Optimizing Craniofacial CT Technique
Hemant A. Parmar, MDa∗hparmar@umich.eduparurad@hotmail.com, Mohannad Ibrahim, MDa and Suresh K. Mukherji, MD, MBAb, aDepartment of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; bDepartment of Radiology, Michigan State University, 846 Service Road, East Lansing, MI 48824, USA
∗Corresponding author. Department of Radiology, University of Michigan, Taubman Center/B1/132 F, 1500 East Medical Center Drive, Ann Arbor, MI 48105.
Over the last two decades, there has been a marked increase in the number of computed tomography (CT) studies performed in the United States, with a resultant increase in the radiation dose delivered to patients. Hence there is an urgent need to optimize CT protocols and to get familiar with the factors affecting the CT radiation dose and with available dose reduction options. This article discusses the basic physics related to CT technique and describes current and future methods of dose reduction. Also briefly described are other CT techniques applicable in the maxillofacial region, such as three-dimensional CT, cone beam CT, and dual-energy CT.
Keywords
Maxillofacial
CT
Technique
Optimization
Key points
• Over the last decade there has been escalating concern regarding the increasing radiation exposure stemming from CT examinations.
• It is becoming increasingly important to optimize CT imaging protocols and to apply dose-reduction techniques to ensure optimal imaging with the lowest possible dose.
• Several other advancements of CT technique applicable to the craniofacial region including three-dimensional CT, cone beam CT, and dual-energy CT are now widely used to best possible information about various craniofacial pathologies.
Introduction
Technological advances in computed tomography (CT) have generated a dramatic increase in the number of CT studies, with resultant increase in the radiation dose to patients. CT accounts for less than 20% of medical imaging studies, but approximately 60% of diagnostic imaging radiation dose.1 Newer developments and usage of ultrasound and magnetic resonance imaging have failed to substantially reduce the overall number of CT examinations. In many instances, the CT scan is the first and only diagnostic imaging examination performed. In addition, advent of helical multidetector CT techniques with rapid acquisition times and newer applications, such as CT angiography, perfusion CT, and dual-energy CT, have led to a further increase in CT examinations. The overall increase in radiation dose is causing increasing concern among the radiologic community and general public alike.
The US Food and Drug Administration has established guidelines to address the growing concern over CT-associated radiation dose.2 Their recommendations center on optimizing CT protocols and encouraging elimination of inappropriate CT referrals and unnecessary repeat examinations. The basic pillars of dose reduction include justification of the study and eliminating inappropriate CT referrals, limiting scan range to the region of interest, limiting the number of contrast phases, and use of a relatively large pitch (Box 1). The goal is a radiation dose as low as reasonably achievable. Radiation dose delivered to the patient is proportional to the amount of energy delivered by the photons within the x-ray beam. This depends on the number of the photons and the individual photon energy, which is dictated by the image acquisition parameters, such as kilovoltage (kilovolt [peak]), tube current (milliampere), and x-ray tube rotation time along with such other factors as slice thickness, scan coverage, and pitch. Additionally, body habitus and size of the patient are important factors for the radiation dose delivered, especially for pediatric patients and small adults. There have been several advances in dose reduction techniques. These include tube current modulation, peak voltage optimization, noise reduction reconstruction algorithms, adaptive dose collimation, and improved detection system efficiency. It is imperative for practicing radiologists to be familiar with these dose reduction techniques and to optimize the imaging protocols to get the best possible images with the least possible dose.
Box 1 Pillars of CT dose reduction
• Justification of the CT study/elimination of inappropriate CT referrals
• Limiting CT scan range to the region of interest
• Limiting the number of contrast phases
• Use of a relatively large pitch
• Use of automated tube current modulation
• Use of adaptive dose shielding
• Use of newer image reconstruction algorithms
This article discusses the basic physics related to CT technique and describes current and future methods of dose reduction. Also briefly described are other CT techniques applicable in the maxillofacial region, such as three-dimensional CT, cone beam CT (CBCT), and dual-energy CT. We provide CT scanning parameters used at our institutions for the maxillofacial region in adults and children (Boxes 2 and 3).
Box 2 Maxillofacial CT parameters for adults
| Gantry rot time/length | 0.5 s full |
Generate axial, coronal, and sagittal reformats in both standard and bone algorithm
Box 3 Maxillofacial CT parameters for children
| Gantry rot time/lengths | 0.5 s full |
| SFOV 12+ years | Small head |
Generate axial, coronal, and sagittal reformats in both standard and bone algorithm
| WW/WL (HD bone) | 4000/1000 |
| WW/WL (HD standard) | 350/50 |
CT radiation dose measurement
CT scans involve continuous exposure around the patient by the rotating gantry...
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