[Oradlist] Input for maxillary implant imaging request

Sun Mar 29 08:35:44 PDT 2009

Dania

I believe that it is our responsibility to educate the referring dentists (or physicians). If all that we know is common sense, and everyone should know what we know, why have a specialty. When you do not get enough information, ask for it and tell the referring doctor why you need it to help her/him in providing the best treatment for the treatment. After all, it's better to get things correct and talk to the doctor with whom you have a common purpose, than to explain why you did not to a lawyer with whom you have an adversarial relationship.

Just my thought. Ich hoffe dass alles gut ist in der Schweiz.

Rgds
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From: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Dania Tamimi
Sent: Saturday, March 28, 2009 8:46 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
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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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