Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Faculté de Médecine, Université Laval, Québec, QC, Canada.
Service de Physique Médicale et de Radioprotection, CHU de Québec - Université Laval, Pavillon Enfant-Jésus, 1401 18e Rue, Québec, G1J 1Z4, Canada.
J Otolaryngol Head Neck Surg. 2021 Nov 19;50(1):66. doi: 10.1186/s40463-021-00541-x.
The advent of 3D navigation imaging has opened new borders to the endoscopic surgical approaches of naso-sinusal inflammatory and neoplastic disease. This technology has gained in popularity among otolaryngologists for endoscopic sinus and skull base surgeries in both adults and children. However, the increased tissue radiation required for data acquisition associated with 3D navigation protocols CT scans is a source of concern because of its potential health hazards. We aimed to compare the effective doses of radiation between 3D navigation protocols and standard protocols for sinus computed tomography (CT) scans for both the adult and pediatric population.
We performed a retrospective cohort study through electronic chart review of patients undergoing sinus CT scans (standard and 3D navigation protocols) from May 2019 to December 2019 using a Siemens Drive (VA62A) CT scanner. The effective dose of radiation was calculated in mSv for all exams. Average irradiation doses were compared using a Student's T-Test or a Kruskall-Wallis test when appropriate.
A total of 115 CT scans were selected for analysis, of which 47 were standard protocols and 68 were 3D navigation protocols CT scans. Among these, 31 exams were performed on children and 84 exams on adults. For the total population, mean effective dose in the non-navigation CT scans was 0.37 mSv (SD: 0.16, N = 47) and mean effective dose in the 3D navigation sinus CT group was 2.33 mSv (SD: 0.45, N = 68). The mean difference between the two groups was statistically significant 1.97 mSv (CI 95% - 2.1 to - 1.83; P < 0.0001). There was a sixfold increase in radiation with utilization of 3D navigation protocols. The ratio was identical when the pediatric as well as the adult subset of patients were analyzed.
In our center, utilization of 3D navigation sinus CT protocols significantly increases radiation exposure. Otolaryngologists should be aware of this significant increase and should attempt to decrease the radiation exposure of their patients by limiting unnecessary scan orders and by evaluating 3D acquisition protocols locally with radiation physicists.
Level IV.
3D 导航成像技术的出现为鼻-鼻窦炎性和肿瘤性疾病的内镜手术方法开辟了新的领域。这项技术在耳鼻喉科医生中越来越受欢迎，用于成人和儿童的鼻窦和颅底手术。然而，与 3D 导航协议 CT 扫描相关的数据采集所需的增加的组织辐射是一个令人关注的问题，因为它有潜在的健康危害。我们旨在比较成人和儿科人群的 3D 导航协议和标准鼻窦 CT 扫描协议的辐射有效剂量。
我们通过电子病历回顾，对 2019 年 5 月至 2019 年 12 月期间使用西门子 Drive（VA62A）CT 扫描仪进行鼻窦 CT 扫描（标准和 3D 导航协议）的患者进行了回顾性队列研究。所有检查的辐射有效剂量均以毫西弗（mSv）计算。平均照射剂量使用学生 t 检验或 Kruskal-Wallis 检验进行比较。
共选择了 115 次 CT 扫描进行分析，其中 47 次为标准方案，68 次为 3D 导航方案 CT 扫描。其中，31 次检查为儿童，84 次检查为成人。对于总人群，非导航 CT 扫描的平均有效剂量为 0.37 mSv（SD：0.16，N=47），3D 导航鼻窦 CT 组的平均有效剂量为 2.33 mSv（SD：0.45，N=68）。两组之间的平均差异具有统计学意义 1.97 mSv（CI 95% - 2.1 至- 1.83；P<0.0001）。使用 3D 导航方案时，辐射增加了六倍。当分析儿科和成人亚组患者时，比率是相同的。
在我们中心，使用 3D 导航鼻窦 CT 方案显著增加了辐射暴露。耳鼻喉科医生应该意识到这一显著增加，并通过限制不必要的扫描订单和通过与放射物理学家一起对 3D 获取协议进行局部评估，尝试减少患者的辐射暴露。
四级。
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