Article Review: CBCT (JADA August 2012)

There was a recent article in the Journal of American Dental Association (JADA) August 2012 regarding the use of cone beam CT in dentistry.  I thought I would summarize it here as well as give a link to the article itself here.  The article was written by the Council on Scientific Affairs.  Here are the main points broken into categories that I feel best fits them with a table showing radiation doses of different types of imaging used in dentistry.

(Image courtesy JADA 2012;143(8):901.)

Prescribing a CBCT

• You MUST review the patients medical and dental history prior to prescribing a CBCT scan.

• You MUST perform a thorough clinical examination prior to prescribing a CBCT scan.

• You MUST show justification that the excess radiation to the patient will result in a benefit outweighing the risk.

• CBCT scans SHOULD only be prescribed when traditional (2D) radiographs will not show the area in question.

• CBCT scans SHOULD be prescribed by a licensed dentist with training and education in CBCT imaging.  This includes staying informed with evidence based articles and continuing education courses on the use of CBCT in dentistry.

Taking a CBCT scan (for offices with a CBCT machine)

• Before a CBCT machine is installed, a health physicist SHOULD be consulted to ensure the machine is placed in an area that abides by federal regulations, state regulations and National Council on Radiation Protection & Measurements (NCRP) report 145.

• ALARA (as low as reasonably achievable) SHOULD always be used. This means using the smallest FOV (field of view) with the shortest exposure time that will show the area in question.

• Thyroid collars and lead aprons SHOULD be used as long as they do not interfere with the area being scanned.

• Dental professionals using a CBCT scan MUST receive training and education about the safe use of a CBCT machine.

• Offices with a CBCT machine SHOULD take continuing education courses on CBCT and radiation safety.

• Offices with a CBCT machine MUST follow federal and state radiation regulations.  Offices SHOULD establish a quality control program including having a health physicist evaluate the machine on a set schedule (typically determined by your state radiation regulations).

Interpretation of a CBCT scan

• CBCT scans SHOULD be evaluated by a dentist with training and education in CBCT interpretation. *Oral and maxillofacial radiologists are a great reference. 🙂

• The entire CBCT scan (or dataset) MUST be interpreted and findings entered into the patient chart. It is the responsibility of the referring dentist to relay these findings to the patient.

Extra recommendations

• The council calls for appropriate agencies (such as the American Academy of Oral and Maxillofacial Radiology – AAOMR) to develop criteria for CBCT imaging and education.  This include all levels of dental professionals and dental students. *Of note, the AAOMR is working on creating a recommended curriculum for dental students on CBCT.  I may have inside knowledge as I am on the pre-doctoral committee for the AAOMR. 😉

This is the short and sweet of the article as it is straight to the point.  I highly recommend reading the entire article if you are involved in any form with CBCT.  For those who would like to see the AAOMR recommendations on CBCT (published in 2008 in OOOOE) check it out here. (Unfortunately, this article is not free unless you subscribe to this journal, for those at universities you may be able to access this through your university at no charge).

Please let me know if you have any questions or comments. Thanks and enjoy!