Lecture on Clinical Justification and Imaging Protocols

• Presenter: Suk Ng
• Course: Level 1 Conebeam CT

Key Topics Covered

• Justification of Conebeam CT
  • Reference to the latest guidelines
  • Clinical examples included
• Imaging Protocols
  • Optimizing dose to the patient
  • Selecting field of view size
  • Clinical examples provided

Guidelines to Follow

• Radiation Protection No. 172
  • Recommended reading
  • Available online
• 20 Basic Principles of Cone Beam CT
  • Separate handout available

Justification Principles

• Every x-ray must be justified by the IRMA practitioner
  • Requires sufficient information from the referrer
  • Use selection criteria for decision-making
• Always use the smallest field of view to reduce patient dose
• No justification for Conebeam CT if:
  • A lower dose conventional technique suffices
  • Only a panoramic or lateral cephalometric view is needed

Selection Criteria and Recommendations

• Developing Dentition
  • Use Conebeam CT if conventional radiography is insufficient
  • Use smallest volume size compatible with the situation
  • Avoid large volume CBCT unless necessary
• Orthodontics
  • Avoid large volume CBCT routinely
  • Justify in complex skeletal abnormalities
• Caries and Periodontal Disease
  • CBCT not indicated routinely
  • Use in specific cases where conventional methods fail

Specific Case Recommendations

• Endodontics
  • CBCT not standard for root canal anatomy
  • Use only if conventional radiograph is inadequate
• Dental Trauma and Implants
  • Indicated for pre-implant assessments
• Bone Pathosis
  • Initial imaging should be MSCT or MRI
  • Use CBCT if detailed bone evaluation is needed

Imaging Protocols

• Determine based on clinical question and referrer's request
• Include:
  • Imaging resolution
  • Smallest field of view
  • Protocol specifics (e.g., kV, mA, rotation)
• Examples:
  • Lower Molar Region Pre-Implant Placement: 85 kV, 6 mA, 4x4 cm FOV, 0.2 mm voxel, 360° rotation

Field of View Sizes

• 4x4 cm: Approx. 6-7 teeth
• 6x6 cm: Entire upper jaw from molar to molar
• 8x8 cm: Whole half of mandible
• 10x10 cm: Mandible up to condyle

Clinical Cases for Practice

• Various examples provided to decide on field of view and protocol
• Emphasis on clinical justification and appropriate selection criteria

Conclusion

• Importance of guideline familiarity
• Role of CBCT in clinical practice
• Engaging clinical examples to illustrate principles

Thank you for your attention!