Evaluation of anatomical landmark position differences for head computed tomography: A reliability study among...

Area of Science:

• Radiology
• Medical Imaging
• Anatomical Standardization

Background:

• Computed tomography (CT) imaging protocols often lack standardized head positioning, leading to significant inter-study image variance.
• This variability can limit the diagnostic accuracy and comparative value of serial CT scans.
• Establishing consistent reference points is crucial for improving CT image reliability.

Purpose of the Study:

• To evaluate the repeatability of multiplanar reformating of head CT using the tuberculum sella (TS) to internal occipital protuberance (IOP) reference line.
• To reduce inter-study image variance in clinical CT imaging through standardized head positioning.
• To assess the impact of technologist training on the accuracy of TS-IOP based CT reformations.

Main Methods:

• Manual review of TS-IOP reference lines on high-resolution CT scans by technologists.
• Calculation of Yaw, Pitch, and Roll angles to quantify head positioning deviations.
• Pre-post design intervention study measuring angle differences before and after technologist training, analyzed with t-tests.
• Intra-rater agreement assessed using the intraclass correlation coefficient (ICC).

Main Results:

• Mean pitch decreased from 6.7° ± 5.4° to 3.2° ± 2.6°, and mean roll decreased from 1.1° ± 1.2° to 0.6° ± 1.1° post-training.
• Technologist training significantly reduced inter-subject variability in pitch (p < 0.001) and roll (p = 0.001) relative to the TS-IOP line.
• No significant difference was observed in yaw correction (p = 0.065), but intra-rater agreement for TS-IOP reformation was excellent (ICC > 0.950).

Conclusions:

• Trained technologists can readily achieve TS-IOP reference line corrections for pitch, yaw, and roll.
• Adoption of the TS-IOP reference line facilitates more reproducible and interpretable CT images.
• Standardization using the TS-IOP line improves intra- and intermodality comparisons in CT imaging.