A systematic review comparing the effective radiation dose of musculoskeletal cone beam computed tomography to other diagnostic imaging modalities

Abstract

Purpose: Cone-Beam CT (CBCT) is well established in orofacial diagnostic imaging and is currently expanding into musculoskeletal applications. This systematic review sought to update the knowledge base on radiation dose comparisons between imaging modalities in MSK imaging and consider how research studies have reported dose measures. Methods: This review utilised a database search and an online literature tool. Studies with potential relevance were screened then before full text review, each performed by two independent reviewers, with a third independent reviewer available for conflicts. Data was extracted using a bespoke tool created within the literature tool. Results: 21 studies were included in the review which compared CBCT with MSCT (13), conventional radiography (1), or both (7). 19 studies concluded that CBCT provided a reduced radiation dose when compared with MSCT: the factor of reduction ranging from 1.71 to 50 with an average of 12. Studies comparing CBCT to DR found DR to have an average dose reduction of 4.55. Conclusions: The claims that CBCT produces a lower radiation dose than MSCT is borne out with most studies confirming doses less than half that of MSCT. Fewer studies include DR as a comparator but confirm that CBCT results in a higher effective dose on average, with scope for CBCT to provide an equivalent radiation dose. This review highlighted a need for consistency in methodology when conducting studies which compare radiation dose across different technologies. Potential solutions lie outside the scope of this review, likely requiring multi-discipline approach to ensure a cohesive outcome.