Basic Approaches to Standardizing the Method of Orbital Computed Tomography in Thyroid Eye Disease

Thyroid Eye Disease (TED) is an autoimmune condition requiring precise imaging for diagnosis, assessment of severity/activity, and treatment planning. The lack of unified orbital Computed Tomography (CT) protocols leads to variability in results and unjustified radiation exposure. Currently, Multi-Slice Computed Tomography (MSCT) is widely used due to its high resolution, short scanning time, low artifact generation, and cost-effectiveness. Standardization of orbital CT is essential to improve reproducibility, diagnostic accuracy, and minimize risks. The aim of the study is to optimize the orbital CT protocol to ensure reproducible and accurate measurements with minimal radiation exposure, in order to obtain reliable data for diagnosing TED, assessing the severity and activity of the process, and for planning and monitoring treatment. The article clearly outlines the indications for orbital CT in TED. Standardized parameters for performing orbital MSCT are presented. A unified setup of key technical scanning parameters, such as tube voltage and current with mandatory use of automatic modulation, along with optimized slice thickness and reconstruction interval, ensures not only high reproducibility and image detail but also guarantees strict adherence to the principle of minimizing radiation exposure for each individual patient. A comparative characteristic of alternative diagnostic methods without radiation exposure (magnetic resonance imaging and ultrasound examination of the orbits) is provided. Parameters for assessment and criteria for evaluating the orbital structures during CT are described in detail. The role of specialized software and deep learning for automating segmentation and volumetric analysis is noted. A structured protocol for a radiologist’s report is proposed. The article presents a comprehensive approach to standardizing orbital CT examination in TED, focusing on optimizing scanning parameters to balance image quality and radiation dose, clear criteria for describing pathology, and the integration of modern technologies. This is necessary to improve diagnosis, prognosis, treatment planning (especially decompression), and minimize risks for patients.

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