Comparative evaluation of flat-panel volume CT protocols for high-resolution visualization of middle ear anatomy in human skull specimens

This study evaluates the imaging quality and radiation dose of six flat-panel volume CT protocols with varying technical parameters, including examination time ("Artis Icono" angiography system (Siemens Healthcare AG, Erlangen, Germany): 14s DCT HEAD MICRO CARE (14s I), 14s DCT HEAD MICRO CARE 4 (14s II), 8s DCT HEAD 70kV CARE 1 (8s I), 8s DCT HEAD 70kV CARE 3 (8s II), 4s DCT HEAD CARE FB (4s I), 4s DCT HEAD CARE FB 2 (4s II)) for middle ear visualization in human skull specimens. A scoring system assessed the delineation of 28 anatomical structures, narrowed to eight for detailed evaluation. Protocols 14s I and 8s I achieved the highest image quality, exceeding the clinical threshold. 8s I protocol demonstrated an optimal balance between image quality and radiation safety, adhering to the ALADA principle ("as low as diagnostically acceptable"). While 14s I offered superior detail, it involved higher radiation exposure without substantial further image improvement, indicating a saturation effect. Shorter protocols, such as 4s I, offered radiation-sparing advantages but did not consistently meet clinical image quality standards. Protocol 8s I is recommended as the standard for middle ear imaging, with 4s I as a potential alternative for cases requiring minimized radiation exposure and reduced motion artifact susceptibility.