Dose reduction in CT imaging for facial bone trauma in adults: A narrative literature review

Abstract

Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.

Structural similarity analysis of midfacial fractures—a feasibility study

“…Computed tomography (CT) is the routine imaging method of choice for the diagnosis of midfacial fractures in emergency department patients (1). Unfortunately, obtaining a good quality image involves a substantial radiation dose (1,2) However, iterative reconstruction (IR) and deep learning algorithms have been proposed to maintain image quality on reducing the radiation dose (1,3).…”

Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis

“…Computed tomography (CT) and cone beam computed tomography (CBCT) are considered the gold-standard imaging modalities for the diagnosis of midfacial fractures [2,5,[22][23][24][25][26][27]. The scanners produce volume datasets with submillimetre-sized voxels in all dimensions [22,28].…”

“…The image data can be used for orthogonal plane reconstruction and three-dimensional volume rendering [29][30][31][32]. Both scanning systems area associated with risks related to exposure to ionizing radiation [25,29,[33][34][35][36][37], which is of concern because of the exponential increase in the use of these systems over the last few decades. The estimated effective radiation dose of scan protocols for midface trauma is considered to be 0.9 to 3.6 mSv [25,36,38].…”

“…Both scanning systems area associated with risks related to exposure to ionizing radiation [25,29,[33][34][35][36][37], which is of concern because of the exponential increase in the use of these systems over the last few decades. The estimated effective radiation dose of scan protocols for midface trauma is considered to be 0.9 to 3.6 mSv [25,36,38]. The effective dose of a CBCT is known to be lower, ranging from 0.08 to 0.21 mSv on average, depending on the field of view that is used [34].…”

“…The effective dose of a CBCT is known to be lower, ranging from 0.08 to 0.21 mSv on average, depending on the field of view that is used [34]. However, the effective dose of both a CT and CBCT can vary significantly based on a multitude of factors such as the system type, scan range, size of the patient and scan protocol parameters [25,34,36,39]. Hence, the interest in investigating whether physical examinations can be used to diagnose a fracture so as to reduce unnecessary imaging, health care costs and exposure to ionizing radiation [40,41].…”