Omar Zurkiya MD, Presenter: Nothing to Disclose

Marc A. Camacho MD, MS, Abstract Co-Author: Nothing to Disclose

To determine the utility of concurrent facial and head CT examinations and develop a model for predicting when facial CT may be avoided, thereby reducing cost and radiation exposure to the patient.

Occurrences of concurrent head and facial CT examinations in an urban, Level I trauma, academic medical center were reviewed retrospectively as part of a quality assurance project exempt from formal IRB review. A total of 265 cases were collected over a period of 9 months. Mechanism of injury, age, sex, CT findings and radiation exposure were recorded. A multiple linear regression model was established. Two-tailed t-test was performed.

The majority of facial CT examinations provided no additional useful diagnostic information (243/265, 92%) when obtained concurrently with head CT. Of the cases where facial CT provided additional information, mandible fracture accounted for the vast majority (18/22, 82%). Additional cases include the presence of maxilla fracture and orbital floor fracture, both inferior to the field of view of head CT. In the latter case, a fracture was suspected by head CT due to the presence of opacification of the maxillary sinus. Linear regression modeling supports the mandible fracture as the only significant variable (p-value<0.00001) when included with age, sex, and mechanism of injury. The average DLP for head and facial CT examinations in the series was 1066 +/- 393 mGy-cm and 866 +/- 188 mGy-cm respectively.

The majority of facial CT examinations obtained concurrently with head CT provide little additional diagnostic information with the notable exception of mandible fracture. Sinus opacification on head CT should also raise concern, prompting further evaluation with facial CT. In the absence of clinical concern for mandible fracture and unexplained sinus opacification on head CT, dedicated facial CT may be avoided, reducing the rate of unnecessary examinations and decreasing radiation exposure to the patient.

The majority of facial CT exams obtained concurrently with head CT do not add diagnostic data with notable exception of mandible fracture. Most may be avoided, reducing cost and radiation exposure.

Zurkiya, O, Camacho, M, Concurrent Head and Maxillofacial CT for Minor Trauma: What is the Yield (and the Toll) of the Shotgun Approach.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043775.html