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Mihailidis DN, Stratis A, Gingold E, Carlson R, DeForest W, Gray J, Lally MT, Pizzutiello R, Rong J, Spelic D, Hilohi MC, Massoth R. AAPM Task Group Report 261: Comprehensive quality control methodology and management of dental and maxillofacial cone beam computed tomography (CBCT) systems. Med Phys 2024; 51:3134-3164. [PMID: 38285566 DOI: 10.1002/mp.16911] [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: 11/04/2022] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/31/2024] Open
Abstract
Cone-beam computed tomography (CBCT) systems specifically designed and manufactured for dental, maxillofacial imaging (MFI) and otolaryngology (OLR) applications have been commercially available in the United States since 2001 and have been in widespread clinical use since. Until recently, there has been a lack of professional guidance available for medical physicists about how to assess and evaluate the performance of these systems and about the establishment and management of quality control (QC) programs. The owners and users of dental CBCT systems may have only a rudimentary understanding of this technology, including how it differs from conventional multidetector CT (MDCT) in terms of acceptable radiation safety practices. Dental CBCT systems differ from MDCT in several ways and these differences are described. This report provides guidance to medical physicists and serves as a basis for stakeholders to make informed decisions regarding how to manage and develop a QC program for dental CBCT systems. It is important that a medical physicist with experience in dental CBCT serves as a resource on this technology and the associated radiation protection best practices. The medical physicist should be involved at the pre-installation stage to ensure that a CBCT room configuration allows for a safe and efficient workflow and that structural shielding, if needed, is designed into the architectural plans. Acceptance testing of new installations should include assessment of mechanical alignment of patient positioning lasers and x-ray beam collimation and benchmarking of essential image quality performance parameters such as image uniformity, noise, contrast-to-noise ratio (CNR), spatial resolution, and artifacts. Several approaches for quantifying radiation output from these systems are described, including simply measuring the incident air-kerma (Kair) at the entrance surface of the image receptor. These measurements are to be repeated at least annually as part of routine QC by the medical physicist. QC programs for dental CBCT, at least in the United States, are often driven by state regulations, accreditation program requirements, or manufacturer recommendations.
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Affiliation(s)
- Dimitris N Mihailidis
- University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | | | - Eric Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ray Carlson
- Radiological Physics Services, Inc, Plymouth, Michigan, USA
| | | | | | - Mary T Lally
- Intersocietal Accreditation Commission, Ellicott City, Maryland, USA
| | | | - John Rong
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - David Spelic
- Food and Drug Administration, Center for Device and Radiological Health, Silver Spring, Maryland, USA
| | - Mike C Hilohi
- Food and Drug Administration, Center for Device and Radiological Health, Silver Spring, Maryland, USA
| | - Richard Massoth
- Sunflower Medical Physics, LLC, Sioux Falls, South Dakota, USA
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Gong J, Zhao R, Zhang W, Li J, Yuan Z, Ma D. Role of Intraoperative Imaging in Improving Closed Reduction of Zygomatic Arch Fractures: A Systematic Review and Meta-analysis. J Oral Maxillofac Surg 2023; 81:1504-1516. [PMID: 37775088 DOI: 10.1016/j.joms.2023.09.003] [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: 04/06/2023] [Revised: 07/08/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined this topic. The aim of this review was to investigate and compare the value of IOI with conventional methods without IOI (N-IOI) for the closed reduction of ZMA fractures. METHODS Electronic retrieval of MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and citation search until December 2, 2022, was used to identify controlled clinical trials that employed IOI for improving adequacy in closed reduction of ZMA fractures. The predictor variable was the use of IOI-yes/no (IOI vs N-IOI). The covariates included imaging technique (ultrasound, C-arm, and cone beam computed tomography) and ZMA fracture type (M-shape fracture, mechanistic force in 1 direction; variable fracture, mechanistic force in 2 directions). The primary outcome variables were the reduction adequacy of ZMA fractures (the remaining cortical step and dislocation angle) compared with the ideal mirrored position. Weighted or mean differences, risk ratios, and corresponding 95% confidence intervals were calculated, where P >.05 and I2<50% fixed effect model was adopted, and a vice versa random effect model was adopted. RESULTS A total of 1250 studies were identified, of which 6 studies with 259 participants were included. The meta-analysis results indicated that compared with N-IOI, IOI yielded fewer cortical steps (-1.76 [-2.42, 1.10], P <.00001, fixed model) and dislocation angles (-5.60 [-8.08, 3.12], P<.00001, fixed model) in patients with variable ZMA fractures, while no significant difference was detected in the M-shape ZMA fracture (-0.72, [-2.93, 1.48], P = .52; -1.48, [-3.51, 0.55], P = .15). Although there was no significant difference in postoperative correction (0.35, [0.06, 2.01] P = .24, fixed model), all secondary revision cases occurred in the N-IOI group. Descriptive analysis showed that IOI yielded better symmetry and appearance satisfaction. CONCLUSION IOI improved the adequacy of the procedure and led to a better postoperative appearance, especially for patients with variable ZMA fractures. Furthermore, the use of IOI avoided the risk of secondary surgery. In future studies, researchers should standardize the scale and outcomes to facilitate the intuitive evaluation of reduction adequacy.
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Affiliation(s)
- Jiaming Gong
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Ruimin Zhao
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Wenlong Zhang
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China
| | - Jianxue Li
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Zhenfei Yuan
- Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Dongyang Ma
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China.
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Jahanshahiafshar Z, Ghorbani H, Seyedmajidi M, Nabahati M, Ebrahimnejad Gorji K, Seyedmajidi S, Moudi E. Genotoxic and Cytotoxic Effects of Cone Beam Computed Tomography and Multidetector Computed Tomography on Exfoliated Buccal Epithelial Cells. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:572-581. [PMID: 38094288 PMCID: PMC10715117 DOI: 10.30476/ijms.2023.96522.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/22/2022] [Accepted: 12/25/2022] [Indexed: 12/18/2023]
Abstract
Background Cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) are frequently used in dental and maxillofacial problems. This study aimed to assess the genotoxicity and cytotoxicity effects of CBCT and MDCT radiographies on exfoliated buccal epithelial cells during dental examinations. Methods This prospective experimental study was conducted at Babol University of Medical Sciences (Babol, Iran) from March 2021 to April 2021. Buccal mucosa smears were collected bilaterally pre-exposure and 12 days after CBCT or MDCT examinations. To compare the frequency of micronuclei and other cytotoxic cellular changes such as pyknosis, karyolysis, and karyorrhexis, the paired sample t test and Wilcoxon test were used. In addition, independent sample t test, Mann-Whitney, and Chi square tests were used to investigate the differences between the imaging methods and between men and women. All statistical analyses were performed using the SPSS software, and P≤0.05 was considered statistically significant. Results The current study included 60 adult patients (30 patients in each group), ranging in age from 21 to 50 years. The micronuclei and the other cytotoxic cellular changes increased significantly after CBCT and MDCT radiographic examinations on the 12th day compared to the pre-exposure results (P<0.001). MDCT had statistically higher cytotoxic and genotoxic effects than CBCT (9.4%, 23.1%, and 40% higher values in micronucleus frequency, the mean frequency of micronuclei, and other cytotoxic changes, respectively). There were no significant differences between men and women in the two examination methods (P=0.46 and P=0.49, respectively). Conclusion Dental examinations with CBCT and MDCT can increase cytotoxicity and chromosomal damage in both men and women. Due to its lower radiation toxicities, CBCT can be recommended as an alternative to MDCT for dental examinations.
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Affiliation(s)
| | - Hakimeh Ghorbani
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Seyedmajidi
- Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Nabahati
- Department of Radiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Kourosh Ebrahimnejad Gorji
- Department of Medical Physics, Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyedali Seyedmajidi
- Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ehsan Moudi
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Ver Berne J, Politis C, Shaheen E, Jacobs R. Cumulative exposure and lifetime cancer risk from diagnostic radiation in patients undergoing orthognathic surgery: a cross-sectional analysis. Int J Oral Maxillofac Surg 2023; 52:1064-1070. [PMID: 36804279 DOI: 10.1016/j.ijom.2023.02.001] [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: 10/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Radiation doses in dentomaxillofacial imaging are typically very low. However, diagnostic and follow-up protocols in orthognathic surgery result in a patient-specific risk in effective dose. Estimating the cancer risks from these exposures remains abstract for many maxillofacial surgeons. In this study, 40 orthognathic patients were randomly sampled and their cumulative effective dose (ED) calculated. The lifetime attributable risk of cancer (LAR) was calculated based on the standard radiological protocol for orthognathic surgery follow-up using methods described in the BEIR VII report and RadRAT. The mean cumulative ED of the 40 sampled patients at the end of their 2-year follow-up period was 1.91 ± 0.58 mSv. The LAR at the end of follow-up was 17.65 (90% confidence interval 6.46-32.90) per 100,000 person-years for male orthognathic patients and 13.93 (90% confidence interval 6.27-25.24) per 100,000 person-years for female orthognathic patients. This represents 0.70% and 0.68%, respectively, of the baseline cancer risk for oral, thyroid, and brain cancer combined. Although theoretical, these results provide a framework for interpreting radiation doses and cancer risks in patients undergoing orthognathic surgery. Considering the increased radiation sensitivity in children and adolescents, indication-oriented and patient-specific imaging protocols should be advised.
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Affiliation(s)
- J Ver Berne
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - R Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium; Department of Dentistry, Karolinska Institutet, Stockholm, Sweden
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El Bachaoui S, Verhelst PJ, de Faria Vasconcelos K, Shaheen E, Coucke W, Swennen G, Jacobs R, Politis C. The impact of CBCT-head tilting on 3D condylar segmentation reproducibility. Dentomaxillofac Radiol 2023; 52:20230072. [PMID: 37606052 PMCID: PMC10461261 DOI: 10.1259/dmfr.20230072] [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: 02/12/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To investigate whether variations in head positioning may influence the reproducibility of cone-beam CT (CBCT) three-dimensional (3D) segmented models of the mandibular condyle. METHODS Five fresh frozen cadaver heads were scanned in four different positions: reference position (RP) and a set of three tilted alternative head positions (AP) in anteroposterior direction (AP1: 2 cm anterior translation, AP2: 5° pitch rotation, AP3: 10° pitch rotation). Surface models of mandibular condyles were constructed and compared with the condylar reference position using voxel-based registration. Descriptive statistics and a linear mixed-effects model were performed to compare condylar volumetric differences and root mean square (RMS) distance between surfaces of AP vs RP. RESULTS The mean differences in condylar volumes of AP vs RP were 14.1 mm³ (95% CI [-79.3, 107.4]) for AP1, 1.0 mm³ (95% CI [-87.2, 89.2]) for AP2 and 0.1 mm³ (95% CI [-88.3, 88.4]) for AP3. Mean and absolute volumetric differences did not exceed earlier reported intraoperator differences of 30 mm³. The RMS distance values obtained per group were 0.12 mm (95% CI [0.05,0.20]) for AP1, 0.17 mm (95% CI [0.10, 0.22]) for AP2 and 0.17 mm for AP3 (95% CI [0.10,0.22]). The confidence intervals (CI) for RMS distance remained far below the threshold for clinical acceptability (0.5 mm). CONCLUSIONS Within the limits of the present study, it is suggested that tilted head positions may affect the reproducibility of 3D condylar segmentation, thereby influencing outcome in repeated CBCT scanning. Nevertheless, observed differences are unlikely to have a meaningful impact on clinical patient diagnosis and management.
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Affiliation(s)
| | | | | | | | - Wim Coucke
- Certified Freelance Statistician, Heverlee, Belgium
| | - Gwen Swennen
- Division of Maxillofacial Surgery, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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Shujaat S, Kesztyüs A, Song D, Regnstrand T, Benchimol D, Nagy K, Jacobs R. Moving toward patient specificity for devising cone-beam computed tomography field-of-views: A normative maxillary skeletal dimensional analysis. Int J Paediatr Dent 2023; 33:477-486. [PMID: 37203232 DOI: 10.1111/ipd.13089] [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: 11/21/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND A lack of evidence exists comprehensively assessing skeletal dimensions in a Caucasian population group at different ages. AIM To provide age- and gender-specific normative skeletal dimensional measurements of the maxillary region using cone-beam computed tomography (CBCT) imaging. DESIGN Cone-beam computed tomography images of Caucasian patients were acquired and divided into different age groups ranging from 8 to 20 years. Linear measurements were taken to evaluate seven distance-based variables, which included anterior nasal spine-posterior nasal spine (ANS-PNS) distance, bilateral maxillary first molar's central fossae (CF) distance, palatal vault depth (PVD), bilateral palatal cementoenamel junction (PCEJ) distance, bilateral vestibular CEJ (VCEJ) distance, bilateral jugulare distance (Jug) and arch length (AL). RESULTS A total of 529 patients (243 male, 286 female) were selected. ANS-PNS and PVD showed the highest change in dimensions from 8 to 20 years of age. On the contrary, AL had the least variability in all age groups. Male patients had larger dimensions and showed a significant change in all dimensional measurements (p < .001) than female patients. CONCLUSION The maxillary linear dimensions varied across different age groups. The presented maxillary normative data could serve as a reference guide for devising patient-specific CBCT field of views.
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Affiliation(s)
- Sohaib Shujaat
- King Abdullah International Medical Research Center, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Artúr Kesztyüs
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Dandan Song
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Regnstrand
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
| | - Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
| | - Krisztian Nagy
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Section of Oral Diagnostics and Surgery, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden
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Hermans R, Boomgaert L, Cockmartin L, Binst J, De Stefanis R, Bosmans H. Photon-counting CT allows better visualization of temporal bone structures in comparison with current generation multi-detector CT. Insights Imaging 2023; 14:112. [PMID: 37395919 DOI: 10.1186/s13244-023-01467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE To compare photon-counting CT (PCCT) and multi-detector CT (MDCT) for visualization of temporal bone anatomic structures. METHODS Thirty-six exams of temporal bones without pathology were collected from consecutive patients on a MDCT, and another 35 exams on a PCCT scanner. Two radiologists independently scored visibility of 14 structures for the MDCT and PCCT dataset, using a 5-point Likert scale, with a 2-month wash-out period. For MDCT, the acquisition parameters were: 110 kV, 64 × 0.6 mm (slice thickness reconstructed to 0.4 mm), pitch 0.85, quality ref. mAs 150, and 1 s rotation time; for PCCT: 120 kV, 144 × 0.2 mm, pitch 0.35, IQ level 75, and 0.5 s rotation time. Patient doses were reported as dose length product values (DLP). Statistical analysis was done using the Mann-Whitney U test, visual grading characteristic (VGC) analysis, and ordinal regression. RESULTS Substantial agreement was found between readers (intraclass correlation coefficient 0.63 and 0.52 for MDCT and PCCT, resp.). All structures were scored higher for PCCT (p < 0.0001), except for Arnold's canal (p = 0.12). The area under the VGC curve was 0.76 (95% CI, 0.73-0.79), indicating a significantly better visualization on PCCT. Ordinal regression showed the odds for better visualization are 354 times higher (95% CI, 75-1673) in PCCT (p < 0.0001). Average (range) of DLP was 95 (79-127) mGy*cm for MDCT and 74 (50-95) mGy*cm for PCCT (p < 0.001). CONCLUSION PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose. CRITICAL RELEVANCE STATEMENT PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose. KEY POINTS 1. PCCT allows high-resolution imaging of temporal bone structures. 2. Compared to MDCT, the visibility of normal temporal bone structures is scored better with PCCT. 3. PCCT allows to obtain high-quality CT images of the temporal bones at lower radiation doses than MDCT.
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Affiliation(s)
- Robert Hermans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium.
| | - Lukas Boomgaert
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lesley Cockmartin
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Joke Binst
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Rashèl De Stefanis
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hilde Bosmans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium
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Brasil DM, Merken K, Binst J, Bosmans H, Haiter-Neto F, Jacobs R. Monitoring cone-beam CT radiation dose levels in a University Hospital. Dentomaxillofac Radiol 2023; 52:20220213. [PMID: 36802857 PMCID: PMC9944015 DOI: 10.1259/dmfr.20220213] [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: 06/22/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To present patient dose levels for different CBCT scanners, acquired by a dose monitoring tool in a University Hospital, as a function of field of view (FOV), operation mode, and patient age. METHODS An integrated dose monitoring tool was used to collect radiation exposure data [type of CBCT unit, dose-area product (DAP), FOV size, and operation mode] and patient demographic information (age, referral department) performed on a 3D Accuitomo 170 and a Newtom VGI EVO unit. Effective dose conversion factors were calculated and implemented into the dose monitoring system. For each CBCT unit, the frequency of examinations, clinical indications, and effective dose levels were obtained for different age and FOV groups, and operation modes. RESULTS A total of 5163 CBCT examinations were analyzed. Surgical planning and follow-up were the most frequent clinical indications. For the standard operation mode, effective doses ranged from 35.1 to 300 µSv and 9.26-117 µSv using 3D Accuitomo 170 and Newtom VGI EVO, respectively. In general, effective doses decreased with increasing age and FOV size reduction. CONCLUSIONS Effective dose levels varied notably between systems and operation modes.Operation mode selection and FOV size were indication-oriented, with larger FOV sizes election serving surgical planning and follow-up. Seeing the influence of FOV size on effective dose levels, manufacturers could be advised to move toward patient-specific collimation and dynamic FOV selection. Systematically monitoring patient doses could be recommended for steering future CBCT optimization.
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Affiliation(s)
| | - Karen Merken
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium
| | - Joke Binst
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | | | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Roman R, Almășan O, Hedeșiu M, Băciuț M, Bran S, Popa D, Ban A, Dinu C. Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography. BIOLOGY 2022; 11:biology11091353. [PMID: 36138832 PMCID: PMC9495726 DOI: 10.3390/biology11091353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Simple Summary In individuals with severe malocclusions, orthognathic surgery seeks to rebalance the relationships between the jaws by providing a stable occlusion, a healthy muscle balance, and the functioning of the temporomandibular joint. Cone beam computed tomography may be used to determine the position of the mandibular condyle in the glenoid fossa. This study aimed to assess how the position of the mandibular condyle varies in class II and III malocclusions before and after bimaxillary orthognathic surgery. Before and after orthognathic surgery, 56 TMJs from 28 patients were studied. Following surgery, both class II and class III patients experienced changes in the anterior joint space, posterior joint space, condyle position, and condyle angle. The preliminary findings are promising for determining changes in condyle position and joint spaces that might guide oral and maxillofacial surgeons to address a debilitating clinical affliction. Abstract This study aimed at evaluating the mandibular condyle position changes before and after bimaxillary orthognathic surgery in class II and III malocclusion patients. CBCT scans from patients who underwent bimaxillary orthognathic surgery were analyzed: Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). Both condyles were independently assessed for their largest anterior and posterior joint spaces, smallest medial joint spaces, and condyle angles concerning the transverse line. In the sagittal plane, the minimum size of the anterior and posterior joint spaces was measured. In the coronal plane, the smallest medial joint space was measured. The position of the condyle within the glenoid fossa was determined before and after surgery. A total of 56 TMJs from 28 patients were studied. Following orthognathic surgery, the anterior and posterior space in class II increased. Postoperatively, the anterior joint space in class III decreased. In 42.85% of malocclusion class II patients and 57.14% of malocclusion class III patients, the pre-and post-surgical position of the condyle changed, the condyle was anteriorly positioned (42.85%) in class II patients and centrically positioned (71.4%) in class III patients. Significant changes in the joint space, condylar position, and condyle angle were found in the class II and class III subjects.
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Affiliation(s)
- Raluca Roman
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
- Correspondence:
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Daiana Popa
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Alina Ban
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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Three-Dimensional Pharyngeal Airway Space Changes Following Isolated Mandibular Advancement Surgery in 120 Patients: A 1-Year Follow-up Study. J Imaging 2022; 8:jimaging8040082. [PMID: 35448209 PMCID: PMC9029548 DOI: 10.3390/jimaging8040082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Lack of evidence exists related to the three-dimensional (3D) pharyngeal airway space (PAS) changes at follow-up after isolated bilateral sagittal split osteotomy (BSSO) advancement surgery. The present study assessed the 3D PAS changes following isolated mandibular advancement at a follow-up period of 1 year. A total of 120 patients (40 males, 80 females, mean age: 26.0 ± 12.2) who underwent BSSO advancement surgery were recruited. Cone-beam computed tomography (CBCT) scans were acquired preoperatively (T0), immediately following surgery (T1), and at 1 year of follow-up (T2). The volume, surface area, and minimal cross-sectional area (mCSA) of the airway were assessed. The total airway showed a 38% increase in volume and 13% increase in surface area from T0 to T1, where the oropharyngeal region showed the maximum immediate change. At T1−T2 follow-up, both volumetric and surface area showed a relapse of less than 7% for all sub-regions. The mCSA showed a significant increase of 71% from T0 to T1 (p < 0.0001), whereas a non-significant relapse was observed at T1−T2 (p = 0.1252). The PAS remained stable at a follow-up period of 1 year. In conclusion, BSSO advancement surgery could be regarded as a stable procedure for widening of the PAS with maintenance of positive space at follow-up.
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Hassing GJ, The V, Shaheen E, Politis C, de Llano-Pérula MC. Long-term three-dimensional effects of orthognathic surgery on the pharyngeal airways: a prospective study in 128 healthy patients. Clin Oral Investig 2021; 26:3131-3139. [PMID: 34826028 DOI: 10.1007/s00784-021-04295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate volumetric and circumferential pharyngeal airway space (PAS) changes and stability over time as evaluated with cone beam computed tomography (CBCT) before and after orthognathic surgery 2 years postoperatively. MATERIALS AND METHODS One hundred twenty-eight patients underwent bimaxillary orthognathic surgery at the Department of Maxillofacial Surgery of University Hospitals, Leuven, Belgium, were recruited prospectively. Patients were divided into 4 groups based on the amount of mandibular advancement in 5 mm increments (< 0 mm, 0-5 mm, 5-10 mm, or > 10 mm). CBCT data was acquired preoperatively and 1-6 weeks, 6 months, 1 year, and 2 years postoperatively. Patients with a history of maxillofacial trauma or surgery, obstructive sleep apnoea syndrome, or craniofacial anomalies were excluded. Nasopharyngeal, oropharyngeal, and hypopharyngeal PAS volumes and constriction surface areas (mCSA) were measured and compared between each time point with a paired t-test. RESULTS The largest significant increase in oropharyngeal volume and mCSA were observed in the 5-10 mm (+ 13.3-21.7%, + 51.3-83.0%)) and > 10 mm (+ 23.3-44.6%, + 92.3-130.0%) mandibular advancement groups. This increase only remained stable 2 years postoperatively in the > 10 mm group. In other mandibular advancement groups, short-term oropharyngeal volume and mCSA increases were noticed, which returned to baseline levels 6 months to 1 year postoperatively. CONCLUSION Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and mCSA, which remains stable between 6 months to 1 year postoperatively. CLINICAL RELEVANCE Long-term stable volumetric and mCSA enlargements were found with > 10 mm mandibular advancements over a period of 2 years. Return towards baseline levels was observed in the other mandibular advancement groups.
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Affiliation(s)
- Gert-Jan Hassing
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Vincent The
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Facial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maria Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
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Three-dimensional evaluation of long-term skeletal relapse following Le Fort I maxillary advancement surgery: a 2-year follow-up study. Int J Oral Maxillofac Surg 2021; 51:501-508. [PMID: 34373185 DOI: 10.1016/j.ijom.2021.07.006] [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: 10/20/2020] [Revised: 04/29/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to assess relapse following Le Fort I (LFI) maxillary advancement with superior or inferior repositioning at 2 years of follow-up. A total of 50 patients (26 female, 24 male; age range 15-56 years) with skeletal class II or III, who underwent bimaxillary surgery with LFI maxillary advancement in combination with either superior or inferior repositioning and also mandibular advancement/setback, were recruited. Preoperative (T0), immediate postoperative (T1), and 2-year postoperative (T2) cone beam computed tomography scans were acquired. Data were imported into a validated module to assess the skeletal movement (T0-T1) and relapse (T1-T2). Overall, the majority of the translational and rotational movements showed a relapse of <1 mm and <1°. Patients undergoing maxillary advancement with inferior repositioning in combination with mandibular advancement showed the highest amount of translational relapse in a superior (0.86 ± 0.85 mm, P < 0.0001) and posterior direction (-0.65 ± 1.11 mm, P < 0.0001). In relation to patients who received a bone graft, inferior repositioning with mandibular setback showed the highest maxillary relapse in a superior direction (1.20 ± 1.56 mm, P = 0.0719) with counterclockwise pitch rotation (2.15 ± 0.64°, P = 0.3759). Amongst the non-grafted procedures, superior repositioning with mandibular setback exhibited the highest relapse in a medial direction (1.38 ± 2.78 mm, P = 0.3981). Maxillary advancement was found to be a highly stable procedure with a lack of superoinferior stability in patients undergoing inferior repositioning.
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da Costa Senior O, Vaes L, Mulier D, Jacobs R, Politis C, Shaheen E. Three dimensional assessment of segmented Le Fort I osteotomy planning and follow-up: A validation study. J Dent 2021; 111:103707. [PMID: 34077799 DOI: 10.1016/j.jdent.2021.103707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The planning accuracy and stability during follow-up of segmented Le Fort I osteotomy, often evaluated using 2D cephalometry and dental cast analysis, is controversial. The aim of this study is to develop and validate a 3D semi-automatic, voxel-based registration assessment protocol to evaluate planning accuracy and stability of segmented Le Fort I osteotomy with individualization of the maxillary segments. METHODS Preoperative, immediate postoperative and six months postoperative CBCT images were used to evaluate accuracy and stability of the individual segments in 20 patients (13 female; 7 male) who underwent segmented Le Fort I osteotomy. Three translational (left/right, intrusion/extrusion, anterior/posterior) and three rotational (pitch, roll, yaw) dimensions were calculated for each maxillary segment by means of a user-friendly module. Inter- and intra-observer Inter Class Coefficient (ICC) and mean absolute difference (MAD) were calculated. RESULTS The inter- and intra-observer reliability ICC varied between 0.93 and 0.99 for the translational and rotational accuracy and stability assessments, indicating excellent reliability. The MAD ranged between 0.21 mm and 0.32 mm for the translational error and between 0.6° and 0.9° for the rotational dimension. CONCLUSIONS The 3D assessment protocol for accuracy of segmented Le Fort I planning and short-term follow-up, proved to have high reliability with only a small margin of error. CLINICAL SIGNIFICANCE The proposed 3D assessment protocol allows future in-depth analysis of segmented Le Fort I osteotomy and might implicate future improvement where necessary.
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Affiliation(s)
- Oliver da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium.
| | - Lukas Vaes
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Delphine Mulier
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, E91, Leuven 3000, Belgium
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Shujaat S, Jazil O, Willems H, Van Gerven A, Shaheen E, Politis C, Jacobs R. Automatic segmentation of the pharyngeal airway space with convolutional neural network. J Dent 2021; 111:103705. [PMID: 34077802 DOI: 10.1016/j.jdent.2021.103705] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed and investigated the performance of a deep learning based three-dimensional (3D) convolutional neural network (CNN) model for automatic segmentation of the pharyngeal airway space (PAS). METHODS A dataset of 103 computed tomography (CT) and cone-beam CT (CBCT) scans was acquired from an orthognathic surgery patients database. The acquisition devices consisted of 1 CT (128-slice multi-slice spiral CT, Siemens Somatom Definition Flash, Siemens AG, Erlangen, Germany) and 2 CBCT devices (Promax 3D Max, Planmeca, Helsinki, Finland and Newtom VGi evo, Cefla, Imola, Italy) with different scanning parameters. A 3D CNN-based model (3D U-Net) was built for automatic segmentation of the PAS. The complete CT/CBCT dataset was split into three sets, training set (n = 48) for training the model based on the ground-truth observer-based manual segmentation, test set (n = 25) for getting the final performance of the model and validation set (n = 30) for evaluating the model's performance versus observer-based segmentation. RESULTS The CNN model was able to identify the segmented region with optimal precision (0.97±0.01) and recall (0.96±0.03). The maximal difference between the automatic segmentation and ground truth based on 95% hausdorff distance score was 0.98±0.74mm. The dice score of 0.97±0.02 confirmed the high similarity of the segmented region to the ground truth. The Intersection over union (IoU) metric was also found to be high (0.93±0.03). Based on the acquisition devices, Newtom VGi evo CBCT showed improved performance compared to the Promax 3D Max and CT device. CONCLUSION The proposed 3D U-Net model offered an accurate and time-efficient method for the segmentation of PAS from CT/CBCT images. CLINICAL SIGNIFICANCE The proposed method can allow clinicians to accurately and efficiently diagnose, plan treatment and follow-up patients with dento-skeletal deformities and obstructive sleep apnea which might influence the upper airway space, thereby further improving patient care.
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Affiliation(s)
- Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium.
| | - Omid Jazil
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | | | | | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Kunzendorf B, Naujokat H, Wiltfang J. Indications for 3-D diagnostics and navigation in dental implantology with the focus on radiation exposure: a systematic review. Int J Implant Dent 2021; 7:52. [PMID: 34041613 PMCID: PMC8155130 DOI: 10.1186/s40729-021-00328-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Dental implants are a common restorative method used to replace missing teeth. Implant placement techniques guided by three-dimensional imaging and navigation are becoming more widely available. Objective The present review focused on the following questions: 1. What are the advantages and disadvantages of 2-D versus 3-D imaging in dental implantology? 2. What are the advantages and disadvantages of freehand implant placement in comparison with navigation-guided implant placement? Methods A systematic review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The following libraries were searched for relevant literature: PubMed, Embase, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) Online, and the Cochrane Library. The risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SiGN) checklist. A total of 70 studies were included after screening, and the evidence from these was gathered for review. Results Three-dimensional imaging is advantageous in terms of image quality, and it provides a distortion-free evaluation of the implant site. However, it is also associated with higher costs and increased radiation exposure. Dynamic and static navigation are equal in accuracy and are both more accurate compared with the freehand method. No benefit in terms of implant survival could be demonstrated within the first 5 years for any specific method. Discussion A panoramic X-ray with a reference body often provides sufficient imaging and is the primary method for two-dimensional imaging. Cone beam computed tomography with low-dose protocol settings should be used if three-dimensional imaging is needed. Navigational support should be considered in the event of especially complex cases. Conclusion The guidance technique used for implant placement should be decided on an individual basis. With the increasing availability of three-dimensional imaging, there should also be an increase in awareness of radiation exposure. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00328-9.
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Affiliation(s)
- Burkhard Kunzendorf
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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16
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Shujaat S, Shaheen E, Politis C, Jacobs R. Three-dimensional evaluation of distal and proximal segment skeletal relapse following isolated mandibular advancement surgery in 100 consecutive patients: A one-year follow-up study. Int J Oral Maxillofac Surg 2021; 51:113-121. [PMID: 33888384 DOI: 10.1016/j.ijom.2021.03.020] [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: 10/20/2020] [Revised: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to perform a three-dimensional evaluation of the skeletal relapse of the proximal and distal mandibular segments following isolated bilateral sagittal split osteotomy advancement surgery. One hundred consecutive patients (mean age 25.8±11.7 years), comprising 65 female patients (mean age 26.4±12.1 years) and 35 male patients (mean age 24.6±11.0 years) requiring mandibular advancement without genioplasty, were enrolled prospectively in the study. Cone beam computed tomography scans were acquired for each patient at three time-points: preoperatively, immediately (1-6 weeks) after surgery, and 1 year after surgery. A validated tool was utilized to assess the surgical movement and relapse. Based on percentage, the majority of the distal and proximal translational and rotational movements relapsed within the range of ≤2mm and ≤2°. The distal segment revealed a significant relapse in a posterior, inferior, and clockwise pitch direction. Both left and right proximal segments showed a significant translational relapse in the medial, posterior, and superior direction. Amongst the rotational parameters, proximal segments relapsed significantly in clockwise pitch, clockwise roll, and counterclockwise yaw direction. Overall, both distal and proximal bone segments showed a clinically acceptable translational and rotational stability. The proximal segments torqued towards their original position with a reduction of flaring.
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Affiliation(s)
- S Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - E Shaheen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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17
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Castro AB, Van Dessel J, Temmerman A, Jacobs R, Quirynen M. Effect of different platelet-rich fibrin matrices for ridge preservation in multiple tooth extractions: A split-mouth randomized controlled clinical trial. J Clin Periodontol 2021; 48:984-995. [PMID: 33847018 DOI: 10.1111/jcpe.13463] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate dimensional changes in the alveolar ridge and bone structure after tooth extraction when L-PRF or A-PRF+ was used in comparison to unassisted socket healing. MATERIALS AND METHODS Twenty patients in need of at least three tooth extractions in the aesthetic zone were included. L-PRF, A-PRF+ or control was randomly assigned, leaving one empty socket/edentulous site between conditions. CBCT scans were obtained immediately after tooth extraction and after 3 months of healing. Horizontal and vertical dimensional changes of the ridge and socket fill were calculated. Histological and micro-CT analysis of bone biopsies were used to evaluate post-surgical bone structural healing. RESULTS Mean horizontal and vertical changes at 1-mm below the crest (buccal and palatal side) were similar for the three sites (p > 0.05). For the socket fill, L-PRF (85.2%) and A-PRF+ (83.8%) showed superior values than the control (67.9%). The histological and radiological analysis reported more newly formed bone for the PRF groups, without any significant differences between both. CONCLUSIONS PRF matrices failed to reduce the dimensional changes after multiple tooth extractions in the premaxilla. After 3-month healing, both PRF matrices showed radiographically a significant superiority for the socket fill. Histologically, they seemed to accelerate new bone formation.
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Affiliation(s)
- Ana B Castro
- Department of Oral Health Sciences, Section of Periodontology and Oral Microbiology, KU Leuven, University Hospitals Leuven Dentistry, Leuven, Belgium
| | - Jeroen Van Dessel
- Department of Imaging and Pathology, OmfsImpath Research Group, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andy Temmerman
- Department of Oral Health Sciences, Section of Periodontology and Oral Microbiology, KU Leuven, University Hospitals Leuven Dentistry, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OmfsImpath Research Group, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marc Quirynen
- Department of Oral Health Sciences, Section of Periodontology and Oral Microbiology, KU Leuven, University Hospitals Leuven Dentistry, Leuven, Belgium
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Li Y, Huang B, Cao J, Fang T, Liu G, Li X, Wu J. ESTIMATING RADIATION DOSE TO MAJOR ORGANS IN DENTAL X-RAY EXAMINATIONS: A PHANTOM STUDY. RADIATION PROTECTION DOSIMETRY 2020; 192:328-334. [PMID: 33320946 DOI: 10.1093/rpd/ncaa196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/30/2020] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
The radiation doses absorbed by major organs of males and females were studied from three types of dental X-ray devices. The absorbed doses from cone-beam computed tomography (CBCT), panoramic and intraoral X-ray machines were in the range of 0.23-1314.85 μGy, and were observed to be high in organs and tissues located in or adjacent to the irradiated area, there were discrepancies in organ doses between male and female. Thyroid, salivary gland, eye lens and brain were the organs that received higher absorbed doses. The organ absorbed doses were considerably lower than the diagnostic reference level for dental radiography in China. The calculated effective radiation doses for males and females were 56.63, 8.15, 2.56 μSv and 55.18, 8.99, 2.39 μSv, respectively, when using CBCT, the panoramic X-ray machine and intraoral X-ray machine. The effective radiation dose caused by CBCT was much higher than those of panoramic and intraoral X-ray machines.
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Affiliation(s)
- Yong Li
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518071, China
| | - Jun Cao
- Department of Stomatology, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Tianqi Fang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518071, China
- Shenzhen University General Hospital Clinical Research Center for Neurological Diseases, Shenzhen 518071, China
| | - Guoqing Liu
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Xuguang Li
- Department of Stomatology, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Jiabao Wu
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
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Accuracy and reliability of voxel-based dentoalveolar registration (VDAR) in orthognathic surgical patients: a pilot study with two years' follow-up. Br J Oral Maxillofac Surg 2020; 59:413-418. [PMID: 33714624 DOI: 10.1016/j.bjoms.2020.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to validate the applicability of using maxillary voxel-based dentoalveolar registration (VDAR) at long-term follow up in orthognathic surgical patients. A retrospective sample of 25 patients (skeletal class II or III) who underwent bimaxillary orthognathic surgery was recruited and divided into two groups. Group A included 15 patients (seven females, eight males, mean (SD) age 25.8 (14.4) years) with unrestored dentition and group B involved 10 patients (five females, five males, mean (SD) age: 26.2 (11.9) years) with dental restorative treatment. Postoperative cone-beam computed tomography (CBCT) scans were acquired at four time-points, one to six weeks (T1), six months (T2), one year (T3) and two years (T4). Voxel- based registration was applied using the cranial base and then complete dental segment with part of the alveolar bone at T1-T2, T1-T3 and T1-T4 time-intervals. The translational and rotational accuracy and reproducibility of the registered maxillary segment was evaluated at these three intervals by analysing the transformation matrix using singular value decomposition. All translational and rotational measurements showed excellent reliability in both groups without any significant difference. The combined translational and rotational difference was found to be within the clinically acceptable range of 2mm and 4°. The VDAR was found to be accurate and reliable to be utilised for a long-term skeletal follow-up in orthognathic surgical patients.
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Virtual Quality Control in Middle Ear Surgery: Is Image-guided Tympanoscopy a Valuable Tool for Depicting Borderline Situations? Otol Neurotol 2020; 41:e893-e900. [PMID: 32658106 DOI: 10.1097/mao.0000000000002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS Before modern imaging was introduced, revision surgery was the only way to evaluate possible reasons for inadequate improvement in hearing after ossicular replacement during reconstructive middle ear surgery. BACKGROUND The aim of this study was to evaluate freely navigable virtual tympanoscopy using different computed tomographic modalities. We compared cone-beam computed tomography (CBCT), flat panel computed tomography (FPCT), and conventional computed tomography in helical mode (CTH), volume mode (CTV), and ultra high resolution mode (CTD). METHODS Four temporal bone specimens were reconstructed with partial or total ossicular replacement prostheses. The best functional results for prosthetic coupling were achieved under the control of laser Doppler vibrometry (LDV). Afterward, a progressive step-by-step decoupling of the prostheses was carried out. Different prosthesis positions were evaluated by LDV as well as different computed tomographic modalities with 3D reconstruction of each dataset. RESULTS Anatomical structures were better depicted and the best position and coupling of inserted prostheses were achieved using CBCT. All imaging techniques could be used to control the position of middle ear prostheses, but CBCT provided the highest resolution and the best image quality in both 2D and 3D reformations and in 3D-animated video representation. CONCLUSION Compared with several other imaging modalities, CBCT was best at depicting miscellaneous coupling problems. Noninvasive detection of coupling problems caused by minimal loss of contact between prostheses and middle ear ossicles will influence the clinical outcome. This early detection will help to determine whether revision surgery is needed.
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Johner JP, Wiedemeier D, Hingsammer L, Gander T, Blumer M, Wagner ME. Improved Results in Closed Reduction of Zygomatic Arch Fractures by the Use of Intraoperative Cone-Beam Computed Tomography Imaging. J Oral Maxillofac Surg 2020; 78:414-422. [DOI: 10.1016/j.joms.2019.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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Quantification of DNA Double Strand Breaks and Oxidation Response in Children and Adults Undergoing Dental CBCT Scan. Sci Rep 2020; 10:2113. [PMID: 32034200 PMCID: PMC7005754 DOI: 10.1038/s41598-020-58746-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/03/2020] [Indexed: 01/22/2023] Open
Abstract
Assessing the possible biological effects of exposure to low doses of ionizing radiation (IR) is one of the prime challenges in radiation protection, especially in medical imaging. Today, radiobiological data on cone beam CT (CBCT) related biological effects are scarce. In children and adults, the induction of DNA double strand breaks (DSBs) in buccal mucosa cells and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) and antioxidant capacity in saliva samples after CBCT examination were examined. No DNA DSBs induction was observed in children nor adults. In children only, an increase in 8-oxo-dG levels was observed 30 minutes after CBCT. At the same time an increase in antioxidant capacity was observed in children, whereas a decrease was observed in adults. Our data indicate that children and adults react differently to IR doses associated with CBCT. Fully understanding these differences could lead to an optimal use of CBCT in different age categories as well as improved radiation protection guidelines.
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Kottou S, Zapros A, Stefanopoulou N, Krompas N, Tsapaki V. CONE BEAM CT IN DENTAL IMPLANT PLANNING: HOW CLOSE ARE PATIENT DOSIMETRY RESULTS WITH DATA FROM PHANTOM STUDIES FOUND IN LITERATURE? RADIATION PROTECTION DOSIMETRY 2019; 187:321-326. [PMID: 31297525 DOI: 10.1093/rpd/ncz169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Advantages of Cone Beam Computed Tomography (CBCT) include high-quality 3D imaging and reduced radiation exposure with relatively low cost. In this study, patient radiation exposure in CBCT implant planning dentistry was measured in terms of Kerma Area Product (KAP). Data were obtained from 217 CBCT scans on 168 individuals using a CS9300 Carestream system. Scans were made using 80-90 kVp, 4-5 mA, 8 and 13.3 s exposure time (depending on voxel size) and a fixed field of view (FOV) of 10 × 10 cm2 (medium). Mean KAP was estimated using two voxel sizes 180 × 180 × 180 μm3 and 200 × 200 × 200 μm3 and found to be 399 and 314 mGycm2, respectively. Corresponding KAP values found in literature ranged between 210 and 2140 mGycm2. Mean E was estimated using conversion coefficient factors found in literature, according to FOV size and tube voltage value and found to range between 24 and 161 μSv.
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Affiliation(s)
- S Kottou
- National and Kapodistrian University of Athens, School of Medicine, Medical Physics Lab, Athens, Greece
| | - A Zapros
- Konstantopoulio General Hospital, Athens, Greece
| | | | - N Krompas
- Branemark Osseointegration Center, Athens, Greece
| | - V Tsapaki
- Konstantopoulio General Hospital, Athens, Greece
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Accuracy of two different voxel sizes for presurgical evaluation of mandibular osteotomy. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:129-132. [PMID: 31476537 DOI: 10.1016/j.jormas.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/22/2019] [Accepted: 08/25/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study was to compare the accuracy of two different voxel resolutions for the preoperative assessment of mandibular osteotomies. The study was conducted on 37 dry adult human mandibles. To obtain measurement standardization, heated gutta-percha cones were placed on the dry mandibles to mark 20 anatomical points. These cones were used for all measurement groups. Cone beam computerized tomography (CBCT) scans of the mandibles were made using 0.200mm3 and 0.400mm3 voxel sizes (Planmeca Promex-3D Helsinki, Finland). The results obtained from these two groups were compared with physical measurements obtained using a digital calliper, in order to analyze their predictive value. In the study, one voxel size did not have supremacy over the other in terms of accuracy. For mandibular osteotomies, 0.400mm3 voxel size can be preferred because of lower radiation dose.
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Abstract
CLINICAL/METHODICAL ISSUE Digital volume tomography (DVT) and cone-beam computed tomography (CT) with C‑arm systems have become established three-dimensional imaging systems as an alternative to CT in some application areas. STANDARD RADIOLOGICAL METHODS The technology of the systems is well developed so that they have become a competing method to CT imaging in terms of image quality and radiation exposure. PERFORMANCE An advantage is the better spatial resolution, preferably with dedicated scanner systems, especially in the z direction. The radiation exposure of CT, cone beam CT and DVT are comparable, if the exposure parameter in CT imaging can be adjusted to the lower exposure levels. ACHIEVEMENTS Advantages of these systems are that they can be used for imaging in a better workflow or to acquire images under conditions not possible in CT, e. g. imaging under stress in orthopedics or to take images in the corona technique with a horizontal gantry in cone-beam CT mammography PRACTICAL RECOMMENDATIONS: The use of three-dimensional imaging is becoming more frequent and will replace planar radiography in additional clinical situations. The three-dimensional imaging without superpositioning of structures has advantages in the visibility of structures and the spatial relation to other organs and structures. In guidelines and recommendations, the number of recommendations given for the use of three-dimensional imaging is increasing. This leads to a small increase in the radiation exposure of patients, a trend which is reflected in the annual reports of the Federal Office for Radiation Protection.
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Stratis A, Zhang G, Jacobs R, Bogaerts R, Bosmans H. The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice. Eur Radiol 2019; 29:7009-7018. [DOI: 10.1007/s00330-019-06287-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/21/2019] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
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Mulier D, Shaheen E, Shujaat S, Fieuws S, Jacobs R, Politis C. How accurate is digital-assisted Le Fort I maxillary osteotomy? A three-dimensional perspective. Int J Oral Maxillofac Surg 2019; 49:69-74. [PMID: 31266680 DOI: 10.1016/j.ijom.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/28/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the surgical accuracy of Le Fort I surgery compared to the three-dimensional (3D) virtual planning. Fifty-five patients (29 males, 26 females; age range 15-58 years) with skeletal class III malocclusion, who underwent bimaxillary surgery were included. A validated 3D accuracy assessment tool was utilized to assess the surgical accuracy of the maxillary positioning. For translational movements, the least amount of error was associated with mediolateral translation, whereas the surgical accuracy for anteroposterior and superoinferior translation showed a tendency towards a more posterior and inferior positioning of the maxilla compared to the planning. For rotational movements, the highest discrepancy was observed for pitch. Linear regression showed increased inaccuracy with increasing advancement for anteroposterior, superoinferior and pitch movements. To conclude, 3D virtual planning of maxilla was generally accurate when compared to achieved outcome for skeletal class III patients undergoing bimaxillary surgery.
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Affiliation(s)
- D Mulier
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - E Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven-University of Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Bengtsson M, Wall G, Becktor J, Rasmusson L. A comparison of cost-effectiveness of computer-assisted 2-and 3-dimensional planning techniques in orthognathic surgery. Br J Oral Maxillofac Surg 2019; 57:352-358. [DOI: 10.1016/j.bjoms.2019.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clin Oral Investig 2019; 23:2573-2581. [PMID: 31025192 DOI: 10.1007/s00784-019-02907-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines. MATERIALS AND METHODS Google Scholar was searched using the words "low-dose CBCT". Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words "pedo," "ortho," "endo," "implant," "perio," and "oral surgery." Furthermore, references of included articles were examined to identify further relevant articles. RESULTS After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine. CONCLUSIONS Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction. CLINICAL RELEVANCE Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.
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Chauhan V, Wilkins RC. A comprehensive review of the literature on the biological effects from dental X-ray exposures. Int J Radiat Biol 2019; 95:107-119. [PMID: 30496029 DOI: 10.1080/09553002.2019.1547436] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Routine dental X-rays are among the most common sources of ionizing radiation exposure for healthy individuals globally, with 300 examinations/1000 individuals/year as documented by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) global survey of medical radiation usage and exposure. Furthermore, in the United States of America, an increased use of dental radiography is evident. However, with the shift from using film to digital image receptors, the dose of radiation per routine examination has decreased. Despite this, there remains public concern of dental X-rays. This continuing concern highlights the need to review the literature on biological and health effects related to exposure, from dental X-rays. MATERIAL AND METHODS This report presents studies investigating biological and health effects related to exposures using dental X-rays in patients and provides a critical evaluation. Relevant studies specific to dental X-rays are reviewed from 1970 and onward with the bulk data in this field resulting from epidemiological and biomonitoring studies. RESULTS While, most epidemiological studies suggest a possible correlation between head/neck related tumors and exposure to dental X-rays, evidence for causation is lacking. Biomonitoring studies suggest that exposure to low-level radiation such as that of dental radiography may not be a factor in inducing long-term chromosomal damage, but may result in localized cytotoxicity in the irradiated region of the mouth, with no long-term harm. CONCLUSIONS In general, the total number of studies is low and the majority of the data has been generated from poorly designed experiments. This review will highlight shortcomings that could influence outcomes and provide a more balanced interpretation that could impact the public perception and the level of public concern on the health effects resulting from dental X-rays.
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Affiliation(s)
- Vinita Chauhan
- a Consumer and Clinical Radiation Protection Bureau, Healthy Environments and Consumer Safety Branch , Health Canada , Ottawa , Canada
| | - Ruth C Wilkins
- a Consumer and Clinical Radiation Protection Bureau, Healthy Environments and Consumer Safety Branch , Health Canada , Ottawa , Canada
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Shaheen E, Shujaat S, Saeed T, Jacobs R, Politis C. Three-dimensional planning accuracy and follow-up protocol in orthognathic surgery: a validation study. Int J Oral Maxillofac Surg 2019; 48:71-76. [DOI: 10.1016/j.ijom.2018.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/24/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
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Matenine D, Schmittbuhl M, Bedwani S, Després P, de Guise JA. Iterative reconstruction for image enhancement and dose reduction in diagnostic cone beam CT imaging. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:805-819. [PMID: 31450539 DOI: 10.3233/xst-190523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Iterative reconstruction is well-established in diagnostic multidetector computed tomography (MDCT) for dose reduction and image quality enhancement. Its application to diagnostic cone beam computed tomography (CBCT) is only emerging and warrants a quantitative evaluation. METHODS Several phantoms and a canine head specimen were imaged using a commercially available small-field CBCT scanner. Raw projection data were reconstructed using the Feldkamp-Davis-Kress (FDK) method with different filters, including denoising via total variation (TV) minimization (FDK-TV). Iterative reconstruction was carried out using the TV-regularized ordered subsets convex technique (OSC-TV). Signal-to-noise ratio (SNR), noise power spectrum (NPS) and spatial resolution of images were estimated. Dose levels were measured via the weighted computed tomography dose index, while low-dose image quality degradation was estimated via structural similarity (SSIM). RESULTS OSC-TV and FDK-TV were shown to significantly improve image signal-to-noise ratio (SNR) compared to FDK with a standard filter, 5.8 and 4.0 times, respectively. Spatial resolution attained with different algorithms varied moderately across different experiments. For low-dose acquisitions, image quality decreased dramatically for FDK but not for FDK-TV nor OSC-TV. For low-dose canine head images acquired using about 1/5 of the dose compared to a reference image, SSIM dropped to about 0.3 for FDK, while remaining at 0.92 for FDK-TV and 0.96 for OSC-TV. CONCLUSION OSC-TV was shown to improve image quality compared to FDK and FDK-TV. Moreover, this iterative approach allowed for significant dose reduction while maintaining image quality.
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Affiliation(s)
- Dmitri Matenine
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
| | - Matthieu Schmittbuhl
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - Stéphane Bedwani
- Département de physique, Université de Montréal, Montréal, QC, Canada
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Philippe Després
- Département de physique, de génie physique et d'optique and Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
- Département de radio-oncologie and Centre de recherche du CHU de Québec, Québec (QC) G1R 2J6, Canada
| | - Jacques A de Guise
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de génie des systèmes, École de technologie supérieure, Montréal, QC, Canada
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Dedulle A, Fitousi N, Zhang G, Jacobs J, Bosmans H. Two-step validation of a Monte Carlo dosimetry framework for general radiology. Phys Med 2018; 53:72-79. [PMID: 30241757 DOI: 10.1016/j.ejmp.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
The Monte Carlo technique is considered gold standard when it comes to patient-specific dosimetry. Any newly developed Monte Carlo simulation framework, however, has to be carefully calibrated and validated prior to its use. For many researchers this is a tedious work. We propose a two-step validation procedure for our newly built Monte Carlo framework and provide all input data to make it feasible for future related application by the wider community. The validation was at first performed by benchmarking against simulation data available in literature. The American Association of Physicists in Medicine (AAPM) report of task group 195 (case 2) was considered most appropriate for our application. Secondly, the framework was calibrated and validated against experimental measurements for trunk X-ray imaging protocols using a water phantom. The dose results obtained from all simulations and measurements were compared. Our Monte Carlo framework proved to agree with literature data, by showing a maximal difference below 4% to the AAPM report. The mean difference with the water phantom measurements was around 7%. The statistical uncertainty for clinical applications of the dosimetry model is expected to be within 10%. This makes it reliable for clinical dose calculations in general radiology. Input data and the described procedure allow for the validation of other Monte Carlo frameworks.
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Affiliation(s)
- An Dedulle
- Qaelum NV, Gaston Geenslaan 9, 3001 Leuven, Belgium; University of Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Herestraat 49, 3000 Leuven, Belgium.
| | - Niki Fitousi
- Qaelum NV, Gaston Geenslaan 9, 3001 Leuven, Belgium.
| | - Guozhi Zhang
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Jurgen Jacobs
- Qaelum NV, Gaston Geenslaan 9, 3001 Leuven, Belgium.
| | - Hilde Bosmans
- University of Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Herestraat 49, 3000 Leuven, Belgium; Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Marcu M, Hedesiu M, Salmon B, Pauwels R, Stratis A, Oenning ACC, Cohen ME, Jacobs R, Baciut M, Roman R, Dinu C, Rotaru H, Barbur I. Estimation of the radiation dose for pediatric CBCT indications: a prospective study on ProMax3D. Int J Paediatr Dent 2018; 28:300-309. [PMID: 29356184 DOI: 10.1111/ipd.12355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND An increasing number of CBCT units and a wide variability of radiation doses have been reported in dentistry lately. AIM To estimate the effective, cumulative, and organ absorbed doses in children exposed to CBCT over 2 years. DESIGN A prospective study was conducted in children who underwent CBCT diagnostic imaging with the ProMax3D machine. Organ and effective doses were calculated by Monte Carlo simulation using 5- and 8-year-old pediatric voxel phantoms. Extrapolation procedures were applied to estimate doses for other ages and CBCT protocols used in clinical conditions. RESULTS The median effective dose was 137.9 μSv, and the median cumulative dose was 231.4 μSv. Statistically significant differences in the effective doses and cumulative doses were found for various indications of CBCT in children (P < 0.001). The median absorbed organ dose for brain and thyroid was significantly higher for the clinical condition that required large FOVs (2.5 mGy and 1.05 mGy, respectively) compared to medium (0.19 and 0.51 mGy) and small FOVs (0.07 and 0.24 mGy; P < 0.05). The radiation dose of salivary glands did not vary significantly with FOV. CONCLUSION The results revealed the variation of CBCT doses and the influence of FOV size in pediatric exposure.
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Affiliation(s)
- Maria Marcu
- Department of Oral Radiology, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Hedesiu
- Department of Oral Radiology, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Benjamin Salmon
- EA 2496-Orofacial Pathologies, Imaging and Biotherapies Lab and Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris Descartes University - Sorbonne Paris Cité, Paris, France
| | - Ruben Pauwels
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Andreas Stratis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anne Caroline Costa Oenning
- EA 2496-Orofacial Pathologies, Imaging and Biotherapies Lab and Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris Descartes University - Sorbonne Paris Cité, Paris, France.,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, Sao Paulo, Brazil
| | - Mike E Cohen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mihaela Baciut
- Department of Maxillofacial Surgery, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Roman
- Department of Oral Radiology, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotaru
- Department of Maxillofacial Surgery, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Barbur
- Department of Maxillofacial Surgery, Faculty of Dentistry, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Radiation doses were measured for the first time in intraoral and panoramic dental radiology at Sudanese hospitals. Doses were determined using various exposure settings for adults and children in 8 intraoral and 6 panoramic X-ray devices. The study sample was equally divided between devices using a digital image receptor (DR) and those using conventional screen film (SF). Radiation doses are reported in terms of incident air kerma (IAK) (intraoral radiology) and kerma area product (PKA) (panoramic radiology). IAK values in intraoral radiology were: 1.45 mGy (DR), 4.45 mGy (SF), and 3.01 mGy (combined). For panoramic radiology, PKA values ranged: from 35.8 to 103.2 mGy cm2 (average: 70.4 mGy cm2) for children and from 65.7 to 151.4 mGy cm2 (average: 103.4 mGy cm2) for adults. The results showed that the downward trend in patient doses can be achieved using digital imaging. The study revealed important concerns surrounding radiation protection, such as the lack of regular quality assurance programs and the use of circular collimators.
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Affiliation(s)
- I I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan; Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, P.O. Box 11642, Riyadh, Saudi Arabia.
| | - Aziza H Abdelgadir
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan
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1st European Congress of Medical Physics September 1-4, 2016; Medical Physics innovation and vision within Europe and beyond. Phys Med 2017; 41:1-4. [PMID: 28709862 DOI: 10.1016/j.ejmp.2017.07.001] [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: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/20/2022] Open
Abstract
Medical Physics is the scientific healthcare profession concerned with the application of the concepts and methods of physics in medicine. The European Federation of Organisations for Medical Physics (EFOMP) acts as the umbrella organization for European Medical Physics societies. Due to the rapid advancements in related scientific fields, medical physicists must have continuous education through workshops, training courses, conferences, and congresses during their professional life. The latest developments related to this increasingly significant medical speciality were presented during the 1st European Congress of Medical Physics 2016, held in Athens, September 1-4, 2016, organized by EFOMP, hosted by the Hellenic Association of Medical Physicists (HAMP), and summarized in the current volume.
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