Hartman, R.N. (2015) Cone Beam Computed Tomografie versus Conventionele röntgen bij de diagnostiek van zygomafracturen na een geïsoleerd trauma. thesis, Medicine.
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Abstract
Zygomatico-orbital fractures are the most commonly found facial-fractures next to fractures of the mandible. Computed tomography (CT), Conventional Radiography (CR) and Cone-Beam Computed Tomography (CBCT) are the most important diagnostic imaging tools available in the assessment of zygomatic fractures. In patients who are admitted to the emergency room with extensive facial injuries after a high energetic trauma, a CT scan is performed. In case of an isolated trauma of the cheek, with no clinical indications of orbital involvement, conventional radiographs can be performed to rule out zygomatic fractures. Advantages of CR are its high accessibility, its low costs and low effective radiation dose for the patient. The most important limitation of CR is superimposition of bony anatomical structures. Superimposition makes the images harder to interpret and can lead to false diagnostic conclusions. CBCT has a relatively low effective radiation dose compared to CT. As of a result of this, CBCT can be an interesting alternative for CR. The goal of this study is to assess whether or not the conventional radiographs can be replaced by CBCT in the assessment of zygomatic fractures in case of an isolated zygomatic trauma. To achieve this goal, a prospective experimental cadaver study was performed. During this study ten fractures of the zygomatic bone were systematically simulated using five human cadavers. Each of the five specimen was fixated after which a blunt trauma was systematically inflicted using a two kilogram free fall impactor technique, in attempt to inflict a zygomatico-orbital fracture. Images of all zygomatico-orbital fractures were then obtained using CR as well as a CBCT scan. A customized software program was developed for this study in order to compare the images of CR and CBCT. All DICOM files were loaded into this software program. A group of assessors was asked to score the visibility of each fracture on both CR as CBCT, using an ordinal scale. The tests were conducted by 15 radiologists and 10 OMF surgeons from three different hospitals. All tests were conducted using validated diagnostic screens. Results of this study show a preference for CBCT was found in 86 percent of all assessed fractures. There is a significant difference (p=0,00) in preference between the two different professions. OMF surgeons had a higher preference for CBCT (94 percent) as compared to 80 percent of radiologists. The binary logistic regression shows the fracture type has a significant effect on the preference of the assessor (p=0,04). A preference for CBCT was found in the assessment of each of all ten fractures. In case of smaller non-dislocated fractures, the preference for CBCT was smaller as compared to dislocated fractures. An average effective radiation dose of 36,26 μSv was found for CBCT. This dose was higher than the average effective dose found in CR (7,17 μSv). This study shows CBCT has a higher diagnostic value in the diagnostics of zygomatico-orbital fractures when compared to CR. Also, CBCT is more comfortable for patients. Features such as MPR and 3D reconstructions have extra value in the evaluation as well as the management of acute facial trauma. Despite the higher effective radiation dose of CBCT, we recommend using CBCT as a primary diagnostic tool in patients suspected of zygomatico-orbital fractures as a result of an isolated zygomatic trauma.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Minnen, Dr. B. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1473 |
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