As low as diagnostically acceptable dose imaging in maxillofacial trauma: a reference quality approach

Abstract

Objectives: As-low-as-diagnostically-acceptable (ALADA) doses are substantially lower than current diagnostic reference levels. To improve dose management, a reference quality approach was tested in which phantom quality metrics of a clinical ALADA dose reference protocol were used to benchmark potential ALADA dose protocols for various scanner models. Methods: Spatial resolution, contrast resolution, contrast-to-noise ratio (CNR) and subjective noise and sharpness were evaluated for a clinical ALADA dose reference protocol at 80 kV and 40 mA (CTDIvol 2.66 mGy) and compared with test protocols of two CT scanners at 100 kV and 35 mA (3.08–3.44 mGy), 80 kV and 54–61 mA (2.65 mGy), 80 kV and 40 mA (1.73–1.92 mGy), and 80 kV and 21–23 mA (1.00–1.03 mGy) using different kernels, filtered backprojection and iterative reconstructions. The test protocols with the lowest dose showing quality metrics non-inferior to the reference protocol were verified in a cadaver study by determining the diagnostic accuracy of detection of maxillofacial fractures and CNR of the optical nerve and rectus inferior muscle. Results: 36 different image series were analysed in the phantom study. Based on the phantom quality metrics, potential ALADA dose protocols at 1.73–1.92 mGy were selected. Compared with the reference images, the selected protocols showed non-inferiority in the detection and classification of maxillofacial fractures and non-inferior CNR of orbital soft tissues in the cadaver study. Conclusions: Reference quality metrics from clinical ALADA dose protocols may be used to guide selection of potential ALADA dose protocols of different CT scanners.