radiation dose levels and even clinical protocols for multi-slice CT (MSCT) still show high doses [3], [4]. The introduction of Cone Beam Computed Tomography (CBCT) holds promising potential for oral and craniofacial imaging applications [5], [6], [7], [8]. Although the radiation dose of CBCT is generally lower than for MSCT, the use of CBCT may increase the collective radiation dose given for medical purposes disproportional to its frequency of justified utilisation. Therefore, there is a need for reference values for the effective radiation dose for protocols used in CBCT scanners.
Loubele et al. and Guerrero et al. reported radiation dose levels for different MSCTs and CBCTs and related the variation in dose levels to the resulting image quality for various exposure protocols [4], [5]. This is an essential relation, although most studies report on either image quality or dose levels. If one would strictly adhere to the ALARA principle, than it is required to try optimising image quality at reasonably low radiation dose levels [9], [10]. In a state-of-the-art report on CBCT, Scarfe et al. already discussed the need for optimisation [6]. Few recent studies examined radiation dose levels for CBCT [11], [12]. Dose levels varied amongst equipment, exposure protocols and applied methodology. Furthermore, no comparison to spiral CT and MSCT was made. From these data, it is obvious that there is a need for a standardised protocol for effective dose determination for both CBCTs and MSCTs, leading to comparative data which can be generated and reported. This can be accomplished by effective radiation dose estimations using a Rando® Alderson phantom [13], [14].
The objective of the present paper is to compare the effective doses of 3 CBCTs for maxillofacial applications with those of corresponding imaging protocols from 3 MSCTs.
Section snippets
Evaluated CBCT scanners
The following CBCTs were evaluated for radiation dose levels: Accuitomo 3D® (J. Morita Corporation, Kyoto, Japan), NewTom 3G® (Quantitative Radiology, Verona, Italy), and i-CAT® (Imaging Sciences International, Hatfield, Pennsylvania, USA) (Table 1).
The Accuitomo 3D® used in the present study works with an analogue detector. However, it should be noted that the newer Accuitomo 3D FPD® includes a flat panel detector (FPD) with advantages for both image quality and radiation dose levels [15]. The
Results
Table 3A shows the effective dose for the different acquired regions, along with the relative organ distribution of the dose of the Accuitomo 3D® and i-CAT®. Table 3B shows the effective dose and organ distribution for two additional protocols of the i-CAT® and for the NewTom 3G®.
For the Accuitomo 3D®, the highest effective dose is found for the premolar and canine upper jaw region (44 μSv) and the lowest effective dose for the front lower jaw region (13 μSv). The red bone marrow absorbs the
Discussion
As demonstrated before, the introduction of Cone Beam Computed Tomography (CBCT) holds promising potential for oral and craniofacial imaging applications [5], [6], [7], [8]. The radiation dose of different CBCT scanners was compared with different MSCT scanners. The radiation dose was evaluated by effective dose measurements on Rando® Alderson phantoms.
A huge difference in effective dose between CBCT and MSCT can be observed, with effective dose ratio's up to 90. However, especially for the
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