Optimizing Cone-Beam Computed Tomography (CBCT) exposures for effective radiation dose and image quality balance

Objectives This study aimed to evaluate the influence of different CBCT acquisition protocols on reducing effective radiation dose while maintaining image quality. Materials and Methods The effective dose emitted by a CBCT Picasso Trio® device was calculated using thermoluminescent dosimeters (TLDs) placed in a Rando Alderson phantom, following the ICRP 103 (2007) guidelines. Image quality was assessed by three experienced evaluators, who examined CBCT images for anatomical structure identification and image quality impressions. The relationship between image quality and confidence was evaluated using Fisher's Exact Test, and the agreement among raters was assessed using the Kappa test. Multiple linear regression analysis was performed to investigate whether the technical parameters could predict the effective dose. Results The optimized protocol with 3 mA, 99 kVp, and 450 projection images demonstrated good image quality and a lower effective dose for radiation-sensitive organs. Image quality and confidence had consistent values for all structures (p < .05). The multiple linear regression analysis resulted in a statistically significant model. The mA (b = 0.504; t = 3.406; p = 0.027), kVp (b = 0.589; t = 3.979; p = 0.016), and projection images (b = 0.557; t = 3.762; p = 0.020) were predictors of the effective dose. Conclusions Optimized CBCT acquisition protocols can significantly reduce effective radiation dose while maintaining acceptable image quality by adjusting the mA, projection images, and kVp. Clinical Relevance: These findings can contribute to the optimization of CBCT imaging protocols, allowing clinicians to obtain high-quality images with reduced radiation exposure.