Cone Beam CT Vs Multi-Detector CT in maxillofacial studies: dosimetry and technical aspects
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1 Cone Beam CT Vs Multi-Detector CT in maxillofacial studies: dosimetry and technical aspects Poster No.: C-779 Congress: ECR 205 Type: Scientific Exhibit Authors: F. Testa, E. Fumero, E. Roberto, S. Chauvie, R. Olivero, C Nyffenegger, M. Marchisio, D. Fraire ; Bra/IT, Cuneo/IT Keywords: Head and neck, Radioprotection / Radiation dose, Radiation physics, Cone beam CT, CT, Dosimetry, Radiation safety, Diagnostic procedure DOI: 0.594/ecr205/C-779 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page of 27
2 Aims and objectives The Cone Beam Computed Tomography (CBCT) is a technology that has gradually spread and that is contending with the conventional Multi Detector Computed Tomography (MDCT) the role of reference in the study of maxillofacial structures, because the reduced size of the equipment and the presumed lower radiation dose. Aim of this work is to compare the effective dose of CBCT studies of the maxillofacial structures with the effective dose of MDCT studies of the maxillofacial structures in a Public Health Department of Radiology. Page 2 of 27
3 Methods and materials A dental and maxillofacial CBCT has been installed at our Department (Planmeca ProMax 3D). This all-digital apparatus allows to perform dental and maxillofacial exams both using conventional techniques (i.e. orthopantomography, stratigraphy of the condyles, cephalometry) and advanced three-dimensional volumetric acquisitions. Fig. : Dental CBCT Planmeca ProMax 3D. References: Radiology, ASL CN2, Santo Spirito - Bra/IT The choice of 3D protocols is based on the height and the size of the desired acquisition volume. Page 3 of 27
4 Fig. 2: Touch screen control panel of Planmeca ProMax 3D References: Radiology, ASL CN2, Santo Spirito - Bra/IT Before dosimetry, we performed quality controls to test the correspondance of the radiological parameters, using a ionization chamber (Unfors Xi, TEMA Sinergie) and a sample of lead. Page 4 of 27
5 Fig. 4: Ionization chamber Unfors Xi is placed onto the flat panel digital detector of the Planmeca Promax 3D to get a quality assessment of radiological data. References: Radiology, ASL CN2, Santo Spirito - Bra/IT Page 5 of 27
6 Fig. 5: Control panel and display of the ionization chamber Unfors Xi. References: Radiology, ASL CN2, Santo Spirito - Bra/IT Page 6 of 27
7 Fig. 6: The sample of lead compared with a euro coin References: Radiology, ASL CN2, Santo Spirito - Bra/IT We performed the dosimetric evaluation on the facial program (fixed height = 0 cm; fixed diameter = 8 cm; kv = 90; ma = 0; s = 4; mas = 36) by an anthropomorphic phantom (Adelson Rando) similar to an average male subject of 75 cm and 73.5 kg. We made on it some acquisitions according to the standard facial protocols. Page 7 of 27
8 Fig. 3: Anthropomorphic phantom Adelson Rando is centered into the CBCT Planmeca Promax 3D. References: Radiology, ASL CN2, Santo Spirito - Bra/IT To estimate effective doses we used a PC-based Monte Carlo program (PCXMC). Page 8 of 27
9 Fig. 7: Monte Carlo simulation by PCXMC software (Stuk). References: Radiology, ASL CN2, Santo Spirito - Bra/IT The evaluation of radiation doses of MDCT studies of the maxillo-facial structures has been made on a 6-MDCT Hitachi Eclos. Page 9 of 27
10 Fig. 8: Hitachi Eclos 6 slices References: Radiology, ASL CN2, Santo Spirito - Bra/IT The standard protocol is a collimation of.25 mm on 8 rows, sec of rotation time, 20 kv, 50 ma and a pitch of The length of the scan is adapted each time to the anatomy of the patient, so we preferred to extract radiological data from the dose reports of 0 real exams of the maxillofacial structures without contrast medium, performed in last year in our Department. For each exam we considered CTDIv and DLP and DLP data have been corrected about overbeaming adding the last helix. Effective doses have been estimated according to the European guidelines 6262 (Edlp). To an image quality evaluation we made an acquisition on Adelson Rando also with MDCT Hitachi Eclos and we compared the two sets of images CBCT and MDCT. Page 0 of 27
11 Images for this section: Fig. : Dental CBCT Planmeca ProMax 3D. Radiology, ASL CN2, Santo Spirito - Bra/IT Page of 27
12 Fig. 2: Touch screen control panel of Planmeca ProMax 3D Radiology, ASL CN2, Santo Spirito - Bra/IT Page 2 of 27
13 Fig. 3: Anthropomorphic phantom Adelson Rando is centered into the CBCT Planmeca Promax 3D. Radiology, ASL CN2, Santo Spirito - Bra/IT Page 3 of 27
14 Fig. 4: Ionization chamber Unfors Xi is placed onto the flat panel digital detector of the Planmeca Promax 3D to get a quality assessment of radiological data. Radiology, ASL CN2, Santo Spirito - Bra/IT Page 4 of 27
15 Fig. 5: Control panel and display of the ionization chamber Unfors Xi. Radiology, ASL CN2, Santo Spirito - Bra/IT Page 5 of 27
16 Fig. 6: The sample of lead compared with a euro coin Radiology, ASL CN2, Santo Spirito - Bra/IT Page 6 of 27
17 Fig. 7: Monte Carlo simulation by PCXMC software (Stuk). Radiology, ASL CN2, Santo Spirito - Bra/IT Page 7 of 27
18 Fig. 8: Hitachi Eclos 6 slices Radiology, ASL CN2, Santo Spirito - Bra/IT Page 8 of 27
19 Results First step of quality controls has involved the test of linearity of the radiation dose as a function of ma and and the repeatability of the voltages and the times. The linearity of the dose has been measured directly on 3D rotational protocol. We kept voltage fixed at 70 kv; the exposure time was predetermined in 4 seconds. We made some aquisitions in steps of 2 ma. The relationship between current and dose was linear with a R²=0,999. ma kv s mgy mm Al , Fig. 9: Linearity of the dose. X-axis: current (ma). Y-axis: dose (mgy). References: Radiology, ASL CN2, Santo Spirito - Bra/IT Page 9 of 27
20 Keeping fixed the current at 0 ma, we made complementary acquisitions at 50 kv, 60 kv and 80 kv. We found a good stability of the apparatus in terms of voltages in a range of 5.4%. ma ideal selected kv real measured kv Using the PCXMC Monte Carlo software, the effective dose of the CBCT of the maxillofacial structures (height = 0 cm; diam = 8 cm) has been measured from experimental data (and a CTDI of 2.45 mgy) as msv. Doses of MDCT studies of maxillofacial structures were extracted from reports of 0 real exams performed in our Department. Mean ± SD CTDIv was calculated as 42.0 ± 33.0 mgy (min = 2.2 mgy; max = 96.4 mgy). Mean ± SD DLP was calculated as 57.2 ± mgy cm (min = 63. mgy cm; max = mgy cm). According to European Guidelines, the mean ± SD MDCT effective dose has been calculated as.3 ±. msv (min = 0.4 msv - max = 4.3 msv). According to these data about studies of maxillofacial structures, the ratio between the mean MDCT effective dose and the mean estimated CBCT effective dose is about 5 :. The comparison between the images made with the CBCT and those performed with MDCT showed a diagnostic quality fully comparable. Page 20 of 27
21 Fig. 0: Comparison between an image made by CBCT Planmeca ProMax 3D (on the left) and an image made by MDCT Hitachi Eclos (on the right). The eye of the radiologist cannot grasp any difference. References: Radiology, ASL CN2, Santo Spirito - Bra/IT Page 2 of 27
22 Images for this section: Fig. 9: Linearity of the dose. X-axis: current (ma). Y-axis: dose (mgy). Radiology, ASL CN2, Santo Spirito - Bra/IT Page 22 of 27
23 Fig. 0: Comparison between an image made by CBCT Planmeca ProMax 3D (on the left) and an image made by MDCT Hitachi Eclos (on the right). The eye of the radiologist cannot grasp any difference. Radiology, ASL CN2, Santo Spirito - Bra/IT Page 23 of 27
24 Conclusion Not all patients can be eligible to a CBCT study of maxillofacial structures because its technical aspects. The patient must be able to stand up and should not move during a long acquisition time: preset 4 s is the effective time of X-Ray pulsed emission but the total time of the acquisition is about 25 s; time of the movements of the tube-detector C-arm before and after the acquisition lead the total time of the stand-up at about minute. We can also perform the examination with the subject sitting on an office adjustable chair, but the operations of centering are more difficult and less effective. According to experimental data that shows a dramatically lower effective dose of CBCT than MDCT, in our Department we shift to the CBCT all those patients who are able to offer a sufficient collaboration. Page 24 of 27
25 Personal information Francesco TESTA, MD - Radiologist Elena FUMERO, Radiographer 2 Emanuele ROBERTO, PhD - Health Physicist Stéphane CHAUVIE, PhD - Health Physicist Roberto OLIVERO, Radiographer 2 Corrado NYFFENEGGER, MD - Radiologist Maurizio MARCHISIO, Radiographer-in-training Dario FRAIRE, MD - Radiologist Radiodiagnostica Ospedale Santo Spirito via Vittorio Emanuele, 3 I-2042 BRA (CN) ITALIA (view map) 2 Fisica Sanitaria ASO Santa Croce e Carle via Coppino 26 I-200 CUNEO (CN) ITALIA Page 25 of 27
26 CORRESPONDANCE: Page 26 of 27
27 References Fumero E, Testa F. Digital Cone-Beam CT Studies in Oral, Facial and Maxillary Region. Graduation Thesis. University of Turin/IT, 204. Torgersen GR, Hol C, Møystad A, Hellén-Halme K, Nilsson M. A phantom for simplified image quality control of dental cone beam computed tomography units. Oral Surg Oral Med Oral Pathol Oral Radiol. 204 Nov;8(5):603-. doi: 0.06/j.oooo Epub 204 Aug 5. Dula K, Bornstein MM, Buser D, Dagassan-Berndt D, Ettlin DA, Filippi A, Gabioud F, Katsaros C, Krastl G, Lambrecht JT, Lauber R, Luebbers HT, Pazera P, Türp JC. SADMFR Guidelines for the Use of Cone-Beam Computed Tomography/ Digital Volume Tomography. Swiss Dent J. 204;24(): 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. 205;44(): doi: 0.259/ dmfr Brüllmann D, Schulze RK. Spatial resolution in CBCT machines for dental/maxillofacial applications-what do we know today? Dentomaxillofac Radiol. 205;44(): doi: 0.259/dmfr Page 27 of 27
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