title: CT radiation dose for computer-assisted endoscopic sinus surgery: dose survey and determination of dose-reduction limits.
abstract: OBJECTIVE
  Computer-assisted navigation is increasingly used in functional endoscopic sinus surgery (FESS) to prevent injury to vital structures, necessitating preparative CT and, thus, radiation exposure. The purpose of our study was to investigate currently used radiation doses for CT in computer-assisted navigation in sinus surgery (CAS-CT) and to assess minimal doses required.
  
  
  METHODS
  A questionnaire inquiring about dose parameters used for CAS-CT was sent to 30 radiologic institutions. The feasibility of low-dose registration was tested with a phantom. The influence of CAS-CT dose on technical accuracy and on the practical performance of 5 ear, nose, and throat (ENT) surgeons was evaluated with cadaver heads.
  
  
  RESULTS
  The questionnaire response rate was 63%. Variation between minimal and maximal dose used for CAS-CT was 18-fold. Phantom registration was possible with doses as low as 1.1 mGy. No dose dependence on technical accuracy was found. ENT surgeons were able to identify anatomic landmarks on scans with a dose as low as 3.1 mGy.
  
  
  CONCLUSIONS
  The vast dose difference between institutions mirrors different attitudes toward image quality and radiation-protection issues rather than being technically founded, and many patients undergo CAS-CT at higher doses than necessary. The only limit for dose reduction in CT for computer-assisted endoscopic sinus surgery is the ENT surgeon's ability to cope with impaired image quality, whereas there is no technically justified lower dose limit. We recommend, generally, doses used for the typical diagnostic low-dose sinus CT (120 kV/20-50 mAs). When no diagnostic image quality is needed, even a reduction down to a third is possible.
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital and University of Berne, Berne, Switzerland. claude.nauer@insel.ch
authors.forename: C B
authors.initials: CB
authors.lastname: Nauer
authors.forename: A
authors.initials: A
authors.lastname: Eichenberger
authors.forename: P
authors.initials: P
authors.lastname: Dubach
authors.forename: J
authors.initials: J
authors.lastname: Gralla
authors.forename: M
authors.initials: M
authors.lastname: Caversaccio
mesh_terms: D002102:Cadaver; D003392:Cranial Sinuses / Q000000981:diagnostic imaging* / Q000601:surgery*; D004724:Endoscopy; D005240:Feasibility Studies; D019538:Health Care Surveys; D006801:Humans; D038361:Neuronavigation / Q000379:methods*; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011795:Surveys and Questionnaires