Image quality optimization of narrow detector dental computed tomography for paediatric patients

Objectives: Dental CBCT exposure parameters should be optimized according to patient-specific indications, mainly for children that are most vulnerable to harmful effects of ionizing radiation. The aim of this study was to determine optimized kV settings for paediatric acquisitions for a dental CBCT device. Methods: Clinical and quantitative evaluations of image quality were performed using 5 and 10 years old (y/o) anthropomorphic phantoms. Technical evaluation was performed with the SEDENTEXCT-IQ phantom. Images were obtained using a PaX-i3D Green CBCT (Vatech, Korea) device, combining tube voltages ranging from 85 to 110 kV and 2 fields of view (FOVs: 21 x 19 and 12 x 9 cm), while maintaining the radiation dose fixed by adjusting the mA accordingly. Clinically, observers assessed images based on overall quality, sharpness, contrast, artefacts, and noise. For quantitative evaluation, mean grey value shift, % increase standard deviation, % beam-hardening and contrast-to-noise ratio were calculated. For technical evaluation, segmentation accuracy, contrast-to-noise ratio and full width at half maximum were measured. Biplot graphs were used to choose representative parameters, from which the best kV was selected for each protocol and evaluation. kV values that had no statistical differences (p > 0.05) with the best kV chosen were considered as having the same quality. Results: Clinically, 95 kV was found as a cut-off value. From the quantitative aspect, 85 kV (p < 0.05) showed the worst quality, except in 12 x 9 cm 5 y/o. Technically, 85 and 110 kV in the large FOV showed significantly worse quality for the large FOV. Conclusion: For paediatric indications, 95 kV or higher (and correspondingly low mA values) was found as optimal.