Patient movement characteristics and the impact on CBCT image quality and interpretability.

Objectives: To assess the impact of patient movement characteristics and metal/radiopaque materials in the field-of-view (FOV) on CBCT image quality and interpretability.

Methods: 162 CBCT examinations were performed in 134 consecutive (i.e. prospective data collection) patients (age average: 27.2 years; range: 9-73). An accelerometer-gyroscope system registered patient's head position during examination. The threshold for movement definition was set at ≥0.5-mm movement distance based on accelerometer-gyroscope recording. Movement complexity was defined as uniplanar/multiplanar. Three observers scored independently: presence of stripe (i.e. streak) artefacts (absent/"enamel stripes"/"metal stripes"/"movement stripes"), overall unsharpness (absent/present) and image interpretability (interpretable/not interpretable). Kappa statistics assessed interobserver agreement. χ tests analysed whether movement distance, movement complexity and metal/radiopaque material in the FOV affected image quality and image interpretability. Relevant risk factors (p ≤ 0.20) were entered into a multivariate logistic regression analysis with "not interpretable" as the outcome.

Results: Interobserver agreement for image interpretability was good (average = 0.65). Movement distance and presence of metal/radiopaque materials significantly affected image quality and interpretability. There were 22-28 cases, in which the observers stated the image was not interpretable. Small movements (i.e. <3 mm) did not significantly affect image interpretability. For movements ≥ 3 mm, the risk that a case was scored as "not interpretable" was significantly (p ≤ 0.05) increased [OR 3.2-11.3; 95% CI (0.70-65.47)]. Metal/radiopaque material was also a significant (p ≤ 0.05) risk factor (OR 3.61-5.05).

Conclusions: Patient movement ≥3 mm and metal/radiopaque material in the FOV significantly affected CBCT image quality and interpretability.