Substantial Dose Reduction in Modern Multi-Slice Spiral Computed Tomography (MSCT)-Guided Craniofacial and Skull Base Surgery

Abstract

Purpose: Reduction of the radiation exposure involved in image-guided craniofacial and skull base surgery is an important goal. The purpose was to evaluate the influence of low-dose protocols in modern multi-slice spiral computed tomography (MSCT) on target registration errors (TREs).

Materials and Methods: An anthropomorphic skull phantom with target markers at the craniofacial bone and the anterior skull base was scanned in Sensation Open (40-slice), LightSpeed VCT (64-slice) and Definition Flash (128-slice). Identical baseline protocols (BP) at 120 kV/100 mAs were compared to the following low-dose protocols (LD) in care dose/dose modulation: (LD-I) 100 kV/35ref. mAs, (LD-II) 80 kV/40 – 41ref. mAs, and (LD-III) 80 kV/15 – 17ref. mAs. CTDIvol and DLP were obtained. TREs using an optical navigation system were calculated for all scanners and protocols. Results were statistically analyzed in SPSS and compared for significant differences (p ≤ 0.05).

Results: CTDIvol for the Sensation Open/LightSpeed VCT/Definition Flash showed: (BP) 22.24 /32.48 /14.32 mGy; (LD-I) 4.61 /3.52 /1,62 mGy; (LD-II) 3.15 /2.01 /0.87 mGy; and (LD-III) na/0.76 /0.76 mGy. Differences between the BfS (Bundesamt für Strahlenschutz) reference CTDIvol of 9 mGy and the lowest CTDIvol were approximately 3-fold for Sensation Open, and 12-fold for the LightSpeed VCT and Definition Flash. A total of 33 registrations and 297 TRE measurements were performed. In all MSCT scanners, the TREs did not significantly differ between the low-dose and the baseline protocols.

Conclusion: Low-dose protocols in modern MSCT provided substantial dose reductions without significant influence on TRE and should be strongly considered in image-guided surgery.

Zusammenfassung

Ziel: Maßnahmen zur Reduktion der Strahlenexposition für bildgesteuerte kraniofaziale und Schädelbasischirugie sind ein bedeutendes Anliegen. Ziel der vorliegenden Arbeit war es, den Einfluss von Low-Dose-Protokollen in der modernen Multi-Slice-Spiralcomputertomografie (MSCT) auf den Target Registration Error (TRE) zu untersuchen.

Material und Methoden: Ein antropomorphes Schädelphantom mit Targetmarkern im kraniofazialen Knochen und der vorderen Schädelbasis wurde im Sensation Open (40-slice), LightSpeed VCT (64-slice) and Definition Flash (128-slice) gescannt. Einheitliche Basisprotokolle (BP) mit 120 kV/100 mAs wurden mit folgenden Low-Dose-Protokollen (LD) in care dose/dose modulation verglichen: (LD-I) 100 kV/35ref. mAs, (LD-II) 80 kV/40 – 41ref. mAs und (LD-III) 80 kV/15 – 17ref. mAs. CTDIvol und DLP wurden bestimmt. TRE wurden unter Verwendung eines optischen Navigationssystems für alle Scanner und Protokolle berechnet. Die Ergebnisse wurden mit SPSS statistisch ausgewertet und auf signifikante Unterschiede geprüft (p ≤ 0,05).

Ergebnisse: Der CTDIvol für Sensation Open/LightSpeed VCT/Definition flash ergab: (BP) 22,24 /32,48 /14,32 mGy; (LD-I) 4,61 /3,52 /1,62 mGy; (LD-II) 3,15 /2,01 /0,87 mGy; und (LD-III) na/0,76 /0,76 mGy. Die Differenz zwischen der BfS (Bundesamt für Strahlenschutz)-Referenz CTDIvol von 9 mGy und dem geringsten CTDIvol waren ungefähr 3-fach für Sensation Open und 12-fach für LightSpeed VCT und Definition Flash. 33 Registrierungen und 297 TRE-Messungen wurden durchgeführt. Für alle MSCT-Scanner zeigte sich kein signifikanter Unterschied der TRE zwischen den Low-Dose- und den Baseline-Protokollen.

Schlussfolgerung: Low-Dose-Protokolle in der modernen MSCT ermöglichen substanzielle Dosiseinsparungen ohne signifikanten Einfluss auf den TRE und sollten für die bildgesteuerte Chirurgie in Betracht gezogen werden.

Key words

CT spiral - radiation safety - skull

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