[Oradlist] Certificate of Need for CBCT

[Allan G Farman]

Craig: 

I have no doubt that you correctly state the position of California regarding maxillofacial cone-bean CT. Essentially maxillofacial cone-beam CT does not differ from cone-beam CT used for any other structure in the body - or for microCT purposes. It is complete coverage tomosynthesis of a series of basis images... and the number of those individual "ceph images" is 300 to 600 - hence, the more than two order of magnitude increased dose over that needed for any one of those basis images - or single digital cephs. My feelings are very strong that we should cease to make 3D image sets routinely for every orthodontic patient - individuals who are of an age that is relatively susceptible to radiation in view of cell turnover and the length of life still to be lived. Certainly the beam is well collimated and the scatter to the operator is relatively lowwith CBCT  - hence, states tend to be less concerned than they would be otherwise. CBCT is a valuable tool that is possibly being more misused currently that appropriately utilized. It is our ethical duty to respect the ALARA Principle... especially while the jury is out on whether 3D cepalometrics actually contributes to improved orthodontic planning and outcomes. In the future perhaps we can move from use of x-radiation to small fixed magnet MR systems as such equipment is now being produced in China for costs that are not that much more than current CBCT prices.

Allan G. Farman