EuroSafe Imaging 2020
Action 2 - Clinical diagnostic reference levels (DRLs), Ear / Nose / Throat, Radioprotection / Radiation dose, Digital radiography, Diagnostic procedure, Dosimetric comparison, Prospective, Cross-sectional study, Performed at one institution
S. Ebad, P. Kala, M. Gangadharappa
Conclusion and recommendations
Digital tomosynthesis [DT] has emerged as a technical and feasible imaging modality. It is a form of limited-angle computed tomography that allows reconstruction of multiple section images from a set of projection data acquired over a limited range of X-ray tube angles.
We made an attempt in this study to compare the image quality [anatomy visualization and pathology detection] and radiation dose in X-ray PNS, and PNS Digital tomosynthesis with CT PNS as standard of reference and determine the diagnostic accuracy of DT in the evaluation of PNS.We found a comparable diagnostic performance of DT to CT in evaluation of PNS with far more improved detection compared with PNS radiography.With a negative predictive value of 90-100%, the overall diagnostic accuracy of DTS was found to be as high as 95-100%.
It has a significant impact on the radiation dose with a dose reduction to about 20% of the dose in routine PNS CT and only a minimal increase as compared to Xray.
Paranasal sinus radiography is the first choice for diagnosis and follow-up for patients with paranasal disease; however due to its low sensitivity and low specificity CT PNS is the choice currently but at the cost of higher doses of radiation and higher costs. We strongly recommend the use of PNS Tomosynthesis routinely, in order to avoid PNS-CT and its related radiation exposure. PNS CT can be exclusively used in trauma cases or where DT reveals a pathology which requires further evaluation.
Our study had limited no of cases representing the population from south India. More studies and much literature is needed from different parts of world to consider and recommend DTS-PNS as standard of care.