A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma: what is the role of 3D?

A panel of 17 trainee maxillofacial surgeons viewed 23 cases of facial trauma, demonstrated on radiographs, axial CT images and three-dimensional (3D) reformatted CT images in a standardized viewing format under standard conditions. Their diagnostic interpretation, extraction of information relevant to surgical management and subjective evaluation of each modality were recorded by standard questionnaire and compared with a gold standard evaluation by a consultant radiologist and surgeon reading based on results of clinical management. There were clear and measurable differences in the viewers' evaluations of radiographs, CT and 3D reformatted images. Overall, surgeons showed more accurate diagnostic reading of radiographs and 3D reformatted images. This was in contrast to their subjective assessment of the clinical value of each modality, which showed a strong preference for 3D over all other techniques and for CT over radiographs. However the perceived benefit of axial CT images over radiographs was not reproduced on objective testing in this group; surgeons appear to perform less well in interpreting CT images than their subjective response to the modality would suggest. This work has supported the view that surgeons value 3D imaging as a front-line tool in the evaluation and management of selected cases of acute facial trauma. We have demonstrated that the perceived benefits of 3D reformatted CT to surgeons appear real.