[Oradlist] CBCT question

Fri Aug 29 10:18:27 PDT 2008

Thanks all for you input. I have been trying to be conservative with my use of the machine worried that I might overprescribe because it really is an incredible tool.  I have been stunned by how readily people would leap at the idea of having one without any regard to radiation exposure.  The patient refused to have a CBCT (said $200 was too expensive!) but we do have a CEPH (courtesy of Ortho)...see attached.  The radiopacity appears to be in the anterior of the sinus.  Should I still insist on a CBCT?  Lisa

Lisa J. Koenig BChD, DDS, MS
Program Director, Oral Medicine and Oral Radiology
Marquette University School of Dentistry, Rm: 370
PO Box 1881
Milwaukee, WI 53201-1881
Tel: (414) 288-5675
Fax: (414) 288-6081
From: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Leif Kullman
Sent: Tuesday, August 26, 2008 3:08 PM
To: Oral Radiology Discussion Group
Subject: Re: [Oradlist] CBCT question

Dear Sharon

I'm not very experienced in diagnosing sinus pathology but couldn¨t this lesion
look like an aggresive polyp in sinus also?

They might cause displacement and destruction of bone and could perhaps be an indication for using CBCT according to my opinion.

Regards Leif

Leif Kullman DDS, PhD
Assoc. Professor
Oral and Maxillofacial Radiology
Faculty of Dentistry
Kuwait University

--- On Tue, 8/26/08, Sharon Brooks <slbrooks at umich.edu> wrote:
From: Sharon Brooks <slbrooks at umich.edu>
Subject: Re: [Oradlist] CBCT question
To: "oradlist" <oradlist at lists.ucla.edu>
Date: Tuesday, August 26, 2008, 1:23 PM
This gets to the whole heart of the issue of selection criteria. The use of imaging should be based on the patient's needs, not the needs of the clinician to be more "comfortable" or "confident" with the diagnosis. The referring dentist/radiologist must use clinical judgment - and there could be some differences of opinion in this matter (as we have seen in this discussion already).

Regarding accessibility of the equipment, that varies from location to location. In my Certificate of Need state (Michigan) the patient may have to travel a very long distance to get a scan. I think we are up to 9 machines in the state now, but they are definitely not available everywhere.

I'm not saying that I would not do a scan in this case (after all, I'm curious too), but I don't think we should automatically jump on 3D imaging in all cases just because it is available.

Sharon
*****************************
Sharon L. Brooks, DDS, MS
Diplomate, American Board of Oral and Maxillofacial Radiology
University of Michigan School of Dentistry
Department of Periodontics and Oral Medicine
Ann Arbor, MI 48109-1078 USA
Tel: +1 734-764-1595   Fax +1-734-764-2469
slbrooks at umich.edu

On 8/26/08 11:42 AM, "Abramovitch, Kenneth" <kenneth.abramovitch at uth.tmc.edu> wrote:
Sharon,

You pose an excellent question.  However, please permit me to introduce some controversy into this discussion.

I no longer feel comfortable evaluating "benign" entities or making judgements on possible "lesions" that may have minimal treatment sequelae from intraoral and panoramic images as the sole imaging modality.  These images are very good at initial detection.  However, my comfort zone and confidence on diagnostic decision making is far greater when I can evaluate a potential pathologic entity in three dimensions.  My decision-making is also more confident when I can better appreciate a potential lesion's proximity to adjacent structures and its affects on adjacent bone cortices (thinning, perforation, expansion, etc...).   The multi-plane views from a CBCT scan affords me this greater degree of confidence.

Since the CBCT technology is more accessible today to the US population both financially and geographically, I find myself more dependent on the technology for the reasons stated above.   I do not want the burden of making a wrong diagnosis that may affect the patient negatively, because I did not request or utilize a more superior evaluation modality that is no longer a GREAT financial expense and no longer inaccessible.    And I certainly do not want to be cross-examined on why I did not take advantage of the available technology when it would have improved my diagnostic confidence and hence accuracy.

I do not know how others feel, but for better or for worse, I am becoming more dependent on the 3D and multi-plane images (acquired with CBCT)  for diagnosing hard tissue pathology beyond dental caries and periodontal disease.

Ken

From: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Sharon Brooks
Sent: Tuesday, August 26, 2008 8:44 AM
To: oradlist
Subject: Re: [Oradlist] CBCT question

However, one could ask whether knowing whether it is an exostosis/osteoma or antrolith will make any difference in the management of the patient. If the patient is asymptomatic and no treatment is planned, then is the CBCT justified - other than for satisfying our curiosity?

Sharon

*****************************
Sharon L. Brooks, DDS, MS
Diplomate, American Board of Oral and Maxillofacial Radiology
University of Michigan School of Dentistry
Department of Periodontics and Oral Medicine
Ann Arbor, MI 48109-1078 USA
Tel: +1 734-764-1595   Fax +1-734-764-2469
slbrooks at umich.edu

On 8/25/08 3:54 PM, "Alan Lurie" <lurie at nso.uchc.edu> wrote:
Hi Lisa,

I think this case is an excellent example of a good indication for CBCT.  One cannot pass on this on the basis on the pan alone.  CBCT will define and locate the entity clearly, at lower radiation and financial cost than medical CT.

Alan G. Lurie, DDS, PhD
Professor, Department of Oral Health and Diagnostic Sciences
Chair, Division of Oral and Maxillofacial Diagnostic Sciences
Chair, Section of Oral and Maxillofacial Radiology
Director, Skeletal, Craniofacial and Oral Biology Training Grant
University of Connecticut School of Dental Medicine
263 Farmington Avenue
Farmington, CT  06030-1605
USA
Telephone    860-679-4049
Telefax         860-679-4760
EMail           lurie at nso.uchc.edu

On 8/25/08 3:12 PM, "Koenig, Lisa" <lisa.koenig at marquette.edu> wrote:
Dear Colleagues,  Now that I have a CBCT it seems that I am asked everyday if someone could have one just because it would be cool. The attached Pan shows a well-defined radiopacity in the left maxillary sinus area...possible osteoma/exostosis...ginormous antrolith. My question is can a CBCT be justified in a case like this?  (Obviously the CBCT would show the exact location)  Thanks, Lisa

Lisa J. Koenig BChD, DDS, MS
Program Director, Oral Medicine and Oral Radiology
Marquette University School of Dentistry, Rm: 370
PO Box 1881
Milwaukee, WI 53201-1881
Tel: (414) 288-5675
Fax: (414) 288-6081
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