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Le LH, Nguyen KCT, La TG, Nguyen VD, Le MB, Kumaradevan P, Kaipatur N, Major PW, Lou EHM. Intraoral Ultrasound Imaging Using a Rotational Transducer with Periodontal Feature Identification by Machine Learning. ACS Sens 2024; 9:3898-3906. [PMID: 39175386 DOI: 10.1021/acssensors.4c00124] [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] [Indexed: 08/24/2024]
Abstract
Innovative intraoral ultrasound devices with smart artificial intelligence-based identification for dento-anatomy could provide crucial information for oral health diagnosis and treatment and shed light on real-time detection of developmental dentistry. However, the grand challenge is that the current ultrasound technologies are meant for external use due to their bulkiness and low frequency. We report a compact versatile ultrasound intraoral device that consists of a rotational probe head robustly pivoted around a hand-held and portable handle for real-time imaging of intraoral anatomy using high-frequency ultrasonography (up to 25 MHz). The intraoral ultrasound device that could be adjusted for various orientations of the imaging planes by rotating the head provides real-time, high-resolution ultrasonograms of intraoral structures, including dento-periodontium of most tooth types and maxillary palate. Machine learning-based algorithms are integrated to automate the identification of important structures, including alveolar bone and cementum-enamel junction. The intraoral ultrasound device smartened with artificial intelligence could innovate oral health diagnosis and treatment plans toward precision health and patient care.
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Affiliation(s)
- Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2 V2
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 1C9
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - Kim-Cuong T Nguyen
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2 V2
| | - Thanh-Giang La
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
| | - Vu Duc Nguyen
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
| | - Minh Binh Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
| | - Punithakumar Kumaradevan
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
| | - Neelambar Kaipatur
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 1C9
| | - Paul W Major
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 1C9
| | - Edmond H M Lou
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2 V2
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 1H9
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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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Patil AB, Patil N, Singh R, Razdan P, Singh S, Mathew RA, Banerjee S. Comparative Assessment of Reliability and Accuracy of Cone-Beam Computed Tomography (CBCT) Over Direct Surgical Measurement for Periodontal Bone Loss: A Prospective, Cross-Sectional Study. Cureus 2023; 15:e44608. [PMID: 37795054 PMCID: PMC10547079 DOI: 10.7759/cureus.44608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Assessing bone condition holds significant value in the diagnosis, treatment planning, and prognosing the periodontal disease; its importance is undeniable. The main aim of the present study was to evaluate the accuracy of alveolar bone measurements due to periodontal disease using cone-beam computed tomography (CBCT), by comparing with surgical measurements, considered as the gold standard. MATERIALS AND METHODS A prospective cross-sectional study included a sample of 40 individuals diagnosed with chronic periodontitis who required periodontal surgery. A total of 202 sites were assessed for vertical and horizontal bone loss in the anterior (76 sites) and posterior (126 sites) teeth. Bone loss was measured using CBCT and a UNC 15 periodontal probe during the surgical intervention, and then compared. The statistical analysis involved employing a Student's t-test to compare measurements. Unpaired t-tests and correlation analyses were conducted using Pearson's correlation coefficient test. To establish statistical significance, a threshold of p<0.05 was considered appropriate. RESULTS The statistical analysis carried out on the mean values of CBCT and direct surgical measurements for vertical bone loss demonstrated a significant difference (p<0.01). However, the values obtained for horizontal bone loss did not display statistical significance. A strong correlation of 0.94-0.99 existed between surgical and CBCT measurements. A statistically significant distinction was observed between the two methods in measuring bone loss at the distal and palatal sites of the anterior teeth. CONCLUSION Both CBCT and direct surgical measurement exhibit comparable accuracy potential in assessing alveolar bone loss. CBCT provides an accessibility advantage by enhancing visual access to challenging sites during surgical interventions, including palatal and distal areas of the teeth.
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Affiliation(s)
- Anshuman B Patil
- Department of Conservative Dentistry and Endodontics, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial (JMF's ACPM) Dental College, Dhule, IND
| | - Nileshrao Patil
- Department of Conservative Dentistry and Endodontics, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial (JMF's ACPM) Dental College, Dhule, IND
| | - Romalpreet Singh
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College, Malout, IND
| | - Priyanka Razdan
- Department of Paediatric and Preventive Dentistry, Yogita Dental College and Hospital, Khed, IND
| | - Sneha Singh
- Department of Conservative Dentistry and Endodontics, Rungta College of Dental Sciences, Bhilai, IND
| | - Rinnu A Mathew
- Department of Periodontics, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial (JMF's ACPM) Dental College, Dhule, IND
| | - Satyabrat Banerjee
- Department of Conservative Dentistry and Endodontics, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial (JMF's ACPM) Dental College, Dhule, IND
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Kweon DC. Radiation exposure in cone beam CT measured using a MOSFET and RPLGD dosimeter and Monte Carlo simulation in phantom. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023:XST230026. [PMID: 37248944 DOI: 10.3233/xst-230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Due to the wide application of the cone beam computed tomography (CBCT) in clinical practice, it is important to assess radiation dose of CBCT more accurately and efficiently in different clinical applications. OBJECTIVE This study aims to calculate effective and absorbed doses in CBCT measured in an anthropomorphic phantom using computer-based Monte Carlo (PCXMC) software, and to conduct comparative evaluations of MOSFET (metal- oxide- semiconductor field-effect transistor) and radiophotoluminescence glass dosimeters (RPLGD). METHODS Effective and absorbed organ doses are compared with those obtained using MOSFET and RPLGD dosimetry in an anthropomorphic phantom given the same exposure settings. Effective and absorbed organ doses from CBCT during scout and main projections are calculated using PCXMC and PCXMCRotation software, respectively. RESULTS The mean effective dose from CBCT calculated using PCXMC software is 233.8μSv, while the doses calculated using dosimetry (MOSFET and RPLGD) are 266.67μSv and 268.78μSv, respectively. The X-ray source variation is 0.79%. The prescription limits based on the Friedman test for MOSFET and RPLGD pre-points (i.e., in an analytical analysis of diagnostic names in CBCT) are not statistically significant. The calculated correlation coefficient between MOSFET- and RPLGD-derived absorbed dose values with respect to a field of view CBCT parameter of 17×13.5 mm is r = 0.8623. CONCLUSIONS The study demonstrates that the PCXMC software may be used as an alternative to MOSFET and RPLGD dosimetry for effective and absorbed organ dose estimation in CBCT conducted with a large FOV in an anthropomorphic phantom.
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Affiliation(s)
- Dae Cheol Kweon
- Department of Radiological Science, Shinhan University, Uijeongbu, Republic of Korea
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Fiebich M, Ammon J, Borowski M, de Las Heras Gala H, Loose R, Mentzel HJ, Poppe B. [Use of patient radiation shielding in diagnostic and interventional radiology]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01157-0. [PMID: 37171543 DOI: 10.1007/s00117-023-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
The use of patient contact shielding provides an opportunity to reduce patient radiation exposure. Recently, the use has been the subject of controversy. The Radiation Protection Committee has published a recommendation on the use of patient radiation shields by considering the recent findings on dose savings but also the risks of incorrect use. In this article, a specification for the more frequently used types of X‑ray examination is given, which describes whether and which radiation contact shielding should be used. This is accompanied by a rationale for the use or non-use of patient radiation protection agents. Problems and possible errors are explained, as well as how to deal with special situations such as pregnant women and children.
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Affiliation(s)
- M Fiebich
- Institut für Medizinische Physik und Strahlenschutz, Technische Hochschule Mittelhessen, Wiesenstr. 14, 35390, Gießen, Deutschland.
| | - J Ammon
- Institut für Medizinische Physik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - M Borowski
- Institut für Röntgendiagnostik und Nuklearmedizin, Klinikum Braunschweig, Braunschweig, Deutschland
| | | | - R Loose
- Institut für Medizinische Physik, Klinikum Nürnberg Nord (i. R.), Nürnberg, Deutschland
| | - H-J Mentzel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - B Poppe
- Universitätsklinik für Medizinische Strahlenphysik, Medizinischer Campus Pius-Hospital, Department für Medizinische Physik und Akustik, Carl-von-Ossietzky-Universität Oldenburg, Oldenburg, Deutschland
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Kanavakis G, Ghamri M, Gkantidis N. Novel Anterior Cranial Base Area for Voxel-Based Superimposition of Craniofacial CBCTs. J Clin Med 2022; 11:jcm11123536. [PMID: 35743607 PMCID: PMC9225157 DOI: 10.3390/jcm11123536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
A standard method to assess changes in craniofacial morphology over time is through the superimposition of serial patient images. This study evaluated the reliability of a novel anterior cranial base reference area, principally including stable midline structures (EMACB) after an early age, and compared it to the total anterior cranial base (TACB) and an area including only midline structures (MACB). Fifteen pairs of pre-existing serial CBCT images acquired from growing patients were superimposed with all techniques by applying a best-fit registration algorithm of corresponding voxel intensities (Dolphin 3D software). The research outcomes were the reproducibility of each technique and the agreement between them in skeletal change detection, as well as their validity. The TACB and EMACB methods were valid, since the superimposed midline ACB structures consistently showed adequate overlap. They also presented perfect overall reproducibility (median error < 0.01 mm) and agreement (median difference < 0.01 mm). MACB showed reduced validity, higher errors, and a moderate agreement to the TACB. Thus, the EMACB method performed efficiently and mainly included the stable midline ACB structures during growth. Based on the technical, anatomical, and biological principles applied when superimposing serial 3D data to assess craniofacial changes, we recommend the EMACB method as the method of choice to fulfil this purpose.
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Affiliation(s)
- Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, UZB-University Center for Dental Medicine, University of Basel, 4058 Basel, Switzerland;
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Mohammed Ghamri
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland;
- Directorate of Health Affairs-Jeddah, Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-031-632-098
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Geist JR. Image properly: Diagnostic reference levels and optimization in oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:359-361. [PMID: 35183482 DOI: 10.1016/j.oooo.2021.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
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Ghamri M, Kanavakis G, Gkantidis N. Reliability of Different Anterior Cranial Base Reference Areas for Voxel-Based Superimposition. J Clin Med 2021; 10:jcm10225429. [PMID: 34830711 PMCID: PMC8622398 DOI: 10.3390/jcm10225429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/22/2023] Open
Abstract
The study aimed to evaluate the reliability and reproducibility and compare the outcomes of two 3D voxel-based superimposition techniques for craniofacial CBCT images, using anterior cranial base areas of different extent as references. Fifteen preexisting pairs of serial CBCTs (initial age: 11.7 ± 0.6 years; interval: 1.7 ± 0.4 years) were superimposed on total anterior cranial base (TACB) or middle anterior cranial base (MACB) structures through the Dolphin 3D software. The overlap of the reference structures was assessed visually to indicate reliability. All superimpositions were repeated by the same investigator. Outcomes were compared to assess the agreement between the two methods. Reliability was perfect for the TACB and moderate for the MACB method (p = 0.044). Both areas showed good overall reproducibility, though in individual cases there were notable differences for MACB superimpositions, ranging from −1.84 to 1.64 mm (TACB range: −0.48 to 0.31 mm). The overall agreement in the detected T0/T1 changes was also good, though it was significantly reduced for individual measurements (median < 0.01 mm, IQR: 0.46 mm, range: −2.81 to 0.73 mm). In conclusion, the voxel-based superimposition on TACB was more reliable and showed higher reproducibility than the superimposition on MACB. Thus, the extended anterior cranial base area is recommended for the assessment of craniofacial changes.
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Affiliation(s)
- Mohammed Ghamri
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland;
- Directorate of Health Affairs-Jeddah, Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, UZB-University Center for Dental Medicine, University of Basel, 4058 Basel, Switzerland;
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-031-632-0985
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Belmans N, Oenning AC, Salmon B, Baselet B, Tabury K, Lucas S, Lambrichts I, Moreels M, Jacobs R, Baatout S. Radiobiological risks following dentomaxillofacial imaging: should we be concerned? Dentomaxillofac Radiol 2021; 50:20210153. [PMID: 33989056 PMCID: PMC8404518 DOI: 10.1259/dmfr.20210153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This review aimed to present studies that prospectively investigated biological effects in patients following diagnostic dentomaxillofacial radiology (DMFR). METHODS Literature was systematically searched to retrieve all studies assessing radiobiological effects of using X-ray imaging in the dentomaxillofacial area, with reference to radiobiological outcomes for other imaging modalities and fields. RESULTS There is a lot of variability in the reported radiobiological assessment methods and radiation dose measures, making comparisons of radiobiological studies challenging. Most radiological DMFR studies are focusing on genotoxicity and cytotoxicity, data for 2D dentomaxillofacial radiographs, albeit with some methodological weakness biasing the results. For CBCT, available evidence is limited and few studies include comparative data on both adults and children. CONCLUSIONS In the future, one will have to strive towards patient-specific measures by considering age, gender and other individual radiation sensitivity-related factors. Ultimately, future radioprotection strategies should build further on the concept of personalized medicine, with patient-specific optimization of the imaging protocol, based on radiobiological variables.
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Affiliation(s)
| | - Anne Caroline Oenning
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São, Leopoldo Mandic, Campinas, Sao Paulo, Brazil
| | | | - Bjorn Baselet
- Belgian Nuclear Research Centre (SCK CEN), Radiobiology Unit, Boeretang 200, Mol, Belgium
| | | | - Stéphane Lucas
- Laboratory of Analysis by Nuclear Reaction (LARN/PMR), Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Ivo Lambrichts
- Morphology Group, Biomedical Research Institute, Hasselt University, Agoralaan Building C, Diepenbeek, Belgium
| | - Marjan Moreels
- Belgian Nuclear Research Centre (SCK CEN), Radiobiology Unit, Boeretang 200, Mol, Belgium
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Reidelbach CS, Neubauer J, Russe MF, Kusterer J, Semper-Hogg W. Evaluation of skin doses for cone-beam computed tomography in dentomaxillofacial imaging: A preclinical study. PLoS One 2021; 16:e0254510. [PMID: 34252156 PMCID: PMC8274873 DOI: 10.1371/journal.pone.0254510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Evaluation of skin organ doses in six different cone-beam computed tomography scanners (CBCT) dedicated to dentomaxillofacial imaging. Our hypothesis is that the dose varies between different devices, protocols and skin areas. Materials and methods An anthropomorphic adult head and neck phantom was used to which a dosimeter (Waterproof Farmer® Chamber, PTW, Freiburg, Germany) was attached to anatomic landmarks of both parotid glands, both ocular lenses, the thyroid gland and the neurocranium. CBCT examinations were performed on six different CBCT devices dedicated to dentomaxillofacial imaging with standard settings and, if available, also in high dose settings. Measurements were repeated five times each. Results The measured mean skin doses ranged from 0.48 to 2.21 mGy. The comparison of the region based dose evaluation showed a high correlation between the single measurements. Furthermore, the distribution of doses between regions was similar in all devices, except that four devices showed side differences for the dose of the parotid region and one device showed side differences for the lens region. The directly exposed regions, such as the parotid glands, showed significant higher values than the more distant regions like the neurocranium. When comparing examination protocols, a significant difference between the standard dose and the high dose acquisitions could be detected. But also a significant dose difference between the different CBCTs could be shown. 3D Accuitomo 170 (Morita, Osaka, Japan) showed the highest absorbed mean dose value for standard settings with 2.21 mGy, especially at the directly exposed regions and their adjacent organs. The lowest mean value for standard settings was achieved with VGi evo (NewTom, Verona, Italy) with 0.48 mGy. Conclusion Repeated measurements of skin organ doses in six different CBCT scanners using a surface dosimeter showed side differences in distribution of dose in five devices for the parotid and lens region. Additionally, significant dose differences between the devices could be detected. Further studies should be performed to confirm these results.
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Affiliation(s)
- Carolin Sophie Reidelbach
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Jakob Neubauer
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Kusterer
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Candela-Juan C, Ciraj-Bjelac O, Sans Merce M, Dabin J, Faj D, Gallagher A, de Las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Use of out-of-field contact shielding on patients in medical imaging: A review of current guidelines, recommendations and legislative documents. Phys Med 2021; 86:44-56. [PMID: 34052671 DOI: 10.1016/j.ejmp.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
The use of patient contact-shielding has become a topic of intensive scientific debate. While it has been common practice during the last decades, some studies have questioned the efficiency of using such shielding while others have highlighted the inconsistencies in its application. The objective of this work is to review current recommendations and legislative documents on the use of out-of-field shielding in X-ray imaging, including those from national authorities and from international and national organisations and professional bodies. The review, performed within the framework of the activities of EURADOS Working Group 12, covers available recommendations on use of contact shielding in adult, pregnant and paediatric patients in general radiography, fluoroscopy, computed tomography, mammography and dental radiology. It includes a comprehensive search of 83 documents from 32 countries and 6 international organisations over the last 39 years. In general, using shielding is recommended only under two conditions: if it does not compromise the diagnostic task and the performance of the procedure and/or if it reassures the patient and comforters that they are appropriately protected against potentially harmful effects of radiation. There are very few specific regulatory requirements to use shielding in a particular imaging modality, although they may consider use of shielding either as part of good radiological practice or as requirements for availability of protective or ancillary tools, without further specification of their use. There is a wide variety of positions among documents that recommend out-of-field shielding, those that do not recommend it and those that are not specific. Therefore, evidence-based consensus is still needed to ensure best and consistent practice.
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Affiliation(s)
- Cristian Candela-Juan
- Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain.
| | | | - Marta Sans Merce
- University Hospital of Geneva, Geneva, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Dario Faj
- Medical Faculty of Osijek, University of Osijek, Croatia; Faculty of Dental Medicine and Health, University of Osijek, Croatia
| | - Aoife Gallagher
- Medical Physics Department, University Hospital Limerick, Ireland
| | | | - Željka Knežević
- Radiation Chemistry and Dosimetry Laboratory, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - George Simantirakis
- Licensing and Inspections Department, Greek Atomic Energy Commission, Ag. Paraskevi, Greece
| | - Chrysoula Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation, Manchester, UK
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12
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Cone-Beam Computed Tomography: A User-Friendly, Practical Roadmap to the Planning and Execution of Every Rhinoplasty-A 5-Year Review. Plast Reconstr Surg 2021; 147:749e-762e. [PMID: 33835107 DOI: 10.1097/prs.0000000000007900] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cone-beam computed tomography has recently rapidly developed worldwide as a versatile and convenient alternative to traditional computed tomography for imaging of the maxillofacial region. However, most surgeons performing rhinoplasty are surprisingly unfamiliar with it, in both the plastic surgery and ear, nose, and throat communities. METHODS The broad clinical experience of a single center over the past 5 years is reviewed. The many applications of cone-beam computed tomography to primary and secondary rhinoplasty are analyzed regarding septum, turbinates, nasal bones, skin thickness, and other issues. The importance of a paradigm shift from a two-dimensional to a three-dimensional approach in image reconstruction is demonstrated, together with the value of surface contour enhancement. RESULTS Cone-beam computed tomography has a multitude of practical applications highly relevant to rhinoplasty. The surface image will strengthen aesthetic analysis, and the detailed preview of bony and functional anatomy will facilitate surgical planning. Cone-beam computed tomography serves as a roadmap to plan and execute rhinoplasties more predictably and efficiently. The availability of spatial views and accurate detail, together with the possibility of easy, accurate measuring, offers a plenitude of potential applications. CONCLUSIONS Cone-beam computed tomography is a user-friendly, quick technique with abundant advantages in planning any rhinoplasty. It causes the patient no inconvenience and has very few, if any, drawbacks, with these being limited to radiation exposure and limited cost.
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Kanavakis G, Häner ST, Matthey F, Gkantidis N. Voxel-based superimposition of serial craniofacial cone-beam computed tomographies for facial soft tissue assessment: Reproducibility and segmentation effects. Am J Orthod Dentofacial Orthop 2021; 159:343-351.e1. [PMID: 33641815 DOI: 10.1016/j.ajodo.2020.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/01/2020] [Accepted: 04/01/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this investigation was to evaluate the reproducibility of a voxel-based 3-dimensional superimposition method and the effect of segmentation error on determining soft tissue surface changes. METHODS A total of 15 pairs of serial cone-beam computed tomography images (interval: 1.69 ± 0.37 years) from growing subjects (initial age: 11.75 ± 0.59 years) were selected from an existing digital database. Each pair was superimposed on the anterior cranial base, in 3 dimensions with Dolphin 3D software (version 2.1.6079.17633; Dolphin Imaging & Management Solutions, Chatsworth, Calif). The reproducibility of superimposition outcomes and surface segmentation were tested with intra- and interoperator comparisons. RESULTS Median differences in inter- and intrarater measurements at various areas presented a range of 0.08-0.21 mm. In few instances, the differences were larger than 0.5 mm. In areas where T0-T1 changes were increased, the error did not appear to increase. However, the method error increased the farther the measurement area was from the superimposition reference structure. For individual images, the median soft tissue segmentation error ranged from 0.05 to 0.06 at various areas and in no subject exceeded 0.13 mm. CONCLUSIONS The presented voxel-based superimposition method was efficient and well reproducible. The segmentation process was a minimal source of error; however, there were a few cases in which the total error was more than 0.5 mm and could be considered clinically significant. Therefore, this method can be used clinically to assess 3-dimensional soft tissue changes during orthodontic treatment in growing patients.
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Affiliation(s)
- Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine, University of Basel, Basel, Switzerland; Department of Orthodontics, Tufts University School of Dental Medicine, Boston, Mass.
| | - Simeon T Häner
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | | | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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Mandibular buccal shelf and infrazygomatic crest thicknesses in patients with different vertical facial heights. Am J Orthod Dentofacial Orthop 2020; 158:349-356. [DOI: 10.1016/j.ajodo.2019.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022]
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Farronato M, Maspero C, Abate A, Grippaudo C, Connelly ST, Tartaglia GM. 3D cephalometry on reduced FOV CBCT: skeletal class assessment through AF-BF on Frankfurt plane-validity and reliability through comparison with 2D measurements. Eur Radiol 2020; 30:6295-6302. [PMID: 32382843 DOI: 10.1007/s00330-020-06905-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/15/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To test the validity of a novel protocol for 3D sagittal jaw discrepancy assessment (skeletal class determination) through comparison with common 2D indexes by the use of reduced FOV (10 × 10) CBCT which shows at least from the Frankfurt plane to the B point vertically, and from the most anterior between A and B point to Po point horizontally. METHODS A sample of CBCT scans of 109 adult patients (46 females; 63 males; mean age 30 years ± 11.6) equally distributed between I, II and III class was selected. Skeletal class was evaluated with specific software using the distance of A and B point's projection (AF-BF) on FHp (Frankfurt horizontal plane) and compared to 2D common indexes (ANB and Witts appraisal). The validity and reliability of the aforementioned analyses were determined using intra-class correlation coefficients, quadratic weighted Cohen's K and sensitivity. RESULT A selected range of values of 2.5 ± 2.5 AF-BF showed a solid correlation with the ANB angle (r = 0.846, K = 0.838, p < 0.001) and moderate with Wits appraisal (r = 0.723, K = 0.720, p < 0.001). CONCLUSIONS AF-BF showed high reliability in skeletal class determination on reduced FOV CBCT without the use of S and N cephalometric landmarks. KEY POINTS • Reduced FOV CT allows skeletal class determination for orthodontic purposes. • A new 3D-reduced FOV cephalometry is proposed. • AF-BF is a reliable alternative to ANB.
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Affiliation(s)
- Marco Farronato
- Department of Medicine, Surgery and Dentistry Department of Orthodontics, Università degli Studi di Milano - Fondazione IRCCS Cà Granda, Milan, Italy.
| | - Cinzia Maspero
- Department of Medicine, Surgery and Dentistry Department of Orthodontics, Università degli Studi di Milano - Fondazione IRCCS Cà Granda, Milan, Italy
| | - Andrea Abate
- Department of Medicine, Surgery and Dentistry Department of Orthodontics, Università degli Studi di Milano - Fondazione IRCCS Cà Granda, Milan, Italy
| | - Cristina Grippaudo
- Department of Medicine, Surgery and Dentistry Department of Orthodontics, University of Rome "La Sapienza", Rome, Italy
| | - Stephen Thaddeus Connelly
- Department of Oral & Maxillofacial Surgery, San Francisco Veterans Affairs Health Care System, University of California San Francisco, San Francisco, CA, USA.,Department of Oral & Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gianluca Martino Tartaglia
- Department of Medicine, Surgery and Dentistry Department of Orthodontics, Università degli Studi di Milano - Fondazione IRCCS Cà Granda, Milan, Italy
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Vandenberghe B. The crucial role of imaging in digital dentistry. Dent Mater 2020; 36:581-591. [PMID: 32299666 DOI: 10.1016/j.dental.2020.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
One of the recent trends in dentistry - and this in every field from the restorative to the orthodontic one- is the introduction of simplified completely digital workflows. Digital dentistry is supposed to allow dentists to work more efficiently, and this at higher precision, and with the possibility of all-in-one sessions using in-house computerized techniques. In this workflow, one of the major tools for simulating and transferring dental treatments is imaging. Both 3D low dose radiographic as well as optical imaging are playing crucial roles and have been overwhelming the market. Novel design platforms, compact and extremely fast milling and printing units are now also plentiful and rapidly being adopted in practice. Nevertheless, many of the steps in this digital dentistry process, no matter how simplified, present risks that can contribute to reduced precision and clinical difficulties. It is therefore the purpose of the article to briefly describe the role of imaging in this digital workflow, and where the pitfalls can be found that may lead to errors and imprecision.
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Affiliation(s)
- Bart Vandenberghe
- Advimago, Center for Advanced Oral Imaging, Emile Clausstraat 42, 1050 Brussels, Belgium.
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Häner ST, Kanavakis G, Matthey F, Gkantidis N. Voxel-based superimposition of serial craniofacial CBCTs: Reliability, reproducibility and segmentation effect on hard-tissue outcomes. Orthod Craniofac Res 2019; 23:92-101. [PMID: 31529585 DOI: 10.1111/ocr.12347] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To test the reliability and reproducibility of a fast and user-friendly voxel-based 3D superimposition method and the effect of bone segmentation on its outcomes. SETTING AND SAMPLE POPULATION This prospective methodological study assessed 15 pairs of pre-existing serial CBCT images (interval: 1.69 ± 0.37 years) obtained from growing patients (initial age: 11.75 ± 0.59 years). MATERIALS AND METHODS Volumes were superimposed on the anterior cranial base using Dolphin 3D software. Reliability was assessed visually, by inspecting the overlap of the superimposition reference structures. Reproducibility was tested with intra- and inter-operator comparisons of superimposition outcomes. RESULTS The method presented good reliability in all cases. The median differences between intra- and inter-operator comparisons at various tested areas ranged from 0.06 to 0.16 mm and from 0.15 to 0.24 mm, respectively. In few individual cases, differences exceeded 0.5 mm. There was no evidence that the error increased upon increase in the magnitude of the detected T0-T1 changes. However, the superimposition error increased when the distance between the measurement area and the superimposition reference also increased. For a single image, the median error of bone surface segmentation ranged in different areas between 0.05 and 0.12 mm, with few exceptions where it slightly exceeded 0.25 mm. CONCLUSIONS The tested voxel-based superimposition method presented good efficiency, cranial base matching and reproducibility in a growing patient sample. Segmentation error was considered minimal. The total error reached clinically relevant levels in very few cases. Thus, this technique is considered appropriate for clinical use, when 3D assessment of craniofacial changes is required.
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Affiliation(s)
- Simeon T Häner
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | | | | | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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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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19
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Crossen D, Morelli T, Tyndall DA, Tawil PZ. Periapical Microsurgery: A 4-dimensional Analysis of Healing Patterns. J Endod 2019; 45:402-405. [DOI: 10.1016/j.joen.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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20
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Dose estimate for cone beam CT equipment protocols using Monte Carlo simulation in computational adult anthropomorphic phantoms. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Ghanbarnezhad Farshi R, Mesbahi A, Johari M, Kara Ü, Gharehaghaji N. Dosimetry of Critical Organs in Maxillofacial Imaging with Cone-beam Computed Tomography. J Biomed Phys Eng 2019; 9:51-60. [PMID: 30881934 PMCID: PMC6409370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/21/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND While the benefits of cone-beam computed tomography (CBCT) are well known in maxillofacial imaging, the use of this modality is not risk-free. OBJECTIVE The aim of this study was to evaluate the exposure doses received by patients during maxillofacial imaging with CBCT. METHODS Entrance surface dose (ESD) was measured by using thermoluminescent dosimeters (TLDs) attached to the eyes lids, parotid glands and thyroid of 64 patients in two imaging centers (A and B). Phantom dosimetry was performed by a cylindrical poly-methyl methacrylate (PMMA) head-size phantom and an ionization chamber for different exposure parameters. NewTom VGi and Planmeca Promax 3D CBCT scanners were used at centers A and B, respectively. RESULTS The mean ESD of the eyes, parotid glands and thyroid were 2.57, 2.33 and 0.28 mGy in center A, 0.35, 2.11 and 0.37 mGy in center B, respectively. ESD of the eyes revealed a significant difference in two centers; in center B, it was 86.4% lower than center A. In the phantom dosimetry, the measured doses of NewTom VGi were 2.63 and 2.08 mGy, respectively by changing field of view (FOV) size from 8×8 cm2 (height × diameter) to 6×6 cm2. For Planmeca Promax 3D, it ranged from 0.98 to 3.24 mGy depending on exposure parameters. CONCLUSION There is a wide range of radiation doses dependent on the units, patients and selected scan parameters. Inappropriate selection of exposure settings, especially FOV size, can seriously increase patient dose.
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Affiliation(s)
- R Ghanbarnezhad Farshi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Mesbahi
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Johari
- Department of Oral & Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ü Kara
- Vocational School of Health Services, Suleyman Demirel University, Isparta, Turkey
| | - N Gharehaghaji
- Radiology Department, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Rottke D, Dreger J, Sawada K, Honda K, Schulze D. Comparison of manual and dose reduction modes of a MORITA R100 CBCT. Dentomaxillofac Radiol 2018; 48:20180009. [PMID: 30182744 DOI: 10.1259/dmfr.20180009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE: To compare effective dose differences when acquiring (1) dose reduction mode and (2) manual mode in a MORITA R100 CBCT. METHODS: 24 exposure protocols with different technique factors were performed in both the dose reduction mode and the manual mode in a Veraviewepocs 3D R100 cone beam CT device. 48 TLD were placed in a RANDO head phantom at 24 different sites. Effective doses were calculated according to the formalism published in the 103rd ICRP report. RESULTS: Effective doses for the dose reduction mode protocols ranged from 14 to 156 µSv [mean = 57 µSv, standard deviation (SD) = 37 µSv], whereas effective doses for the manual mode protocols ranged from 22 to 267 µSv (mean = 94 µSv, SD = 65 µSv). Thus, across all protocols, the dose reduction mode leads to a drop of the effective dose by 38 % (SD = 6 %). CONCLUSIONS: The estimated effective doses are significantly lower if dose reduction protocols are acquired.
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Affiliation(s)
- Dennis Rottke
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany.,2 Department of Odontology, Oral and Maxillofacial Radiology, Faculty of Medicine, Umeå University , Umeå , Sweden
| | - Julia Dreger
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany
| | - Kunihiko Sawada
- 3 Department of Radiology, Nihon University School of Dentistry , Tokyo , Japan
| | - Kazuya Honda
- 3 Department of Radiology, Nihon University School of Dentistry , Tokyo , Japan
| | - Dirk Schulze
- 1 Digital Diagnostic Center , Freiburg im Breisgau , Germany
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da Silva Moura W, Chiqueto K, Pithon GM, Neves LS, Castro R, Henriques JFC. Factors influencing the effective dose associated with CBCT: a systematic review. Clin Oral Investig 2018; 23:1319-1330. [DOI: 10.1007/s00784-018-2561-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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24
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Vandenberghe B. The digital patient – Imaging science in dentistry. J Dent 2018; 74 Suppl 1:S21-S26. [DOI: 10.1016/j.jdent.2018.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022] Open
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Hayashi T, Arai Y, Chikui T, Hayashi-Sakai S, Honda K, Indo H, Kawai T, Kobayashi K, Murakami S, Nagasawa M, Naitoh M, Nakayama E, Nikkuni Y, Nishiyama H, Shoji N, Suenaga S, Tanaka R. Clinical guidelines for dental cone-beam computed tomography. Oral Radiol 2018; 34:89-104. [PMID: 30484133 DOI: 10.1007/s11282-018-0314-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
Dental cone-beam computed tomography (CBCT) received regulatory approval in Japan in 2000 and has been widely used since being approved for coverage by the National Health Insurance system in 2012. This imaging technique allows dental practitioners to observe and diagnose lesions in the dental hard tissue in three dimensions (3D). When performing routine radiography, the examination must be justified, and optimal protection should be provided according to the ALARA (as low as reasonably achievable) principles laid down by the International Commission on Radiological Protection. Dental CBCT should be performed in such a way that the radiation exposure is minimized and the benefits to the patient are maximized. There is a growing demand for widespread access to cutting-edge health care through Japan's universal health insurance system. However, at the same time, people want our limited human, material, and financial resources to be used efficiently while providing safe health care at the least possible cost to society. Japan's aging population is expected to reach a peak in 2025, when most of the baby boomer generation will be aged 75 years or older. Comprehensive health care networks are needed to overcome these challenges. Against this background, we hope that this text will contribute to the nation's oral health by encouraging efficient use of dental CBCT.
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Affiliation(s)
- Takafumi Hayashi
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.
| | - Yoshinori Arai
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, 1-8-13 Surugadai Kand Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Toru Chikui
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Sachiko Hayashi-Sakai
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Kazuya Honda
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, 1-8-13 Surugadai Kand Chiyoda-ku, Tokyo, 101-8310, Japan
| | - Hiroko Indo
- Division of Oncology, Department of Maxillofacial Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Kaoru Kobayashi
- Department of Oral and Maxillofacial Radiology and Diagnosis, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masako Nagasawa
- Division of Bio-Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan
| | - Eiji Nakayama
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Ishikari-Tobetsu, Hokkaido, 061-0293, Japan
| | - Yutaka Nikkuni
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Hideyoshi Nishiyama
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Noriaki Shoji
- Division of Oral Diagnosis, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Shigeaki Suenaga
- Division of Oncology, Department of Maxillofacial Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ray Tanaka
- Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, SAR, China
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da Fonte JB, Andrade TMD, Albuquerque RL, de Melo MDFB, Takeshita WM. Evidence of genotoxicity and cytotoxicity of X-rays in the oral mucosa epithelium of adults subjected to cone beam CT. Dentomaxillofac Radiol 2017; 47:20170160. [PMID: 29091472 DOI: 10.1259/dmfr.20170160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess cytological evidence of genotoxicity and cytotoxicity of X-rays in oral exfoliated cells of adults subjected to partial and total cone beam CT (CBCT) (stitching module) by means of micronuclei frequency, associated with counting of degenerative nuclear alterations (pyknosis, karyolysis, karyorrhexis, buds and broken eggs), besides comparing the partial and total CBCT (stitching module) in search of possible differences in the nature and/or intensity of the effects. METHODS 29 adults who were referred to total or partial CBCT were selected. All CBCT were performed with a Carestream CS 9000 3D scanner (Carestream Health Inc., Rochester, NY). Material collection was done immediately before CBCT and 10 days later, by scraping the left and right cheek mucosa with a plastic spatula. Statistical analysis was performed using the Wilcoxon test (paired data), at a significance level of 5%. RESULTS The statistically significant difference was noted in the frequency of micronucleated cells for both partial and total acquisition (p = 0.008 and p < 0.001, respectively). Regarding to cytotoxicity, there was a statistically significant difference for both partial and total acquisition (p < 0.001 and p < 0.001, respectively). CONCLUSIONS The partial and total CBCT seems to offer risks of inducing genetic damage. In addition both forms of CBCT acquisition have promoted the induction of cytotoxic nuclear alterations.
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Affiliation(s)
- Juliana Bm da Fonte
- 1 Department of Dentistry, Master's Degree Program in Dentistry, Federal University of Sergipe, UFS, Aracaju, Brazil.,2 Department of Dentistry, Discipline of Radiology and Dental Imaging, Federal University of Sergipe, UFS Aracaju, Brazil
| | - Taís M de Andrade
- 3 Department of Dentistry, Federal University of Sergipe, UFS, Aracaju, Brazil
| | - Ricardo Lc Albuquerque
- 4 Department of Dentistry, Discipline of Oral and Maxillofacial Pathology, Tiradentes University, UNIT, Aracaju, Brazil
| | - Maria de Fátima B de Melo
- 2 Department of Dentistry, Discipline of Radiology and Dental Imaging, Federal University of Sergipe, UFS Aracaju, Brazil.,5 Departament of Oral Pathology, Radiology & Medicine, University of Iowa, Iowa, IA, USA
| | - Wilton M Takeshita
- 2 Department of Dentistry, Discipline of Radiology and Dental Imaging, Federal University of Sergipe, UFS Aracaju, Brazil
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Haas LF, Zimmermann GS, De Luca Canto G, Flores-Mir C, Corrêa M. Precision of cone beam CT to assess periodontal bone defects: a systematic review and meta-analysis. Dentomaxillofac Radiol 2017; 47:20170084. [PMID: 28869397 DOI: 10.1259/dmfr.20170084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard (in situ measurement). METHODS Studies in which the main objective was to evaluate the diagnostic validity of CBCT in measuring periodontal bone defects when compared with the reference standard were selected. Four databases were searched. The studies were selected by two independent reviewers. The methodology of selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies. The quality of evidence and strength of recommendation was assessed by The Grading of Recommendations Assessment Tool, Development and Evaluation. RESULTS Using a selection process in two phases, 16 studies were identified and, in seven articles meta-analysis was performed. The results from these meta-analyses showed that no difference between the measurements of CBCT and in situ for alveolar bone loss, and demonstrated a concordance of 82.82% between CBCT and in situ for the classification of the degree of furcation involvement. CONCLUSIONS Based on a moderate level of evidence, CBCT could be useful for furcation involvement periodontal cases, but it should only be used in cases where clinical evaluation and conventional radiographic imaging do not provide the information necessary for an adequate diagnosis and proper periodontal treatment planning.
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Affiliation(s)
- Letícia Fernanda Haas
- 1 Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - G De Luca Canto
- 2 Department of Dentistry, Federal University of Santa Catarina, Santa Catarina, Brazil.,3 Department of Dentistry, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- 3 Department of Dentistry, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada
| | - Márcio Corrêa
- 2 Department of Dentistry, Federal University of Santa Catarina, Santa Catarina, Brazil
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Ernst M, Manser P, Dula K, Volken W, Stampanoni MF, Fix MK. TLD measurements and Monte Carlo calculations of head and neck organ and effective doses for cone beam computed tomography using 3D Accuitomo 170. Dentomaxillofac Radiol 2017; 46:20170047. [PMID: 28749697 DOI: 10.1259/dmfr.20170047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES In dentistry, the use of cone beam CT has steadily increased over the last few years. The aim of this study was to measure organ doses and to perform dose calculations based on Monte Carlo (MC) simulations to work out a basis for full three-dimensional (3D) dose calculations for any patient examination performed with the machine used in this study. METHODS TLD-100 LiF detectors were placed at 71 measurement positions on the surface and within a RT-Humanoid phantom to cover all relevant radiosensitive organs and tissues. Three examinations with different protocols were performed with the 3D Accuitomo® and dose calculations with MC simulations were carried out for the same three protocols using the EGSnrc MC transport code system. RESULTS Field of views of 140 × 100, 80 × 50 and 40 × 40 mm2 were selected, the mean organ doses were measured as 5.2, 2.75 and 1.5 mGy and the effective doses were determined as 250, 97 and 48 µSv. For the MC simulation of organ doses and the thermoluminescent dosemeter measurements, an overall agreement within ±10.1% (two standard deviations) was achieved. The measured dose values for 3D Accuitomo® were about a factor 2 lower when compared with conventional CT examinations. CONCLUSIONS Reliable results for the organ doses as well as effective dose values were achieved with thermoluminescent dosemeter measurements in the RT-Humanoid phantom. This study provides the basis for the application of MC simulations for further dose determinations of cone beam CT machines. The MC calculation may therefore be a valuable tool to support the dentists in the evaluation of the trade-off between additional information that may be relevant to the choice of therapy and the additional dose given to the patient.
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Affiliation(s)
- Marina Ernst
- 1 Department of Physics, ETH Zurich, Zurich, Switzerland.,2 Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,3 Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
| | - Peter Manser
- 2 Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karl Dula
- 4 Section of Dental Radiology, Department of Oral Surgery and Stomatology, University of Bern, Bern, Switzerland
| | - Werner Volken
- 2 Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Michael K Fix
- 2 Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Rottke D, Andersson J, Ejima KI, Sawada K, Schulze D. Influence of lead apron shielding on absorbed doses from cone-beam computed tomography. RADIATION PROTECTION DOSIMETRY 2017; 175:110-117. [PMID: 27664428 DOI: 10.1093/rpd/ncw275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
Abstract
The aim of the present work was to investigate absorbed and to calculate effective doses (EDs) in cone-beam computed tomography (CBCT). The study was conducted using examination protocols with and without lead apron shielding. A full-body male RANDO® phantom was loaded with 110 GR200A thermoluminescence dosemeter chips at 55 different sites and set up in two different CBCT systems (CS 9500®, ProMax® 3D). Two different protocols were performed: the phantom was set up (1) with and (2) without a lead apron. No statistically significant differences in organ and absorbed doses from regions outside the primary beam could be found when comparing results from exposures with and without lead apron shielding. Consequently, calculating the ED showed no significant differences between the examination protocols with and without lead apron shielding. For the ProMax® 3D with shielding, the ED was 149 µSv, and for the examination protocol without shielding 148 µSv (SD = 0.31 µSv). For the CS 9500®, the ED was 88 and 86 µSv (SD = 0.95 µSv), respectively, with and without lead apron shielding. The results revealed no statistically significant differences in the absorbed doses between examination with and without lead apron shielding, especially in organs outside the primary beam.
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Affiliation(s)
- Dennis Rottke
- Digital Diagnostic Center, Kaiser-Joseph-Str. 263, 79098 Freiburg im Breisgau, Germany
- Department of Odontology, Oral and Maxillofacial Radiology, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Radiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ken-Ichiro Ejima
- Department of Radiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Kunihiko Sawada
- Department of Radiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Dirk Schulze
- Digital Diagnostic Center, Kaiser-Joseph-Str. 263, 79098 Freiburg im Breisgau, Germany
- Department of Radiology, Nihon University School of Dentistry, Tokyo, Japan
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Abstract
BACKGROUND The use of radiation protection equipment can reduce the radiation exposure of patients. OBJECTIVES The aim was to show which patient shields should be used for the different types of examination. METHODS The results of multiple studies were compiled and analyzed and recommendations made for the use of patient shields. The absolute dose values and the protective effect were considered. RESULTS Radiological protection should be used in many investigations; particularly in the case of CT investigations, a reasonable dose reduction potential exists due to the higher radiation dose. CONCLUSIONS Based on these recommendations, workflow changes in some types of investigation are expected due to the use of additional patient shields.
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Affiliation(s)
- M Fiebich
- Institut für Medizinische Physik und Strahlenschutz, Technische Hochschule Mittelhessen, Wiesenstr. 14, 35390, Gießen, Deutschland.
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Is Cone-Beam Computed Tomography Always Necessary for Dental Implant Placement? J Oral Maxillofac Surg 2017; 75:285-289. [DOI: 10.1016/j.joms.2016.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
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Lin WC, Wang HH, Hsu WL, Cao BH, Chen DJ, Tsai CJ. Investigation of an optimized scanning protocol for the dentomaxillofacial region using 320-slice multidetector computed tomography. Dentomaxillofac Radiol 2017; 46:20160395. [PMID: 28128650 DOI: 10.1259/dmfr.20160395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To propose an imaging protocol that provides satisfactory image quality for oral examination while minimizing radiation dosage using 320-slice multidetector CT (MDCT). METHODS An anthropomorphic head phantom was scanned using 320 MDCT with protocols combining different scanning modes: volume scanning (whole or local) vs helical scanning (80- or 64-slice detectors); tube voltage settings (80 kVp, 120 kVp and 135 kVp); and tube current settings (60 mA, 80 mA, 100 mA and 120 mA). A total of six anatomical bone structures and three anatomical soft-tissue structures were assessed using quantitative and qualitative analysis in the three orthographic planes (axial, sagittal and coronal). A figure of merit (FOM) was used to determine the optimal imaging protocol in terms of tube voltage, tube current and scanning mode. RESULTS The 80-kVp setting had the worst quantitative and qualitative results (both p < 0.001) compared with the 135-kVp and 120-kVp settings, especially for soft-tissue structures. A significant difference was noted for the scores obtained using a tube current between 120 mA and 60 mA by quantitative analysis, but not by qualitative analysis. Volume scans using either whole or local modes had a significantly higher FOM than helical scanning of 80 or 64 slices. CONCLUSIONS In 320 MDCT, a protocol using 135 kVp, 80 mA and the volume-scanning mode (whole or local) offers adequate visualization of both soft-tissue and bone structures while keeping the radiation dose as low as possible. This may therefore be considered a first choice among a wide selection of scanning protocols for dentomaxillofacial CT.
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Affiliation(s)
- Wei-Chan Lin
- 1 Department of Radiology, Cathay General Hospital, Taipei, Taiwan.,2 School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Hsueh-Han Wang
- 3 Department of Radiology, National Yang-Ming University Hospital, Yilan City, Taiwan
| | - Wen-Lin Hsu
- 4 School of Medicine, Tzu-Chi University, Hualien, Taiwan.,5 Department of Radiation Oncology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Bi-Hui Cao
- 6 Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - De-Ji Chen
- 6 Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chia-Jung Tsai
- 7 Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
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Takeshita Y, Shimizu M, Okamura K, Yoshida S, Weerawanich W, Tokumori K, Jasa GR, Yoshiura K. A new method to evaluate image quality of CBCT images quantitatively without observers. Dentomaxillofac Radiol 2017; 46:20160331. [PMID: 28045343 DOI: 10.1259/dmfr.20160331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To develop an observer-free method for quantitatively evaluating the image quality of CBCT images by applying just-noticeable difference (JND). METHODS We used two test objects: (1) a Teflon (polytetrafluoroethylene) plate phantom attached to a dry human mandible; and (2) a block phantom consisting of a Teflon step phantom and an aluminium step phantom. These phantoms had holes with different depths. They were immersed in water and scanned with a CB MercuRay (Hitachi Medical Corporation, Tokyo, Japan) at tube voltages of 120 kV, 100 kV, 80 kV and 60 kV. Superimposed images of the phantoms with holes were used for evaluation. The number of detectable holes was used as an index of image quality. In detecting holes quantitatively, the threshold grey value (ΔG), which differentiated holes from the background, was calculated using a specific threshold (the JND), and we extracted the holes with grey values above ΔG. The indices obtained by this quantitative method (the extracted hole values) were compared with the observer evaluations (the observed hole values). In addition, the contrast-to-noise ratio (CNR) of the shallowest detectable holes and the deepest undetectable holes were measured to evaluate the contribution of CNR to detectability. RESULTS The results of this evaluation method corresponded almost exactly with the evaluations made by observers. The extracted hole values reflected the influence of different tube voltages. All extracted holes had an area with a CNR of ≥1.5. CONCLUSIONS This quantitative method of evaluating CBCT image quality may be more useful and less time-consuming than evaluation by observation.
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Affiliation(s)
- Yohei Takeshita
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Mayumi Shimizu
- 2 Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Kazutoshi Okamura
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Shoko Yoshida
- 3 Section of Image Diagnostics, Department of Diagnostics and General Care, Fukuoka Dental College, Fukuoka, Japan
| | - Warangkana Weerawanich
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kenji Tokumori
- 4 Department of Radiological Technology, Faculty of Fukuoka Medical Technology, Teikyo University, Fukuoka, Japan
| | - Gainer R Jasa
- 5 Oral Radiology Division, Faculty of Dentistry, Republic University, Montevideo, Uruguay
| | - Kazunori Yoshiura
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Timothy J, Wilson J, Rice E, Hall R. Nanocrystalline hydroxyapatite intervertebral cages induce fusion after anterior cervical discectomy and may be a safe alternative to PEEK or carbon fiber intervertebral cages. Br J Neurosurg 2016; 30:654-657. [PMID: 27100665 DOI: 10.3109/02688697.2016.1173192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Nanocrystalline hydroxyapatite (nHA) cages have emerged as a new alternative to carbon fiber or polyether ether ketone (PEEK) devices to promote intervertebral fusion. No evidence has been published to date regarding rates of fusion for these devices after anterior cervical discectomy and fusion (ACDF). METHODS Eight patients underwent one- or two-level ACDF with nHA intervertebral cages (Nanoss®-Cervical, Pioneer® Surgical Technology, Inc., Marquette, MI). Radiographs, neck disability index (NDI) and visual analog scores (VAS) for pain were taken preoperatively and at a minimum of 19 months postoperatively. RESULTS At an average follow-up of 21 months, all eight patients (100%) achieved fusion as assessed by plain radiographs. Reduction in preoperative symptomology was comparable to previously published data with a mean reduction of neck VAS of 3, arm VAS of 6 and NDI reduced by 27%. Radiographs showed clear evidence of bridging bone. CONCLUSIONS This series provides evidence that nHA intervertebral cages can successfully promote fusion after ACDF and may provide an alternative to carbon fiber and PEEK cages.
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Affiliation(s)
- Jake Timothy
- a Department of Neurosurgery , Leeds General Infirmary , Leeds , UK
| | - Jamie Wilson
- a Department of Neurosurgery , Leeds General Infirmary , Leeds , UK
| | - Edward Rice
- a Department of Neurosurgery , Leeds General Infirmary , Leeds , UK
| | - Richard Hall
- b Department of Engineering , University of Leeds , Leeds , UK
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Langner S. Optimized imaging of the midface and orbits. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 14:Doc05. [PMID: 26770279 PMCID: PMC4702054 DOI: 10.3205/cto000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A variety of imaging techniques are available for imaging the midface and orbits. This review article describes the different imaging techniques based on the recent literature and discusses their impact on clinical routine imaging. Imaging protocols are presented for different diseases and the different imaging modalities.
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Affiliation(s)
- Sönke Langner
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
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Ludlow JB, Timothy R, Walker C, Hunter R, Benavides E, Samuelson DB, Scheske MJ. Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 2015; 44:20140197. [PMID: 25224586 DOI: 10.1259/dmfr.20140197] [Citation(s) in RCA: 273] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This article analyses dose measurement and effective dose estimation of dental CBCT examinations. Challenges to accurate calculation of dose are discussed and the use of dose-height product (DHP) as an alternative to dose-area product (DAP) is explored. METHODS The English literature on effective dose was reviewed. Data from these studies together with additional data for nine CBCT units were analysed. Descriptive statistics, ANOVA and paired analysis are used to characterize the data. RESULTS PubMed and EMBASE searches yielded 519 and 743 publications, respectively, which were reduced to 20 following review. Reported adult effective doses for any protocol ranged from 46 to 1073 µSv for large fields of view (FOVs), 9-560 µSv for medium FOVs and 5-652 µSv for small FOVs. Child effective doses from any protocol ranged from 13 to 769 µSv for large or medium FOVs and 7-521 µSv for small FOVs. Effective doses from standard or default exposure protocols were available for 167 adult and 52 child exposures. Mean adult effective doses grouped by FOV size were 212 µSv (large), 177 µSv (medium) and 84 µSv (small). Mean child doses were 175 µSv (combined large and medium) and 103 µSv (small). Large differences were seen between different CBCT units. Additional low-dose and high-definition protocols available for many units extend the range of doses. DHP was found to reduce average absolute error for calculation of dose by 45% in comparison with DAP. CONCLUSIONS Large exposure ranges make CBCT doses difficult to generalize. Use of DHP as a metric for estimating effective dose warrants further investigation.
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Affiliation(s)
- J B Ludlow
- 1 North Carolina Oral Health Institute, Koury Oral Health Sciences, Chapel Hill, NC, USA
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Koivisto JH, Wolff JE, Kiljunen T, Schulze D, Kortesniemi M. Characterization of MOSFET dosimeters for low-dose measurements in maxillofacial anthropomorphic phantoms. J Appl Clin Med Phys 2015; 16:266–278. [PMID: 26219008 PMCID: PMC5690001 DOI: 10.1120/jacmp.v16i4.5433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 11/23/2022] Open
Abstract
The aims of this study were to characterize reinforced metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters to assess the measurement uncertainty, single exposure low-dose limit with acceptable accuracy, and the number of exposures required to attain the corresponding limit of the thermoluminescent dosimeters (TLD). The second aim was to characterize MOSFET dosimeter sensitivities for two dental photon energy ranges, dose dependency, dose rate dependency, and accumulated dose dependency. A further aim was to compare the performance of MOSFETs with those of TLDs in an anthropomorphic phantom head using a dentomaxillofacial CBCT device. The uncertainty was assessed by exposing 20 MOSFETs and a Barracuda MPD reference dosimeter. The MOSFET dosimeter sensitivities were evaluated for two photon energy ranges (50-90 kVp) using a constant dose and polymethylmethacrylate backscatter material. MOSFET and TLD comparative point-dose measurements were performed on an anthropomorphic phantom that was exposed with a clinical CBCT protocol. The MOSFET single exposure low dose limit (25% uncertainty, k = 2) was 1.69 mGy. An averaging of eight MOSFET exposures was required to attain the corresponding TLD (0.3 mGy) low-dose limit. The sensitivity was 3.09 ± 0.13 mV/mGy independently of the photon energy used. The MOSFET dosimeters did not present dose or dose rate sensitivity but, however, presented a 1% decrease of sensitivity per 1000 mV for accumulated threshold voltages between 8300 mV and 17500 mV. The point doses in an anthropomorphic phantom ranged for MOSFETs between 0.24 mGy and 2.29 mGy and for TLDs between 0.25 and 2.09 mGy, respectively. The mean difference was -8%. The MOSFET dosimeters presented statistically insignificant energy dependency. By averaging multiple exposures, the MOSFET dosimeters can achieve a TLD-comparable low-dose limit and constitute a feasible method for diagnostic dosimetry using anthropomorphic phantoms. However, for single in vivo measurements (<1.7 mGy) the sensitivity is too low.
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Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters. RADIATION PROTECTION DOSIMETRY 2015; 165:156-161. [PMID: 25805884 DOI: 10.1093/rpd/ncv057] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The widespread use of cone-beam CT (CBCT) in dentistry has led to increasing concern regarding justification and optimisation of CBCT exposures. When used as a substitute to multidetector CT (MDCT), CBCT can lead to significant dose reduction; however, low-dose protocols of current-generation MDCTs show that there is an overlap between CBCT and MDCT doses. More importantly, although the 3D information provided by CBCT can often lead to improved diagnosis and treatment compared with 2D radiographs, a routine or excessive use of CBCT would lead to a substantial increase of the collective patient dose. The potential use of CBCT for paediatric patients (e.g. developmental disorders, trauma and orthodontic treatment planning) further increases concern regarding its proper application. This paper provides an overview of justification and optimisation issues in dental and maxillofacial CBCT. The radiation dose in CBCT will be briefly reviewed. The European Commission's Evidence Based Guidelines prepared by the SEDENTEXCT Project Consortium will be summarised, and (in)appropriate use of CBCT will be illustrated for various dental applications.
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Affiliation(s)
- Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Effective dose comparison between stitched and single FOV in CBCT protocols for complete dental arcade. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Al-Okshi A, Lindh C, Salé H, Gunnarsson M, Rohlin M. Effective dose of cone beam CT (CBCT) of the facial skeleton: a systematic review. Br J Radiol 2015; 88:20140658. [PMID: 25486387 DOI: 10.1259/bjr.20140658] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To estimate effective dose of cone beam CT (CBCT) of the facial skeleton with focus on measurement methods and scanning protocols. METHODS A systematic review, which adhered to the preferred reporting items for systematic reviews (PRISMA) Statement, of the literature up to April 2014 was conducted. Data sources included MEDLINE®, The Cochrane Library and Web of Science. A model was developed to underpin data extraction from 38 included studies. RESULTS Technical specifications of the CBCT units were insufficiently described. Heterogeneity in measurement methods and scanning protocols between studies made comparisons of effective doses of different CBCT units and scanning protocols difficult. Few studies related doses to image quality. Reported effective dose varied across studies, ranging between 9.7 and 197.0 μSv for field of views (FOVs) with height ≤5 cm, between 3.9 and 674.0 μSv for FOVs of heights 5.1-10.0 cm and between 8.8 and 1073.0 μSv for FOVs >10 cm. There was an inconsistency regarding reported effective dose of studies of the same CBCT unit with the same FOV dimensions. CONCLUSION The review reveals a need for studies on radiation dosages related to image quality. Reporting quality of future studies has to be improved to facilitate comparison of effective doses obtained from examinations with different CBCT units and scanning protocols. A model with minimum data set on important parameters based on this observation is proposed. ADVANCES IN KNOWLEDGE Data important when estimating effective dose were insufficiently reported in most studies. A model with minimum data based on this observation is proposed. Few studies related effective dose to image quality.
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Affiliation(s)
- A Al-Okshi
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
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Study of effective dose of various protocols in equipment cone beam CT. Appl Radiat Isot 2015; 100:21-6. [PMID: 25665897 DOI: 10.1016/j.apradiso.2015.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/16/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
This study has the purpose of assessing the radiation absorbed dose in organs/tissues and estimating the effective dose using five different models of Cone Beam Computed Tomography equipment using protocols with similar purpose. For this purpose, 26 thermoluminescent dosimeters were inserted in the position of the organs/tissues of a female anthropomorphic phantom. From the measurements the contribution of wT×HT in the organs and tissues the effective dose were calculated. The measurements have shown the effective dose values within the range 9.3-111.5µSv. The effective dose values by field of view (FOV) size are within the following ranges: 9.3-51.2µSv, 17.6-52.0µSv, and 43.1-111.5µSv for small/located, medium and large FOV respectively. Protocols with same purpose, carried out with different models of equipment, presented significant differences in the values of the equivalent and effective doses. From the point of view of radiological protection, it is not enough to have knowledge about the dimensions of the FOV and the purpose of the examination. It is necessary to assess the dose using the different models of the equipment and protocols available. In this context, this study provides useful information for this assessment.
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Horner K, O'Malley L, Taylor K, Glenny AM. Guidelines for clinical use of CBCT: a review. Dentomaxillofac Radiol 2015; 44:20140225. [PMID: 25270063 PMCID: PMC4277440 DOI: 10.1259/dmfr.20140225] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify guidelines on the clinical use of CBCT in dental and maxillofacial radiology, in particular selection criteria, to consider how they were produced, to appraise their quality objectively and to compare their recommendations. METHODS A literature search using MEDLINE (Ovid(®)) was undertaken prospectively from 1 January 2000 to identify published material classifiable as "guidelines" pertaining to the use of CBCT in dentistry. This was supplemented by searches on websites, an internet search engine, hand searching of theses and by information from personal contacts. Quality assessment of publications was performed using the AGREE II instrument. Publications were examined for areas of agreement and disagreement. RESULTS 26 publications were identified, 11 of which were specifically written to give guidelines on the clinical use of CBCT and contained sections on selection criteria. The remainder were a heterogeneous mixture of publications that included guidelines relating to CBCT. Two had used a formal evidence-based approach for guideline development and two used consensus methods. The quality of publications was frequently low as assessed using AGREE II, with many lacking evidence of adequate methodology. There was broad agreement between publications on clinical use, apart from treatment planning, in implant dentistry. CONCLUSIONS Reporting of guideline development is often poorly presented. Guideline development panels should aim to perform and report their work using the AGREE II instrument as a template to raise standards and avoid the risk of suspicions of bias.
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Affiliation(s)
- K Horner
- School of Dentistry, University of Manchester, Manchester, UK
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Pauwels R, Zhang G, Theodorakou C, Walker A, Bosmans H, Jacobs R, Bogaerts R, Horner K. Effective radiation dose and eye lens dose in dental cone beam CT: effect of field of view and angle of rotation. Br J Radiol 2014; 87:20130654. [PMID: 25189417 DOI: 10.1259/bjr.20130654] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To quantify the effect of field of view (FOV) and angle of rotation on radiation dose in dental cone beam CT (CBCT) and to define a preliminary volume-dose model. METHODS Organ and effective doses were estimated using 148 thermoluminescent dosemeters placed in an anthropomorphic phantom. Dose measurements were undertaken on a 3D Accuitomo 170 dental CBCT unit (J. Morita, Kyoto, Japan) using six FOVs as well as full-rotation (360°) and half-rotation (180°) protocols. RESULTS For the 360° rotation protocols, effective dose ranged between 54 µSv (4 × 4 cm, upper canine) and 303 µSv (17 × 12 cm, maxillofacial). An empirical relationship between FOV dimension and effective dose was derived. The use of a 180° rotation resulted in an average dose reduction of 45% compared with a 360° rotation. Eye lens doses ranged between 95 and 6861 µGy. CONCLUSION Significant dose reduction can be achieved by reducing the FOV size, particularly the FOV height, of CBCT examinations to the actual region of interest. In some cases, a 180° rotation can be preferred, as it has the added value of reducing the scan time. Eye lens doses should be reduced by decreasing the height of the FOV rather than using inferior FOV positioning, as the latter would increase the effective dose considerably. ADVANCES IN KNOWLEDGE The effect of the FOV and rotation angle on the effective dose in dental CBCT was quantified. The dominant effect of FOV height was demonstrated. A preliminary model has been proposed, which could be used to predict effective dose as a function of FOV size and position.
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Affiliation(s)
- R Pauwels
- 1 Oral Imaging Center, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Hidalgo A, Davies J, Horner K, Theodorakou C. Effectiveness of thyroid gland shielding in dental CBCT using a paediatric anthropomorphic phantom. Dentomaxillofac Radiol 2014; 44:20140285. [PMID: 25411710 DOI: 10.1259/dmfr.20140285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of the study is to evaluate the effectiveness of thyroid shielding in dental CBCT examinations using a paediatric anthropomorphic phantom. METHODS An ATOM(®) 706-C anthropomorphic phantom (Computerized Imaging Reference Systems Inc., Norfolk, VA) representing a 10-year-old child was loaded with six thermoluminescent dosemeters positioned at the level of the thyroid gland. Absorbed doses to the thyroid were measured for five commercially available thyroid shields using a large field of view (FOV). RESULTS A statistically significant thyroid gland dose reduction was found using thyroid shielding for paediatric CBCT examinations for a large FOV. In addition, a statistically significant difference in thyroid gland doses was found depending on the position of the thyroid gland. There was little difference in the effectiveness of thyroid shielding when using a lead vs a lead-equivalent thyroid shield. Similar dose reduction was found using 0.25- and 0.50-mm lead-equivalent thyroid shields. CONCLUSIONS Thyroid shields are to be recommended when undertaking large FOV CBCT examinations on young patients.
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Affiliation(s)
- A Hidalgo
- 1 School of Dentistry, University of Manchester, Manchester, UK
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Chambers D, Bohay R, Kaci L, Barnett R, Battista J. The effective dose of different scanning protocols using the Sirona GALILEOS(®) comfort CBCT scanner. Dentomaxillofac Radiol 2014; 44:20140287. [PMID: 25358865 PMCID: PMC4614170 DOI: 10.1259/dmfr.20140287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the effective dose and CT dose index (CTDI) for a range of imaging protocols using the Sirona GALILEOS(®) Comfort CBCT scanner (Sirona Dental Systems GmbH, Bensheim, Germany). METHODS Calibrated optically stimulated luminescence dosemeters were placed at 26 sites in the head and neck of a modified RANDO(®) phantom (The Phantom Laboratory, Greenwich, NY). Effective dose was calculated for 12 different scanning protocols. CTDI measurements were also performed to determine the dose-length product (DLP) and the ratio of effective dose to DLP for each scanning protocol. RESULTS The effective dose for a full maxillomandibular scan at 42 mAs was 102 ± 1 μSv and remained unchanged with varying contrast and resolution settings. This compares with 71 μSv for a maxillary scan and 76 μSv for a mandibular scan with identical milliampere-seconds (mAs) at high contrast and resolution settings. CONCLUSIONS Changes to mAs and beam collimation have a significant influence on effective dose. Effective dose and DLP vary linearly with mAs. A collimated maxillary or mandibular scan decreases effective dose by approximately 29% and 24%, respectively, as compared with a full maxillomandibular scan. Changes to contrast and resolution settings have little influence on effective dose. This study provides data for setting individualized patient exposure protocols to minimize patient dose from ionizing radiation used for diagnostic or treatment planning tasks in dentistry.
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Affiliation(s)
- D Chambers
- 1 Division of Graduate Orthodontics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, Law CS, Levin MD, Sauer RA, Valachovic RW, Zeller GG, Goske MJ. The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:257-61. [DOI: 10.1016/j.oooo.2014.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/27/2022]
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Costa FF, Pinheiro LR, Umetsubo OS, Santos Júnior OD, Gaia BF, Cavalcanti MGP. Influence of Cone-beam Computed Tomographic Scan Mode for Detection of Horizontal Root Fracture. J Endod 2014; 40:1472-6. [DOI: 10.1016/j.joen.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/13/2014] [Accepted: 03/01/2014] [Indexed: 11/28/2022]
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Koivisto J, Schulze D, Wolff J, Rottke D. Effective dose assessment in the maxillofacial region using thermoluminescent (TLD) and metal oxide semiconductor field-effect transistor (MOSFET) dosemeters: a comparative study. Dentomaxillofac Radiol 2014; 43:20140202. [PMID: 25143020 PMCID: PMC4240264 DOI: 10.1259/dmfr.20140202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/11/2014] [Accepted: 08/19/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare the performance of metal oxide semiconductor field-effect transistor (MOSFET) technology dosemeters with thermoluminescent dosemeters (TLDs) (TLD 100; Thermo Fisher Scientific, Waltham, MA) in the maxillofacial area. METHODS Organ and effective dose measurements were performed using 40 TLD and 20 MOSFET dosemeters that were alternately placed in 20 different locations in 1 anthropomorphic RANDO(®) head phantom (the Phantom Laboratory, Salem, NY). The phantom was exposed to four different CBCT default maxillofacial protocols using small (4 × 5 cm) to full face (20 × 17 cm) fields of view (FOVs). RESULTS The TLD effective doses ranged between 7.0 and 158.0 µSv and the MOSFET doses between 6.1 and 175.0 µSv. The MOSFET and TLD effective doses acquired using four different (FOV) protocols were as follows: face maxillofacial (FOV 20 × 17 cm) (MOSFET, 83.4 µSv; TLD, 87.6 µSv; -5%); teeth, upper jaw (FOV, 8.5 × 5.0 cm) (MOSFET, 6.1 µSv; TLD, 7.0 µSv; -14%); tooth, mandible and left molar (FOV, 4 × 5 cm) (MOSFET, 10.3 µSv; TLD, 12.3 µSv; -16%) and teeth, both jaws (FOV, 10 × 10 cm) (MOSFET, 175 µSv; TLD, 158 µSv; +11%). The largest variation in organ and effective dose was recorded in the small FOV protocols. CONCLUSIONS Taking into account the uncertainties of both measurement methods and the results of the statistical analysis, the effective doses acquired using MOSFET dosemeters were found to be in good agreement with those obtained using TLD dosemeters. The MOSFET dosemeters constitute a feasible alternative for TLDs for the effective dose assessment of CBCT devices in the maxillofacial region.
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Affiliation(s)
- J Koivisto
- 1 Department of Physics, University of Helsinki, Helsinki, Finland
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Wenzel A. Radiographic display of carious lesions and cavitation in approximal surfaces: Advantages and drawbacks of conventional and advanced modalities. Acta Odontol Scand 2014; 72:251-64. [PMID: 24512205 DOI: 10.3109/00016357.2014.888757] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Treatment strategies have changed with efforts on arresting carious lesions suspected to have an intact surface sparing operative treatment for cavitated lesions. Radiography is still the most recommended adjunct method in the diagnosis of clinically inaccessible approximal surfaces. BITEWING RADIOGRAPHY: The major drawback of bitewing radiography for caries diagnosis is that the clinical state of the surface cannot be determined; i.e. if cavitation has developed or the demineralized surface is still intact. Based on studies of the relationship between radiographic lesion depth and clinical cavitation in approximal surfaces, a threshold for operative treatment decision has been suggested when a lesion is observed radiographically more than one-third into dentine. However, the results from previous studies are contradictory and the majority of studies are ~25 years old. In addition, there are few longitudinal observational studies on the behaviour of dentinal carious lesions, particularly in adults. CONE BEAM COMPUTED TOMOGRAPHY: Cone beam CT is an advanced 3-dimensional radiographic modality, which seems much more accurate than intra-oral modalities for displaying cavitation in approximal surfaces. Nonetheless, there are several drawbacks with CBCT, such as radiation dose, costs and imaging artefacts. Therefore, CBCT cannot be advocated at current as a primary radiographic examination with the aim of diagnosing cavitated carious lesions. CONCLUSIONS Bitewing radiography is, thus, still state-of-the-art as an adjunct in diagnosing carious lesions in clinically inaccessible approximal surfaces. The risk for cavitation is related to lesion depth, but new studies are needed in both child and adult populations to validate current thresholds for the operative treatment decision based on the radiographic lesion depth.
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Affiliation(s)
- Ann Wenzel
- Oral Radiology, Department of Dentistry, Aarhus University , Denmark
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Greco PM. Let the truth be known. Am J Orthod Dentofacial Orthop 2013; 144:788-9. [DOI: 10.1016/j.ajodo.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 09/16/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
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