Accelerated flat panel computed tomography for pre-operative temporal bone imaging: Image quality and dosimetry comparison to conventional high resolution multislice computed tomography

PURPOSE: High-resolution multislice CT (HR-MSCT) and cone beam CT (CBCT) are commonly used for preoperative temporal bone imaging, with HR-MSCT often preferred due to its shorter scan duration and lower susceptibility to motion artifacts. However, recent advancements in accelerated flat panel CT (Acc-FPCT) available with the latest generation angiography systems have addressed traditional limitations of CBCT by significantly decreasing scan time. This cadaver-based study evaluates the diagnostic performance and radiation dose of Acc-FPCT compared to HR-MSCT in preoperative temporal bone imaging. METHODS: Six different Acc-FPCT protocols were acquired on five whole-head cadaveric specimens (ten temporal bones). Three neuroradiologists experienced in temporal bone imaging assessed the image quality of Acc-FPCT protocols in comparison to that of HR-MSCT for the visualization of 31 landmarks of middle and inner ear using a 5-point Likert scale. We also compared radiation dose parameters (CT dose index and dose length product) among the protocols. RESULTS: Two high-Resolution Acc-FPCT protocols were found to be superior to HR-MSCT by all raters (p < 0.001). There were no significant differences between the two HR-FPCT protocols (p = 0.25). The remaining Acc-FPCT protocols were rated significantly inferior to HR-MSCT. The inter-rater reliability was excellent (ICC (2,k) = 0.925; CI [0.92-0.93]). The dose length product was significantly lower in all Acc-FPCT protocols compared to HR-MSCT. CONCLUSION: The results of our cadaver-based study highlight the utility of certain Acc-FPCT protocols as a viable alternative to HR-MSCT in preoperative temporal bone imaging, improving the visualization of critical anatomical landmarks without increasing radiation exposure.