CBCT Scans in Dentistry - ADA Statement - August 2012

The recent publicity given to the subject of radiation exposure in dentistry and the new CBCT scan technology prompted the ADA's Council on Scientific Affairs to come up with a statement and principles for the safe use of CBCT scans in dentistry.
The statement explains that although CBCT scans produce a higher radiation dose that routine dental x-rays, this dose is significantly lower than the one produced by a medical CT scan.
The dental CBCT units are also capable of further reducing radiation exposure by reducing the area exposed ( also called FOV or field of view).
There have been many measures taken to provide guidance in the safe use of CBCT in dentistry, such as position statements^6,7 and professional guidelines for CBCT use.^4,8 Recommendations for adequate operator education have been published.^1,6
The guidelines state that children are more sensitive to radiation so "Additional considerations should be weighed prior to the exposure of children and adolescents".  Also that CBCT scans should be prescribed only when the diagnostic yield will benefit patient care, enhance patient safety, and significantly improve clinical outcomes.
Another term you may have heard is the ALARA Principle which means “as-low-as-reasonably-achievable” , so the radiation dose for dental patients should be optimized to achieve the lowest practical level for a specific image.
In our dental office, as it should be in general, we try to taylor the recommendations for radiographic images to each individual patient's needs, and patient safety.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

References

1. Horner K, et al. Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009;38(4):187–195. 
2. Pauwels R, et al SEDENTEXCT Project Consortium. Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 2012;81(2):267–271.
3. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(1):106–114.↵
4. The SEDENTEXCT Project. Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology: Evidence Based Guidelines 2011 (v2.0 Final). www.sedentexct.eu/files/guidelines_final.pdf. Accessed May 11, 2012.
5. Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: the impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation. JADA 2008;139(9):1237–1243.
6. Carter L, et al. American Academy of Oral and Maxillofacial Radiology. American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(4):561–562.
7. Joint Position Statement of the American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology. Use of cone-beam computed tomography in endodontics. www.aaomr.org/resource/resmgr/Docs/AAOMR-AAE_postition_paper_CB.pdf. Accessed July 10, 2012.
8. Academy of Osseointegration. 2010 guidelines of the Academy of Osseointegration for the provision of dental implants and associated patient care. Int J Oral Maxillofac Implants 2010;25(3):620–627.
9. Scarfe WC “All that glitters is not gold”: standards for cone-beam computerized tomographic imaging (published online ahead of print Feb. 3, 2011). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(4):402–408. doi:10.1016/j.tripleo.2011.01.006.
10. National Council on Radiation Protection & Measurements. Radiation Protection in Dentistry (Report No. 145). Bethesda, Md.: NRCP Publications; 2003.
11. American Dental Association; U.S. Department of Health and Human Services. The Selection of Patients for Dental Radiographic Examinations. Chicago: American Dental Association; 2004.www.ada.org/sections/professionalResources/pdfs/topics_radiography_examinations.pdf.
12. National Research Council of The National Academies, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board of Radiation Effects Research, Division on Earth and Life Studies. 2006. Health Risks From Exposure to Low Levels of Ionizing Radiation: BEIR VII phase 2. Washington: National Academy of Sciences, National Academies Press; 2006.
13. International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection (publication 103). Ann ICRP 2007;37(2–4):1–332.
14. National Council on Radiation Protection & Measurements. Structural Shielding Design for Medical Imaging Facilities (Report No. 147). Bethesda, Md.: NRCP Publications; 2004.