CBCT Selection Criteria: Under what clinical circumstances should CBCT be used?
Friends and fellow colleagues,
This post outlines and illustrates the recommended best practices for choosing when to use a CBCT scan and is based on the recently published CBCT guidelines by the ADA and the AAOMR (American Academy of Oral and Maxillofacial Radiology).
These guidelines are recommendations based on an in-depth review of the scientific and clinical literature. They're not based so much on the opinion but on the state-of-the-art as we know from the published literature. These guidelines are recommendations and are not legally binding. The clinician still should use their own clinical judgment and decision making about ordering radiographs and CBCT scans for specific individual patients.
The overall general theme is to order radiographs or CBCT scans based on the patient's history, clinical findings and current needs. This has not changed from the previous recommendations published in 2012. Acquiring a cone beam CT on every patient is not recommended.
I hope this generates some discussion. Please feel free to ask questions and express your own point of view.
Best regards,
Don Tyndall
I have been involved in this thechno for many years since the advent of ct imaging. My criteria and prejucice is a function of the tremendous amount of pathology uncovered in my patient population that are many times asymptomatic. I many times have stumbled across significant pathology in the paranasals, temporal bones, jaw joints, retropharyngeal asymmetry, mid cranial fossa, and on and on. This last week alone our images revealed dehisced superior semicircular canals, coalescent mastoiditis, msdo sinus pathology, periapical osseous expansile fibrous dysplasia, and sphenoid sinus fungal infection. I scan all adult patients every 3 to 5 years, depending on history and medical status.
Don,
Thank you for the attachment. I am grateful for your summary. CBCT is indeed an amazing part of diagnostic and treatment phases of treatment.
How do you view the relentless drive by the AI assisted image processing software companies (too numerous to list) to accentuate, even normalize, using massed CBCT data to deliver full charting baseline findings. To me, this push feeds into the sped up world of patient demand/immediate gratification and increased productivity at the expense of radiation exposure. How do we, as an entire profession, guard against this?
Chris
Hi Thomas,
Thank you for your contribution. Yes, it is true that there are incidental findings found in many CBCT scans. There have been many articles published on the topic including one from UNC (Price JB, Thaw KL, Tyndall DA, Ludlow JB and Padilla R : Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study Clinical Oral Implants Research 2012(11):1261-1268.) Most of the studies have similar conclusions that about 30% of CBCT scans have “actionable” findings. About half are suggestions for follow up imaging and the other half need clinical therapy, usually periapical lesions undetected with previous imaging. Interestingly, a recent publication demonstrated that about half of the incidental findings seen in cone beam CT can also be seen in two-dimensional images (Crockett B, Broome A, Tawil P, Tyndall D. Comparison of incidental findings on cone beam computed tomographic and 2-dimensional images. Gen Dent. 2023 Jul-Aug;71(4):64-71. PMID: 37358586). Nevertheless, it's important to remember that incidental findings that require follow up do occur with CBCT images. The panel of reviewers, which represented all disciplines, judged that the frequency and the importance of these findings were not justified by taking CBCT scans on every patient. That being said, as I mentioned in the post, these are recommendations only. In the end it is the clinician ordering the CBCT scans to determine the selection criteria that works best in their practice.