INTRODUCTION: With the introduction of digital radiography, the feedback between image quality and over-exposure has been partly lost which in some cases has led to a steady increase in dose. Over the years the introduction of exposure index (EI) has been used to resolve this phenomenon referred to as 'dose creep'. Even though EI is often vendor specific it is always a related of the radiation exposure to the detector. Due to the nature of this relationship EI can also be used as a patient dose indicator, however this is not widely investigated in literature.METHODS: A total of 420 dose-area-product (DAP) and EI measurements were taken whilst varying kVp, mAs and body habitus on two different anthropomorphic phantoms (pelvis and chest). Using linear regression, the correlation between EI and DAP were examined. Additionally, two separate region of interest (ROI) placements/per phantom where examined in order to research any effect on EI.RESULTS: When dividing the data into subsets, a strong correlation between EI and DAP was shown with all R-squared values > 0.987. Comparison between the ROI placements showed a significant difference between EIs for both placements.CONCLUSION: This research shows a clear relationship between EI and radiation dose which is dependent on a wide variety of factors such as ROI placement, body habitus. In addition, pathology and manufacturer specific EI's are likely to be of influence as well.IMPLICATIONS FOR PRACTICE: The combination of DAP and EI might be used as a patient dose indicator. However, the influencing factors as mentioned in the conclusion should be considered and examined before implementation.
Abstract Background: We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM). Methods: Pretreatment and post-treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity-modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut-off values and risk groups. Results: Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO). Conclusions: Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
Introduction: Zygomatic fractures can be diagnosed with either computed tomography (CT) or direct digital radiography (DR). The aim of the present study was to assess the effect of CT dose reduction on the preference for facial CT versus DR for accurate diagnosis of isolated zygomatic fractures. Materials and methods: Eight zygomatic fractures were inflicted on four human cadavers with a free fall impactor technique. The cadavers were scanned using eight CT protocols, which were identical except for a systematic decrease in radiation dose per protocol, and one DR protocol. Single axial CT images were displayed alongside a DR image of the same fracture creating a total of 64 dual images for comparison. A total of 54 observers, including radiologists, radiographers and oral and maxillofacial surgeons, made a forced choice for either CT or DR. Results: Forty out of 54 observers (74%) preferred CT over DR (all with P < 0.05). Preference for CT was maintained even when radiation dose reduced from 147.4 mSv to 46.4 mSv (DR dose was 6.9 mSv). Only a single out of all raters preferred DR (P ¼ 0.0003). The remaining 13 observers had no significant preference. Conclusion: This study demonstrates that preference for axial CT over DR is not affected by substantial (~70%) CT dose reduction for the assessment of zygomatico-orbital fractures.
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