El Sahili N, David-Tchouda S, Thoret S, Nasseh I, Berberi A, Fortin T
1School of Dentistry, Lebanese University, Beirut, Lebanon.
2Medico-economic Evaluation Unit, University Hospital of Grenoble, France/ThEMAS TIMC, UMR CNRS 5525, Grenoble Joseph Fourier University, Grenoble, France.
J Maxillofac Oral Surg. 2018 Dec;17(4):520-530. doi: 10.1007/s12663-017-1075-y. Epub 2017 Dec 20.
Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants.
To assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates).
Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements.
There were no significant differences in bone measurements taken on high- or low-dose images by all seniors and by the majority of juniors ( > 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low- and high-dose images for senior observers (from = 0.287 at low dose to = 0.718 at high does) but not for juniors ( = 0.661 and = 0.509 for low and high dose, respectively).
Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.
锥形束计算机断层扫描（CBCT）设备存在差异且缺乏标准化，导致患者接受的辐射剂量超过诊断所需，尤其是在规划牙种植体手术植入位置时。
评估低剂量和高剂量毫安设置对CBCT图像的影响，以用于资深专家（5年经验）和初级医生（应届毕业生）进行客观和主观的种植体规划。
使用Carestream CS 9300机器，在低剂量（2 mA）和高剂量（6.3 mA）设置下对两个干燥颅骨（上颌的4个半上颌骨段和下颌的4个半上颌骨段）进行扫描。5位资深医生和5位初级医生对两种图像质量的横断面切片进行评估，以确定其在种植体规划中的主观图像实用性以及进行客观的线性骨测量。
所有资深医生以及大多数初级医生（P>0.05）在高剂量或低剂量图像上进行的骨测量均无显著差异。在定性图像评估中，几乎所有观察者的评估与图像质量之间均无相关性。对于下颌后牙种植体植入的规划，增加剂量可提高资深观察者在低剂量和高剂量图像之间的一致性和kappa值（从低剂量时的κ = 0.287提高到高剂量时的κ = 0.718），但初级医生则不然（低剂量和高剂量时分别为κ = 0.661和κ = 0.509）。
毫安数的降低并不影响客观骨测量的诊断图像质量，并且在定性评估中产生了足够的一致性。根据个体诊断需求明智地优化毫安设置可在不影响诊断决策的情况下显著降低剂量。
