Influence of Cone Beam Computed Tomography Radiation Dose on Image Quality and Usability in Virtual Reality and Traditional Computer Interfaces

Featured Application: This work demonstrates that low-dose CBCT can provide diagnostically acceptable image quality for CMF CASS across both CIs and VR interfaces. The findings highlight VR’s potential as a future adjunct or alternative to conventional CI-based radiological evaluation, particularly for complex CMF procedures such as BIMAX. These results may support the development of clinically validated DICOM-standardised VR platforms for surgical planning and radiological workflows. Computer-assisted surgical simulation (CASS) in craniomaxillofacial (CMF) surgery is traditionally performed using a computer interface (CI) with a two-dimensional monitor, while the adoption of immersive virtual reality (VR) remains limited. This study examined how low-dose (LD) and high-dose (HD) cone beam computed tomography (CBCT) imaging modes influence image quality and usability across both CI and VR environments. Five CMF radiologists rated CBCT views and 3D-segmented models on a 0–4 Likert scale, and intra- and interobserver agreement was calculated. VR usability was further assessed using the NASA Task Load Index and follow-up interviews. LD imaging performed comparably to HD in both interfaces, with slightly higher scores for CBCT views in LD mode. For 3D models, HD scored marginally higher in CI, whereas LD performed slightly better in VR. Observer agreement ranged from fair to excellent, and VR demonstrated reliability like CI. NASA-TLX results indicated reductions in mental and temporal demand, along with decreased effort and frustration during VR use, suggesting diminishing cognitive and emotional strain over time. In this pilot study, the findings suggest that LD CBCT may be feasible for selected CMF CASS applications and that VR offers an immersive and user-friendly alternative without compromising diagnostic reliability, supporting its potential role in future surgical planning.