[Oradlist] Input for maxillary implant imaging request
Allan G Farman
agfarm01 at louisville.edu
Fri Mar 27 16:08:46 PDT 2009
I concur with Dania on this. Collimation yes... but not at the exclusion of valuable information relative to the context of the imaging. AS I mentioned previously a 6 cm FOV is usually adequate to reach the ostea of the sinuses and the full TMJ when making images for maxillary implant planning. However, you do need to assess patient size. I do use four different CBCT systems from three different manufacturers. Where appropriate, I use the smallest FOV possible for evaluation of conditions relative to a single tooth or two, and I would not use a CBCT system that cannot be collimated... but collimated both smaller and larger. With the i-CAT system, I actually only use the 8 cm scan for imaging the mandible where third molars are high in the ramus or for viewing the maxilla in very large individuals - and never at all for the purpose it is said to be designed - to show the dentitions of both jaws in a single scan. For that purpose, I use the full 13 cm FOV to include relevant adjacent tissues. I can think of no dental treatment plan requiring 3D imaging that includes simply the teeth of both jaws and does not require any knowledge at all of the TMJ. Like Dania, it is a great frustration to receive over-collimated images to read and make a professional judgment and report. Somehow the conditions of greatest influence on the patients overall health seem to be at the periphery of the image more times than not, and excluded when relying on an 8 cm scan of both dentitions.
Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR
Prof. Radiology & Imaging Science
Univ. Louisville School of Dentistry: SUHD
501 South Preston Street,
Louisville, Kentucky 40292, USA
Tel: +1(502) 852.1241
>>> Dania Tamimi <daniatamimi at hotmail.com> 03/27/2009 05:32 PM >>>
Ok, and this is just me, but I get frustrated when the field of view is limited for the following reasons:
a) Sometimes it is not done appropriately and important structures are cut off (like the tops of a condyle on a TMJ scan, or parts of third molars on third molar evaluation, collimated to "decrease radiation exposure" but ends up making the scan useless). This is why proper training should be done for the staff in the dentist's office, or referral to a scanning center with a radiologist or certified dental radiographic technician should be employed.
b) Occasionally, I get a scan that has been collimated to include only the maxilla or mandible (for implant evaluation), but then I see something at the edge of the scan (still in the OMF region) that needs further investigation and - you guessed it - another scan that will re-expose the already imaged area.
c) I have an obsession with anatomy and head and neck radiology and I like the challenge ;) But that isn't a legitimate reason to order a scan ;)
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