Imaging Sci Dent.  2023 Mar;53(1):69-75. 10.5624/isd.20220190.

Can ultra-low-dose computed tomography reliably diagnose and classify maxillofacial fractures in the clinical routine?

• Widmann G
• Dangl M
• Lutz E
• Fleckenstein B
• Offermanns V
• Gassner EM
• Puelacher W
• Salbrechter L

• KMID: 2541266
• DOI: http://doi.org/10.5624/isd.20220190

Abstract

Purpose
Maxillofacial trauma predominantly affects young adults between 20 and 40 years of age. Although radioprotection is a legal requirement, the significant potential of dose reduction in computed tomography (CT) is still underused in the clinical routine. The objective of this study was to evaluate whether maxillofacial fractures can be reliably detected and classified using ultra-low-dose CT.
Materials and Methods
CT images of 123 clinical cases with maxillofacial fractures were classified by two readers using the AOCOIAC software and compared with the corresponding results from post-treatment images. In group 1, consisting of 97 patients with isolated facial trauma, pre-treatment CT images at different dose levels (volumetric computed tomography dose index: ultra-low dose, 2.6 mGy; low dose, <10 mGy; and regular dose, <20 mGy) were compared with post-treatment cone-beam computed tomography (CBCT). In group 2, consisting of 31 patients with complex midface fractures, pre-treatment shock room CT images were compared with post-treatment CT at different dose levels or CBCT. All images were presented in random order and classified by 2 readers blinded to the clinical results. All cases with an unequal classification were re-evaluated.
Results
In both groups, ultra-low-dose CT had no clinically relevant effect on fracture classification. Fourteen cases in group 2 showed minor differences in the classification code, which were no longer obvious after comparing the images directly to each other.
Conclusion
Ultra-low-dose CT images allowed the correct diagnosis and classification of maxillofacial fractures. These results might lead to a substantial reconsideration of current reference dose levels.

Keyword

Tomography, X-Ray Computed; Cone-Beam Computed Tomography; Fractures; Bone; Radiation Protection