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Molina MAV, Silva GO, Candemil AP, Camargo RVD, Pauwels R, Jacobs R, Sousa-Neto MD, Mazzi-Chaves JF. Evaluation of 2- and 3-dimensional anatomic parameters of C-shaped root canals with cone beam computed tomography, microcomputed tomography, and nanocomputed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:759-768. [PMID: 37580223 DOI: 10.1016/j.oooo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate 2-dimensional (2D) and 3D morphometric parameters of C-shaped root canals on cone beam computed tomography (CBCT) and microcomputed tomography (microCT) images using nanocomputed tomography (nanoCT) as the reference standard. STUDY DESIGN Sixty mandibular molars with C-shaped canals were individually scanned using nanoCT and microCT. Cone beam computed tomography acquisitions were then performed with 4 CBCT systems, using high and standard resolutions. The 2D parameters of roundness and major and minor diameters were obtained in the cross sections of the root canals at 1, 2, and 3 mm from the root apex. The 3D parameters of surface area, volume, and structure model index were measured considering the entire extension of the root canals. Absolute error (AE) in measurement was calculated against the nanoCT values. Data were statistically analyzed with the Shapiro-Wilk test and analysis of variance (α = 0.05). RESULTS No significant differences in AE were discovered for the 2D parameters among microCT and the CBCT scans. The AE values for the 3D parameters of volume and surface area were significantly smaller in microCT compared to all CBCT units (P < .05). Significantly lower AE values for surface area were observed in high resolution compared to standard resolution for all CBCT units (P < .05). Structure model index did not differ significantly among microCT and all CBCT protocols. CONCLUSIONS Cone beam computed tomography images showed accuracy for evaluating 2D parameters and over- and underestimation for 3D parameters.
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Affiliation(s)
- Miguel Angel Ventura Molina
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Giovane Oliveira Silva
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Rafael Verardino de Camargo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Ruben Pauwels
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium; Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil.
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Klingler S, Biel P, Tschanz M, Schulze R. CBCTs in a Swiss university dental clinic: a retrospective evaluation over 5 years with emphasis on radiation protection criteria. Clin Oral Investig 2023; 27:5627-5636. [PMID: 37522991 PMCID: PMC10492752 DOI: 10.1007/s00784-023-05184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To retrospectively evaluate all cone-beam computed tomography (CBCT) scans acquired from 2017 to 2022 in a Swiss university dental clinic with particular emphasis on radiation protection aspects. MATERIAL AND METHODS Radiological databases at the dental clinic of the University of Bern, Switzerland, were explored using a self-developed search algorithm. Data of all acquired CBCT from 01.01.2017 to 27.06.2022 were screened. Exposure parameters (exposure time, exposure angle, milliampere (mA), kilovoltage (kV), field of view (FOV) size), dose area product (DAP), age, and sex of the patient were recorded anonymously. The collected data were analyzed mainly descriptively. Correlations measured the statistical relationships between the variables. RESULTS A total of 10,348 CBCT datasets were analyzed. Patient age ranged from 5 to 96 years (mean: 49.4 years, SD: 21.6 years). The number of CBCTs in patients under 25 years was around 20% each year. In total, 10,313 (99.7%) CBCTs were acquired in small to medium FOV (FOV up to 10 cm of height), and 35 (0.3%) in large FOV (height > 10 cm). DAPs of small FOVs were 518.3 ± 233.2 mGycm2 (mean ± SD), of medium FOV 1233 ± 502.2 mGycm2, and of large FOV 2189 ± 368.7 mGycm2. DAP (ρ = 0.4048, p < 0.0001) and kV (ρ = 0.0210, p = 0.0327) correlated positively with age. Reduced scan angle correlated with young age (rpb 0.2729, p < 0.001). mA did not correlate with age (p = 0.3685). CONCLUSIONS This study demonstrates that certain well-known radiation protection aspects as the reduction of FOV, mA, kV, and scan angle were only partly considered. CLINICAL RELEVANCE Known radiation protection aspects, especially in young patients, should be fully applied in regular clinical practice.
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Affiliation(s)
- Samuel Klingler
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Philippe Biel
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Moses Tschanz
- Information Technology (IT) Group, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Ralf Schulze
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Division of Oral Diagnostic Sciences, Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Pauwels R. A new formula for converting dose-area product to effective dose in dental cone-beam computed tomography. Phys Med 2023; 112:102639. [PMID: 37441822 DOI: 10.1016/j.ejmp.2023.102639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE The purpose of this study was to determine a dedicated conversion formula between dose-area product (DAP) and effective dose (E) for dental CBCT, which incorporates X-ray beam energy as well as geometric factors. METHODS CBCT exposures of an adult phantom were simulated using PCXMC 2.0 (STUK, Finland). Fifty-seven fields of view (FOV) were included, ranging from Ø4x4cm to Ø21x19cm. Six tube voltages (70 kV to 120 kV), eight combinations of Al (2.5 to 10 mm) and Cu (0 to 0.5 mm) filtration, and four source-isocentre distances (35 to 65 cm) were used, resulting in 10 896 simulated scan protocols. In addition, 10 944 random combinations of scan parameters within the aforementioned ranges were simulated, resulting in 21 840 scan protocols that were used for fitting a formula using multiple linear regression with 8 independent variables. Finally, 2304 random scan protocols were simulated as validation data to evaluate the formula's generalizability. RESULTS E/DAP ranged between 0.031 µSv/mGy.cm2 and 0.294 µSv/mGy.cm2, with a mean of 0.150 µSv/mGy.cm2. Due to extensive clustering of the E/DAP, three formulas were determined according to FOV categories (Small: <100 cm2, Medium: 100-400 cm2, Large: >400 cm2). The resulting formulas showed mean absolute errors of 7.9%, 4.0% and 3.6%, respectively, for the validation data. CONCLUSION The new formulas allow for a straightforward, yet accurate, estimation of the effective dose for dental CBCT based on DAP. Further fine-tuning of the model could be achieved by incorporating, for example, bowtie filtration and off-axis beam geometries.
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Affiliation(s)
- Ruben Pauwels
- Department of Dentistry and Oral Health, Aarhus University, Denmark; Aarhus Institute of Advanced Studies, Aarhus University, Denmark; Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Vogiatzi T, Menz R, Verna C, Bornstein MM, Dagassan-Berndt D. Effect of field of view (FOV) positioning and shielding on radiation dose in paediatric CBCT. Dentomaxillofac Radiol 2022; 51:20210316. [PMID: 35762346 PMCID: PMC10043625 DOI: 10.1259/dmfr.20210316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of two different large field of view (FOV) positions in the vertical dimension and shielding (thyroid collar and eyeglasses) on the effective dose and the local doses of various sites of the craniofacial complex. METHODS Organ doses and effective doses were calculated based on the measured doses using 27 pairs of thermoluminescent dosemeters in a paediatric tissue-equivalent of a 10-year-old anthropomorphic phantom. The large FOV of the 3D Accuitomo F170 CBCT scanner was used to image parts of the craniofacial complex. Six protocols were performed: (A) cranial position without shielding; (B) cranial position with shielding; (C) caudal position without shielding; (D) caudal position with shielding, (E) similar to C with 3600 rotation and (F) similar to D with 360° rotation. Measurements were obtained in duplicate, and the relative δ value (%) was applied to compare the average doses between the protocols. RESULTS Changing the FOV position from cranial to caudal without using shielding resulted in an increase of the effective dose of 18.8%. Use of shielding in the caudal position reduced the dose by 31.6%. Local absorbed dose of the thyroid had the most relevant impact on calculation of the effective dose, followed by oesophagus, bone marrow and bone surfaces, especially when comparing the different protocols. CONCLUSIONS Application of shielding devices for thyroid in combination with a most caudal positioning of FOV led to the lowest local absorbed doses as well as the effective dose in a child phantom model.
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Affiliation(s)
- Theodosia Vogiatzi
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Roman Menz
- Division of Radiological Physics, Department of Radiology, University of Basel, Basel, Switzerland
| | - Carlalberta Verna
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Michael M. Bornstein
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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OUP accepted manuscript. Eur J Orthod 2022; 44:513-521. [DOI: 10.1093/ejo/cjac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pinto CA, Caetano GFDR, Andrade MEA, Panzarella FK, Junqueira JLC, Peroni LV, Nascimento MDCC. Dosimetric evaluation for temporomandibular joint cone beam computed tomography exams using different field of view. Biomed Phys Eng Express 2021; 7. [PMID: 34488205 DOI: 10.1088/2057-1976/ac240a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022]
Abstract
Objectives.To optimize the absorbed organ dose in relation to the field of view for temporomandibular joint examinations in four cone beam computed tomography devices.Methods.An anthropomorphic adult head and neck phantom, and 192 LiF dosimeters (TLD-100) were used. The dosimeters were placed in the region corresponding to the lens, parotid glands, submandibular glands, and thyroid. Small, medium and large FOVs were selected on Orthopantomograph OP300 Maxio, PaX-i3D Smart, ORTHOPHOS XG, and i-CAT Next Generation device when it was possible.Results.A wide range of absorbed dose values was recorded for all organs due to the different exposure parameters of each device. The radiosensitive organ with the highest dose was the parotid glands. The devices with 5 × 5 cm FOV recorded a lower dose in this protocol, while for the device without a small FOV (≤5 × 5 cm), the lowest dose was observed with the large FOV (6 × 16 cm).Conclusions.We recommend a double exposure with an FOV of 5 × 5 cm in the OP300 Maxio, PaX-i3D Smart, and ORTHOPHOS XG device, while in the i-CAT Next Generation device, a single exposure FOV of 6 × 16 cm is indicated.
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Affiliation(s)
- Carla Alves Pinto
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - Gabriela Franco da Rosa Caetano
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | | | - Francine Kull Panzarella
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - José Luiz Cintra Junqueira
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
| | - Leonardo Vieira Peroni
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, 13045-755, Brazil
| | - Monikelly do Carmo Chagas Nascimento
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo (SP), 13045-755, Brazil
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Maret D, Vergnes JN, Peters OA, Peters C, Nasr K, Monsarrat P. Recent Advances in Cone-beam CT in Oral Medicine. Curr Med Imaging 2021; 16:553-564. [PMID: 32484089 DOI: 10.2174/1573405615666190114152003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/09/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The cone-beam computed tomography (CBCT) technology has continuously evolved since its appearance in oral medicine in the early 2000s. OBJECTIVES To present recent advances in CBCT in oral medicine: i) selection of recent and consensual evidence-based sources, ii) structured summary of the information based on an iterative framework and iii) compliance with ethical, public health and patient-centered concerns. MAIN FINDINGS We will focus on technological advances, such as sensors and reconstruction algorithms used to improve the constant quality of the image and dosimetry. CBCT examination is now performed in almost all disciplines of oral medicine: currently, the main clinical disciplines that use CBCT acquisitions are endodontics and oral surgery, with clearly defined indications. Periodontology and ear, nose and throat medicine are more recent fields of application. For a given application and indication, the smallest possible field of view must be used. One of the major challenges in contemporary healthcare is ensuring that technological developments do not take precedence over admitted standards of care. The entire volume should be reviewed in full, with a systematic approach. All findings are noted in the patient's record and explained to the patient, including incidental findings. This presupposes the person reviewing the images is sufficiently trained to interpret such images, inform the patient and organize the clinical pathway, with referrals to other medical or oral medicine specialties as needed. CONCLUSION A close collaboration between dentists, medical physicists, radiologists, radiographers and engineers is critical for all aspects of CBCT technology.
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Affiliation(s)
- Delphine Maret
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,AMIS Laboratory - Laboratoire Anthropologie Moléculaire et Imagerie de Synthèse, Université de Toulouse, UMR 5288 CNRS, UPS, Toulouse, France
| | - Jean-Noel Vergnes
- Epidemiology and Public Health Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Ove A Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Christine Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States
| | - Karim Nasr
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
| | - Paul Monsarrat
- Oral Rehabilitation Department, Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm U1031, UPS, Toulouse, France
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Modern 3D cephalometry in pediatric orthodontics-downsizing the FOV and development of a new 3D cephalometric analysis within a minimized large FOV for dose reduction. Clin Oral Investig 2021; 25:4651-4670. [PMID: 33492515 DOI: 10.1007/s00784-021-03779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Dose reduction achieved by downsizing the field of view (FOV) in CBCT scans has brought no benefit for pediatric orthodontics, until now. Standard 2D or 3D full-size cephalometric analyses require large FOVs and high effective doses. The aim of this study was to compare a new 3D reduced-FOV analysis using the Frankfurt horizontal (FH) plane as reference plane with a conventional full-size analysis using the Sella-Nasion (S-N) plane as reference plane. MATERIALS AND METHODS Thirty-eight CBCT data sets were evaluated using full- and reduced-FOV analysis. The measurements of a total of 20 skeletal and dental standard 3D full-size variables were compared with the measurements of 22 corresponding 3D reduced-FOV variables. Statistical analysis was performed to prove mathematic relation between standard and alternative variables. Regression analyses were carried out. RESULTS Coefficients of determination (R2) between 0.15 and 0.95 (p < 0.001-0.055) were described. All variables showed obvious relations of different strength except for SNA and its alternative Po_R-Or_R-A (°) (R2 = 0.15, p = 0.055), but a second variable Ba_A (mm) showed stronger relation (R2 = 0.28, p = 0.003). CONCLUSIONS All standard variables related to the reference plane S-N could be described with alternative variables related to the FH. Further research should define more reliable landmarks for coordinate systems and reference points. CLINICAL RELEVANCE Minimized large FOVs meet the demand of 3D cephalometric analyses and enable the application of CBCT scans in pediatric orthodontic patients in many specific indications. Dose reduction is accompanied by increasing access to all the advantages of 3D imaging over 2D imaging.
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Kuramoto T, Takarabe S, Shiotsuki K, Shibayama Y, Hamasaki H, Akamine H, Okamura K, Chikui T, Kato T, Yoshiura K. X-ray dose reduction using additional copper filtration for dental cone beam CT. Phys Med 2020; 81:302-307. [PMID: 33349541 DOI: 10.1016/j.ejmp.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
This study aims to quantitatively evaluate the effect of additional copper-filters (Cu-filters) on the radiation dose and contrast-to-noise ratio (CNR) in a dental cone beam computed tomography (CBCT). The Cu-filter thickness and tube voltage of the CBCT unit were varied in the range of 0.00-0.20 mm and 70-90 kV, respectively. The CBCT images of a phantom with homogeneous materials of aluminum, air, and bone equivalent material (BEM) were acquired. The CNRs were calculated from the voxel values of each homogeneous material. The CTDIvol was measured using standard polymethyl methacrylate CTDI test objects. We evaluated and analyzed the effects of tube current and various radiation qualities on the CNRs and CTDIvol. We observed a tendency for higher CNR at increasing tube voltage and tube current in all the homogeneous materials. On the other hand, the CNR reduced at increasing Cu-filter thickness. The tube voltage of 90 kV showed a clear advantage in the tube current-CNR curves in all the homogeneous materials. The CTDIvol increased as the tube voltage and tube current increased and decreased with the increase in the Cu-filter thickness. When the CNR was fixed at 9.23 of BEM at an exposure setting of 90 kV/5 mA without a Cu-filter, the CTDIvol at 90 kV with Cu-filters was 8.7% lower compared with that at 90 kV without a Cu-filter. The results from this study demonstrate the potential of adding a Cu-filter for patient dose reduction while ensuring the image quality.
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Affiliation(s)
- Taku Kuramoto
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Shinya Takarabe
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Kenshi Shiotsuki
- Medical Technology Department, Oita University Hospital, 1-1 Idaigaoka, Hasama-cho, Yufu-shi, Oita 879-5593, Japan
| | - Yusuke Shibayama
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Hamasaki
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Akamine
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazutoshi Okamura
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Toru Chikui
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Toyoyuki Kato
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazunori Yoshiura
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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Deleu M, Dagassan D, Berg I, Bize J, Dula K, Lenoir V, Ott B, Ott JG, Verdun FR, Weber R, Ziglinas P, Zingariello C, Sans Merce M. Establishment of national diagnostic reference levels in dental cone beam computed tomography in Switzerland. Dentomaxillofac Radiol 2020; 49:20190468. [PMID: 32267774 PMCID: PMC7461735 DOI: 10.1259/dmfr.20190468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to establish diagnostic reference levels (DRLs) in the field of dental maxillofacial and ear-nose-throat (ENT) practices using cone beam CT (CBCT) in Switzerland. METHODS A questionnaire was sent to owners of CBCTs in Switzerland; to a total of 612 institutions. The answers were analyzed for each indication, provided that enough data were available. The DRLs were defined as the 75th percentile of air kerma product distribution (PKA). RESULTS 227 answers were collected (38% of all centers). Third quartile of PKA values were obtained for five dental indications: 662 mGy cm² for wisdom tooth, 683 mGy cm² for single tooth implant treatment, 542 mGy cm² for tooth position anomalies, 569 mGy cm² for pathological dentoalveolar modifications, and 639 mGy cm² for endodontics. The standard field of view (FOV) size of 5 cm in diameter x 5 cm in height was proposed. CONCLUSIONS Large ranges of FOV and PKA were found for a given indication, demonstrating the importance of establishing DRLs as well as FOV recommendations in view of optimizing the present practice. For now, only DRLs for dental and maxillofacial could be defined; because of a lack of ENT data, no DRL values for ENT practices could be derived from this survey.
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Affiliation(s)
| | - Dorothea Dagassan
- University Center of Dental Medicine Basel, Center for Dental Imaging, University of Basel, Basel, Switzerland
| | | | - Julie Bize
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Karl Dula
- University of Bern, Bern, Switzerland
| | - Vincent Lenoir
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Barbara Ott
- Radiation Protection Division, Federal office of Public Health, Bern, Switzerland
| | | | - Francis R. Verdun
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Robert Weber
- Division of Medical Radiation Physics, Inselspital, Bern, Switzerland
| | | | - Cesare Zingariello
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Marta Sans Merce
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
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Kühnisch J, Anttonen V, Duggal MS, Spyridonos ML, Rajasekharan S, Sobczak M, Stratigaki E, Van Acker JWG, Aps JKM, Horner K, Tsiklakis K. Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document. Eur Arch Paediatr Dent 2019; 21:375-386. [PMID: 31768893 DOI: 10.1007/s40368-019-00493-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. METHODS Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. RESULTS Several clinical-based recommendations and statements were agreed upon. CONCLUSION There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).
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Affiliation(s)
- J Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Goethestraße 70, 80336, München, Germany.
| | - V Anttonen
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M S Duggal
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - S Rajasekharan
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, Ghent, Belgium
| | - M Sobczak
- Specialized Dental Practice, Warsaw, Poland
| | - E Stratigaki
- Department of Orthodontics and Paediatric Dentistry, University of Basel, Basel, Switzerland
| | - J W G Van Acker
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, Ghent, Belgium
| | - J K M Aps
- Division of Oral Diagnostic and Surgical Sciences, University of Western Australia, Perth, Australia
| | - K Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Tsiklakis
- Department of Oral Diagnosis and Radiology National and Kapodistrian, University of Athens, Athens, Greece
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12
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Cone-Beam Computed Tomography in Orthodontics. Dent J (Basel) 2019; 7:dj7030089. [PMID: 31480667 PMCID: PMC6784482 DOI: 10.3390/dj7030089] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
Abstract
Unlike patients receiving implants or endodontic treatment, most orthodontic patients are children who are particularly sensitive to ionizing radiation. Cone-beam computed tomography (CBCT) carries risks and benefits in orthodontics. The principal risks and limitations include ionizing radiation, the presence of artifacts, higher cost, limited accessibility, and the need for additional training. However, this imaging modality has several recognized indications in orthodontics, such as the assessment of impacted and ectopic teeth, assessment of pharyngeal airway, assessment of mini-implant sites, evaluation of craniofacial abnormalities, evaluation of sinus anatomy or pathology, evaluation of root resorption, evaluation of the cortical bone plate, and orthognathic surgery planning and evaluation. CBCT is particularly justified when it brings a benefit to the patient or changes the outcome of the treatment when compared with conventional imaging techniques. Therefore, CBCT should be considered for clinical orthodontics for selected patients. Prescription of CBCT requires judicious and sound clinical judgment. The central question of this narrative review article is: when does CBCT add value to the practice of orthodontics? To answer this question, this article presents discussion on radiation dosage of CBCT and other imaging techniques used in orthodontics, limitations of CBCT in orthodontics, justifying the use of CBCT in orthodontics, and the benefits and evidence-based indications of CBCT in orthodontics. This review summarizes the central themes and topics in the literature regarding CBCT in orthodontics and presents ten orthodontic cases in which CBCT proved to be valuable.
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13
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Halve the dose while maintaining image quality in paediatric Cone Beam CT. Sci Rep 2019; 9:5521. [PMID: 30940872 PMCID: PMC6445070 DOI: 10.1038/s41598-019-41949-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/20/2019] [Indexed: 11/08/2022] Open
Abstract
Cone beam CT (CBCT) for dentomaxillofacial paediatric assessment has been widely used despite the uncertainties of the risks of the low-dose radiation exposures. The aim of this work was to investigate the clinical performance of different CBCT acquisition protocols towards the optimization of paediatric exposures. Custom-made anthropomorphic phantoms were scanned using a CBCT unit in six protocols. CT slices were blinded, randomized and presented to three observers, who scored the image quality using a 4-point scale along with their level of confidence. Sharpness level was also measured using a test object containing an air/PMMA e,dge. The effective dose was calculated by means of a customized Monte Carlo (MC) framework using previously validated paediatric voxels models. The results have shown that the protocols set with smaller voxel size (180 µm), even when decreasing exposure parameters (kVp and mAs), showed high image quality scores and increased sharpness. The MC analysis showed a gradual decrease in effective dose when exposures parameters were reduced, with an emphasis on an average reduction of 45% for the protocol that combined 70 kVp, 16 mAs and 180 µm voxel size. In contrast, both "ultra-low dose" protocols that combined a larger voxel size (400 µm) with lower mAs (7.4 mAs) demonstrated the lowest scores with high levels of confidence unsuitable for an anatomical approach. In conclusion, a significant decrease in the effective dose can be achieved while maintaining the image quality required for paediatric CBCT.
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Brasil DM, Pauwels R, Coucke W, Haiter-Neto F, Jacobs R. Image quality optimization of narrow detector dental computed tomography for paediatric patients. Dentomaxillofac Radiol 2019; 48:20190032. [PMID: 30864834 DOI: 10.1259/dmfr.20190032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Dental CBCT exposure parameters should be optimized according to patient-specific indications, mainly for children that are most vulnerable to harmful effects of ionizing radiation. The aim of this study was to determine optimized kV settings for paediatric acquisitions for a dental CBCT device. METHODS Clinical and quantitative evaluations of image quality were performed using 5 and 10 years old (y/o) anthropomorphic phantoms. Technical evaluation was performed with the SEDENTEXCT-IQ phantom. Images were obtained using a PaX-i3D Green CBCT (Vatech, Korea) device, combining tube voltages ranging from 85 to 110 kV and 2 fields of view (FOVs: 21 × 19 and 12 × 9 cm), while maintaining the radiation dose fixed by adjusting the mA accordingly. Clinically, observers assessed images based on overall quality, sharpness, contrast, artefacts, and noise. For quantitative evaluation, mean grey value shift, % increase standard deviation, % beam-hardening and contrast-to-noise ratio were calculated. For technical evaluation, segmentation accuracy, contrast-to-noise ratio and full width at half maximum were measured. Biplot graphs were used to choose representative parameters, from which the best kV was selected for each protocol and evaluation. kV values that had no statistical differences (p > 0.05) with the best kV chosen were considered as having the same quality. RESULTS Clinically, 95 kV was found as a cut-off value. From the quantitative aspect, 85 kV (p < 0.05) showed the worst quality, except in 12 × 9 cm 5 y/o. Technically, 85 and 110 kV in the large FOV showed significantly worse quality for the large FOV. CONCLUSION For paediatric indications, 95 kV or higher (and correspondingly low mA values) was found as optimal.
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Affiliation(s)
- Danieli Moura Brasil
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba, Sao Paulo , Brazil
| | - Ruben Pauwels
- 2 OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, and Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,3 Department of Mechanical Engineering, Catholic University of Leuven , Leuven , Belgium.,4 Department of Radiology, Faculty of Dentistry, Chulalongkorn University , Bangkok , Thailand
| | - Wim Coucke
- 5 Freelance statistician, Brugstraat 107, 3001 Heverlee , Leuven , Belgium
| | - Francisco Haiter-Neto
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba, Sao Paulo , Brazil
| | - Reinhilde Jacobs
- 2 OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, and Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,6 Department of Dental Medicine, Karolinska Institutet , Stockholm , Sweden
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15
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Brasil DM, Pauwels R, Coucke W, Haiter-Neto F, Jacobs R. Image quality optimization using a narrow vertical detector dental cone-beam CT. Dentomaxillofac Radiol 2019; 48:20180357. [PMID: 30604636 DOI: 10.1259/dmfr.20180357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: To determine the optimized kV setting for a narrow detector cone-beam CT (CBCT) unit. METHODS: Clinical (CL) and quantitative (QUANT) evaluations of image quality were performed using an anthropomorphic phantom. Technical (TECH) evaluation was performed with a polymethyl methacrylate phantom. Images were obtained using a PaX-i3D Green CBCT (Vatech, Hwaseong, Korea) device, with a large 21 × 19 and a medium 12 × 9 cm field of view (FOV), and high-dose (HD-ranging from 85 to 110 kV) and low-dose (LD-ranging from 75 to 95 kV) protocols, totaling four groups (21 × 19 cm HD, 21 × 19 cm LD, 12 × 9 cm HD, 12 × 9 cm LD). The radiation dose within each group was fixed by adapting the mA according to a predetermined dose-area product. For CL evaluation, three observers assessed images based on overall quality, sharpness, contrast, artefacts, and noise. For QUANT evaluation, mean gray value shift, % increase of standard deviation (SD), % of beam hardening and contrast-to-noise ratio (CNR) were calculated. For TECH evaluation, segmentation accuracy, CNR, metal artefact SD, metal object area, and sharpness were measured. Representative parameters were chosen for CL, QUANT, and TECH evaluations to determine the optimal kV based on biplot graphs. kV values of the same protocol were compared by the bootstrapping approach. The ones that had statistical differences with the best kV were considered as worse quality. RESULTS: Overall, kV values within the same group showed similar quality (p > 0.05), except for 110 kV in 21 × 19 cm HD and 85 kV in 12 × 9 cm HD of CL score; also 85, 90 kV in 21 × 19 cm HD and 75, 80 kV in 21 × 19 cm LD of QUANT score which were worse (p < 0.05). CONCLUSION: At a constant dose, low and high kV protocols yield acceptable image quality for a narrow-detector CBCT unit.
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Affiliation(s)
- Danieli Moura Brasil
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba , Brazil
| | - Ruben Pauwels
- 2 Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven , Leuven , Belgium.,3 Department of Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,4 Department of Mechanical Engineering, Catholic University of Leuven , Leuven , Belgium.,5 Department of Radiology, Faculty of Dentistry, Chulalongkorn University , Bangkok , Thailand
| | - Wim Coucke
- 6 Freelance statistician , Leuven , Belgium
| | - Francisco Haiter-Neto
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP) , Piracicaba , Brazil
| | - Reinhilde Jacobs
- 2 Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven , Leuven , Belgium.,3 Department of Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,7 Department of Dental Medicine, Karolinska Institute , Stockholm , Sweden
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16
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El Sahili N, David-Tchouda S, Thoret S, Nasseh I, Berberi A, Fortin T. Effect of Milliamperage Reduction on Pre-surgical Implant Planning Using Cone Beam Computed Tomography by Surgeons of Varying Experience. J Maxillofac Oral Surg 2018; 17:520-530. [PMID: 30344396 PMCID: PMC6181865 DOI: 10.1007/s12663-017-1075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants. AIM To assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates). MATERIALS AND METHODS Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements. RESULTS There were no significant differences in bone measurements taken on high- or low-dose images by all seniors and by the majority of juniors (p > 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low- and high-dose images for senior observers (from K = 0.287 at low dose to K = 0.718 at high does) but not for juniors (K = 0.661 and K = 0.509 for low and high dose, respectively). CONCLUSION Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.
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Affiliation(s)
- N. El Sahili
- School of Dentistry, Lebanese University, Beirut, Lebanon
| | - S. David-Tchouda
- Medico-economic Evaluation Unit, University Hospital of Grenoble, France/ThEMAS TIMC, UMR CNRS 5525, Grenoble Joseph Fourier University, Grenoble, France
| | - S. Thoret
- Investigation Clinical Center of Grenoble, INSERM, Grenoble, France
| | - I. Nasseh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - A. Berberi
- Department of Oral and MaxilloFaciale Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - T. Fortin
- Department of Oral Surgery, Dental University of Lyon, University Claude Bernard, Lyon 1, France. UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, 38041 Grenoble, France
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Panmekiate S, Rungwittayathon P, Suptaweeponboon W, Tangtraitham N, Pauwels R. Optimization of exposure parameters in dental cone beam computed tomography using a 3-step approach. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:545-552. [PMID: 30237039 DOI: 10.1016/j.oooo.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/17/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to find the optimal balance among tube voltage (kV), tube current (mA), and exposure time (s) in cone beam computed tomography (CBCT). STUDY DESIGN Three human hemimandibles were scanned by using the 3D Accuitomo 170 scanner (J. Morita, Kyoto, Japan). First, 3 combinations of kilovolt (kV) and milliampere (mA) were used at a constant radiation dose. Seven observers evaluated the images; the kV of the highest-scoring scan was considered optimal. Second, the lowest acceptable mA for visualizing different anatomic structures was determined. Finally, the samples were scanned by using 3 combinations of tube current and exposure time; the observers determined the combination with the highest image quality. RESULTS At a constant radiation dose, the highest available voltage (i.e., 90 kV) resulted in the highest image quality in terms of general impression, sharpness, noise, and artefacts. Depending on the anatomic structure, mA reductions of 20% to 40% compared with the default setting were possible. Fast-scan protocols showed equal or slightly better image quality compared with the standard-scan mode. CONCLUSIONS For the CBCT model used in this study, optimization implies the use of the highest kV along with the shortest exposure time and a task-specific mA. The proposed stepwise optimization approach could be applied to any CBCT unit, preferably during commissioning.
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Affiliation(s)
- Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Peera Rungwittayathon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Wijuck Suptaweeponboon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattarus Tangtraitham
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Mechanical Engineering Department, Catholic University of Leuven, Leuven, Belgium.
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RADIOLOGICAL BIOMARKERS ON THE CONE BEAM COMPUTED TOMOGRAPHY BASIS FOR THE FUNCTIONAL ASYMMETRY DETECTION OF THE MAXILLA AND MANDIBULA IN YOUNG PEOPLE. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-3-65-167-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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