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Perspective on 3D Imaging, ALARA, i-CAT and CBCT Justification by Aaron Molen DDS, MS

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I have been fortunate to watch the development of cone beam computed tomography (CBCT) imaging over the years. When I was doing dental research in 2001 using the first FDA-approved CBCT system, we had to wait overnight for our volumes to be reconstructed. Now, we have the opportunity to capture and reconstruct 3D images in a matter of seconds.

Even since 2001, practitioners have been sensitive to the ALARA (as low as reasonably achievable) principle and cognitive of the radiation exposure to our patients. When a patient is in my chair, I always think, "If this was my child, what decision would I make regarding the diagnostic records that I need to treatment plan this case?" The answer is that each clinician needs to determine the benefits based on treatment philosophy and patient needs.

As a speaker, and in informal settings with colleagues, I am often asked about radiation dose versus diagnostic information obtained in 2D versus 3D imaging. When taking ALARA into consideration, the i-CAT FLX, which was recently released by Imaging Sciences International, has made it easier to make the decision to implement a 3D system. Now, a 2D panoramic and lateral ceph can result in a larger radiation dose than taking a scan with an i-CAT FLX using the QuickScan+ setting. You can, for the most part, capture from Menton to Orbitale using the largest QuickScan+ FOV for around 11 microsieverts of radiation*, compared to a pano-ceph combination of, on average, 30 microsieverts - a substantial radiation savings. At this point, the argument of whether you can justify a 3D scan is flipped on its head. Now, the question is, with all of the information obtained with a CBCT, how can I justify not taking a 3D scan using the low-dose QuickScan+ setting versus exposing patients to higher radiation from a traditional pano-ceph?

As orthodontists, we don't need the same spatial resolution as endodontists or oral surgeons. We are trying to localize teeth, evaluate the overall craniofacial morphology, identity eruption paths, and ectopic teeth. We don't need to see the trabeculation of the bone, so we are able to sacrifice some of that spatial resolution for a lower dose. And by doing so, we get the diagnostic information we need, and it still looks great reconstructed in the volume renderings.

Misdiagnoses and treatment plans that may go awry can often be prevented with the more robust diagnostic records provided by CBCT. There is a saying, "Your treatment plan is only as good as your diagnosis." Improving your diagnostic power by using CBCT results in improved treatment plans, and ultimately, better treatment results.

It is an exciting time to be an orthodontist. I think it is fantastic that i-CAT is taking the lead in low-dose 3D imaging research and development. However, the real winners are the patients and the doctors.

*data on file with Imaging Sciences

Author's Bio
Dr. Aaron Molen has given more than 40 lectures and published several papers and textbook chapters on CBCT. He serves on the AJO-DO Technology Editorial Board and volunteers as a faculty member at UCLA. Dr. Molen sits on the AAO's Committee on Technology and is in private practice south of Seattle.

Dr. Molen is not employed by Imaging Sciences nor does he have any financial interests in the company.
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