UPDATE ON CBCT OR 3D SCANS
With Great Power Comes Great Responsibility
Everyone wants to have the latest gadget...like the new iphone X with face recognition...so on and so forth. However, a new x-ray unit on the dental market has been a hot commodity....CBCT or 3D-Scan.
It has some very powerful uses in dentistry, such as diagnosis, surgical planning, implants, etc. but can be limited in some areas in dentistry. In particular, the image resolution still can't pick up micro-cracks or small vertical root fractures which are the Achilles heal in root canal therapy when trying to decide whether to save a tooth with a root canal or extract.
It is also important to note for any dentist or specialist who acquires a CBCT scan, to properly interpret the scan. So who is responsible for the interpretation and legal responsibilities regarding incidental findings? According to Bruno Azevedo, D.D.S., M.S Board-certified oral and maxillofacial radiologist the answer is simple. Just like for 2-D imaging, a clinician who acquires or interacts with the CBCT volume (even if acquired in another practice or imaging center) is responsible for the interpretation of the acquired or provided volume. Furthermore, for example some endodontist are under the misperception that they are only responsible for the endodontic interpretation of the volume. Clinicians are responsible for all information within the 2-D radiograph and/or CBCT volume, regardless of the intent of the exam. Oral and maxillofacial radiology is a recognized specialty in dentistry. Practitioners who perform and evaluate CBCT scans are held to the same professional standards as Board-certified radiologists. Yes, just like any other specialist such as a general dentist performing a root canal at the same level as an endodontist.
Dr. Azevedo also says proper documentation of the presence of CBCT artifacts, such as beam hardening and streaking, is highly encouraged, as they may compromise interpretation of the scan. It is imperative that practioners report all their interpretation findings (both primary and incidental) in the patient’s chart. This is only the first stage of radiographic interpretation, which is to recognize normal versus abnormal anatomy and pathology. Secondly, differential diagnosis for such incidental findings should also be provided. If help is needed to provide interpretation of CBCT scans or to come up with differential diagnosis for incidental findings, a consultation with a Board-certified radiologist is highly encouraged because they are trained to read and provided expert consultation.
So before you just jump out and buy a conebeam machine so you can be "up to date", maybe impress your friends, and possibly if you are a specialist ~ some referring dentist, make sure you understand the machine and get proper training. If not, send images to a board certified oral maxillofacial radiologist who can help you interpret the image, be fair to the patient who's paying for it, and avoid any misdiagnosis leading to potential law suits.
Finally, CBCT should not be used as a screening tool nor should it be used to replace 2D imaging. Practioners should follow the ALARA principle (As Low As Reasonable Acheivable) which means making every reasonable effort to maintain exposures to ionizing radiation as far below the dose limits as possible. Always take a 2D image if possible and use other diagnostic tools to evaluate the area of concern. If that does not give you enough information, then take the 3D scan.
Dr. Rico D. Short
Board Certified Endodontist
Apex Endodontics P.C / Atlanta