Reduced-Dose Computed Tomography in the Evaluation of Craniocerebral and Craniofacial Trauma: A Systematic Review of Image Quality and Radiation Dose Optimization.

OBJECTIVE

To systematically review and compare reduced-dose and standard-dose computed tomography (CT) protocols for craniocerebral and craniofacial trauma, focusing on image quality and radiation dose optimisation strategies.

METHODS

A systematic review was conducted following the PRISMA 2020 guidelines. Searches were performed across PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, LILACS, and TripDatabase for studies published between November 2024 and January 2025. Observational studies comparing reduced-dose with standard-dose CT protocols were eligible. Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by consensus. Data were extracted regarding scanner type, acquisition parameters, dose metrics (CTDIvol, DLP) and image quality assessments.

RESULTS

Of 641 records screened, 7 studies met the inclusion criteria. None reported diagnostic accuracy metrics; therefore, a quantitative descriptive synthesis was performed. Across studies, reduced-dose CT protocols achieved 21%-89% dose reduction while maintaining comparable subjective and objective image quality. Iterative reconstruction, spectral shaping and current modulation were the most effective techniques for optimising image quality with lower radiation.

LIMITATIONS: Evidence was limited to observational studies without diagnostic reference standards, and heterogeneity in protocol reporting restricted data comparability.

CONCLUSION

Reduced-dose CT protocols demonstrate comparable subjective and objective image quality to standard-dose acquisitions while achieving substantial radiation dose reductions. Techniques such as iterative reconstruction, tube-voltage modulation, spectral shaping and automated exposure control were consistently associated with meaningful dose optimisation. These findings support the clinical feasibility and safety of implementing dose-optimised CT protocols in trauma imaging.

IMPLICATIONS FOR PRACTICE: Findings support the clinical feasibility and safety of implementing dose-optimised CT protocols for trauma imaging.