Q: Is it legal to take a cone-beam CT image and reconstruct it to an orthopantomogram or ceph image?
A: This a good question that required a little help to answer, so I turned to some of my friends.
Dale Miles D.D.S., M.S., (www.learndigital.net) an oral and maxillofacial radiologist who is an expert on cone-beam CT (CBCT), wrote "Yes … it's what radiology technicians and radiologists do to perform feature extraction; that is, process the image features to make the suspected disease process or lesion more apparent or discernible. IT HELPS US MAKE A DIAGNOSIS! Every [CT] scan, PET scan, and MR image is reconstructed, subjected to image processing algorithms, etc. for this purpose … always have and always will be."
Paul Feuerstein, D.M.D., (www.computersindentistry.com) wrote, "There is no issue using reconstructed scans but they ARE reconstructed. Vatech-Ewoo has the Picasso Trio (Pan, Ceph, cone-beam CT) that has all three in one and is priced pretty well in that arena. Those are pure scans for each."
One of the most important aspects to note is that this dramatic improvement in imaging capability brings with it the obligation to look at much more clinical radiographic data to avoid missing a significant finding in what is termed the data volume. This means that scans need to be read by a qualified person (usually an oral and maxillofacial or medical radiologist). The dentist is responsible for any information contained in the data set. This means that the greater the volume of data the increase in liability if something is missed on the CBCT scan. For more information on this aspect of imaging, see Dr. Miles' article, "Interpreting the Cone Beam Data Volume for Occult Pathology" (Seminars in Orthodontics, March 2009, Vol. 15:1, pp. 70-76).
From a strict liability standpoint, if you take a conventional cephalometric or panoramic radiograph, then you should be comfortable in interpreting the images. Even if you reconstruct the cephalometric or panoramic from the cone-beam CT scan data, you still are responsible for all the data in the scan.
Martin Jablow, D.M.D., is a practicing dentist and a self-professed technophile who lectures and blogs on a variety of technologies used in dentistry (dentechblog.blogspot.com). If you have a technology question for Dr. Jablow, e-mail it to us at [email protected].
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