[Oradlist] Input for maxillary implant imaging request

Sat Mar 28 08:20:03 PDT 2009

Good idea! 

 I try to bridge that gap by calling and forming a professional relationship with the dentist, and sometimes lecturing to dental professionals. When given a chance, I go out into the community and shake some hands, but doing that pan US (and pan globe) could prove to be challenging. 

Dania

Date: Sat, 28 Mar 2009 09:30:50 -0500
From: DouglasBenn at creighton.edu
To: oradlist at lists.ucla.edu
Subject: Re: [Oradlist] Input for maxillary implant imaging request

Dear Dania,

Perhaps we should be including a picture of the reporting radiologist's face since they are also human and the impersonal report from a stranger (you) is part of the problem since the referring dentist does not relate to you.

Just a thought....

Douglas

Dr Douglas K Benn, BDS, M.Phil., Ph.D., Dipl. Dental Radiology (Royal College of Radiologists, England).
Professor
Dept of General Dentistry
Creighton University Dental School
2500 California Plaza
Omaha
Nebraska 68178

Tel:                (402)280 5025        
Fax: (402)280 5094

-----Original Message-----
From: oradlist-bounces at lists.ucla.edu on behalf of Dania Tamimi
Sent: Sat 3/28/2009 8:45 AM
To: oradlist at lists.ucla.edu
Subject: Re: [Oradlist] Input for maxillary implant imaging request

Gutentag Axel from Switzerland!

 I'm just voicing a frustration. There is no logic when you're jetlagged and awake at 4am local time :). But that aside, I don't know if it would do terrible harm to include the TMJ when doing a scan for a mandibular implant to rule out TMJ pathology that may impact the treatment, or including the both jaws when the patient has combination syndrome (no teeth on one arch) and is scanned without a stent, with no reference for location other than the opposing dentition. The list goes on and on.. I know, I know, ALARA and all that, but we've have this discussion before :)

 On the other hand, I believe we need to treat the patient as a whole, and not in sections. If it could be related to or impact the treatment, then perhaps it should be scanned? After all, there is a lot more to us than 32 teeth? On the other hand, not all limited views are created equal, so what kind of a description do you use for exact location of the scan so that you are responsible for what lies beyond?

The main problem I face in private practice is the disconnect with the dentist and patient. The dentist does not do me the courtesy of filling up the referral form with clinical history, or returning my calls requesting history or following up, which is why I prefer a comprehensive scan to cover my bases (note the phrase: "I prefer" not "I recommend"). It's almost as if they expect me to have ESP, or maybe they do not view the radiologist as a clinical equal or professional colleague. Does any one else have this problem?

 I've attached an interesting article from RSNA news on how photos of patients faces viewed with the scans increased the report length and the report of incidental findings. Radiologists are human, after all..

http://www.rsna.org/Publications/rsnanews/March-2009/Photos_feature.cfm

 Dania

From: axel-ruprecht at uiowa.edu
To: oradlist at lists.ucla.edu
Date: Sat, 28 Mar 2009 08:08:06 -0500
Subject: Re: [Oradlist] Input for maxillary implant imaging request

Dania

There is always an edge to the field, and always something just at the edge. Using that logic a whole body scan is indicated.

Rgds

From: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Dania Tamimi
Sent: Friday, March 27, 2009 4:32 PM
To: oradlist at lists.ucla.edu
Subject: Re: [Oradlist] Input for maxillary implant imaging request

 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 ;)

 Dania

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