Evaluation of a low dose CBCT protocol in reliably detecting simulated facial fractures associated with sports injuries.

Abstract

<h3>Objective</h3> To evaluate the value of a low dose CBCT protocol that uses 180-degree rotation scan in the detection of simulated facial fractures, compared to the standard 360-degree rotational protocol. <h3>Study Design</h3> Three dry human skulls were selected for imaging. The skulls were scored in 11 locations using a dental hand piece and diamond bur to simulate small cortical bone facial fractures that best represent the most commonly occurring fractures in sports. Fractures were simulated bilaterally and centrally in the mandibular symphysis, angle, condyles, zygomatic process of temporal bones, and the zygomatic process of the maxilla. Wax was used to simulate a deviated/fractured nasal septum. CBCT scans of the skulls were scanned using 180 degree and 360 degree rotation. Two observers evaluated the images using all 3 multiplanar reformations, volumetric renderings, and maximum intensity projections reconstructed with InVivo6 software to identify and measure the fractures on axial, sagittal, and coronal views. Measurements of the length of the fractures were made on the maximum intensity projection (MIP) in both scan protocols. Krippendorff's alpha (α) statistical test was used to measure the agreement among raters. <h3>Results</h3> There was a high inter-rater reliability for both the acquisition protocols. Image quality of the 180 degree scans was diagnostic and there was no difficulty in identifying or measuring the fractures. <h3>Conclusion</h3> In this ex-vivo study, the 180 degree CBCT acquisition protocol was comparable to the conventional 360 degree acquisition protocol in its ability to detect and measure simulated facial fractures. <b>Statement of Ethical Review</b> Ethical Review or exemption was not warranted for this study