Title: SIU-SDM HAWAIIAN CRUISE
1SIU-SDM HAWAIIAN CRUISE
2SIU-SDM HAWAIIAN CRUISE
CONE BEAM C T IS IT FOR THE GENERALISTS OFFICE?
3DEBRA DIXON, DMD
- SDM GRADUATE 1993
- SDM AEGD 1995
- SDM IMPLANT FELLOW 1996
- THE UNIVERSITY OF LONDON MSc DENTAL
RADIOLOGY 2002 - SDM DIRECTOR OF RADIOLOGY
4FUR
5OUR AGENDA
- History
- Radiology
- Digital Radiology
- CT
- Cone Beam CT
- What it is and What it can do for me
6HISTORY
- Nov 8, 1895 Wilhelm RÖntgen discovers the X-Ray
- Digital radiography is more than 25 years old
- 11 to 30 of dentists have converted to digital
- Financial investment
- Complexity of computers
- Software
- Hardware
- Simply reluctant to switchif everything is
running smoothly, why change it?
Van der Stelt 2008
7BASICS OF DIGITAL IMAGING
- Composed of pixels (picture elements) which are
characterized by 3 numbers - These numbers are stored in an image file in the
computer - Image processing is possible
- Brightness/Darkness
- Contrast
- Zoomlimited by the resolution of the system
8BASICS OF DIGITAL IMAGING
- Image Analysis
- Measurement of root length for Endo
- Digital subtraction radiography
9BASICS OF DIGITAL IMAGING
- Advantages
- Immediate image with CCD sensor
- Ability to manipulate the image
- Integrated storage with software systems
- Security of backup and off-site archiving of
images - Ease of transfer by email
- Security of the original image
- DICOM (Digital Imaging and Communications in
Medicine) format standards
10BASICS OF DIGITAL IMAGING
- Dose Reduction?
- Once promoted as a huge advantage to digital
imaging - Why the dose reduction is not as large as often
suggested - Dose per exposure
- Reduction of 0 to 50 as compared with F speed
film - Increase in the number of radiographs made
- Increase in the number of retakes due to the ease
of exposing additional images -
Van der Stelt 2008
11SALLY
12C TCOMPUTED TOMOGRAPHY
13C T
- History
- Basics of Tomography
- Generations of Scanners
- 1st Generation
- 2nd Generation
- 3rd Generation
- 4th Generation
- 5th Generation
- Conventional data gathering versus Spiral
geometry
14C T
- History
- The word Tomography can be traced to the 1920s
- Tomography section, from the Greek tomos
- Dr. Godfrey Hounsfield
- Born 1919 in Nottinghamshire, England
- The inventor of clinical computed tomography
- First patient scanned in 1972
- Demonstrated a suspected brain lesion
- Dr. Allan Cormack
- Born 1924 in Johannesburg, South Africa
- Developed solutions for the mathematical problems
in CT
Seeram, Computed Tomography, 2001
15C T
- History
- Dr. Robert Ledley
- 1948 Doctorate in Dental Surgery, New York
University - 1949 Masters in theoretical physics, Columbia
University - Developed the first whole-body CT scanner
Seeram, Computed Tomography, 2001
16C T
- History
- Tomography
- X-ray tube and film move simultaneously and in
opposite directions - This keeps the object of interest in focus while
blurring out the structures around it - Panoramic technique
Seeram, Computed Tomography, 2001
17C T
- History
- A
- 1st Generation
- B
- 2nd Generation
- C
- 3rd Generation
- D
- 4th Generation
Seeram, Computed Tomography, 2001
18C T
- History
- 1st Generation
- Minimum 4.5 to 5.5 minute whole body scan
- Parallel beam, Translate Rotate
- After 1 translation, the tube and detector rotate
by 1 and translate again, repeated for 180
around the patient
Seeram, Computed Tomography, 2001
19C T
- History
- 2nd Generation
- Scan time 20 sec to 3.5 minutes
- Fan beam, Translate Rotate
- Fan beam 30 detectors coupled to the x-ray
tube and multiple pencil beams - Process is repeated for 180
Seeram, Computed Tomography, 2001
20C T
- History
- 3rd Generation
- Scan time of a few seconds
- Fan beam geometry that rotates continuously
around the patient for 360
Seeram, Computed Tomography, 2001
21C T
- History
- 4th Generation
- Scan time is very short, varies by manufacturer
- A rotating fan beam within a stationary ring of
detectors
Seeram, Computed Tomography, 2001
22C T
- History
- 5th Generation
- High-speed CT scanners
- EBCT Electron Beam CT scanner
- DSR
- Dynamic Spatial Reconstructor
- Scan time of milliseconds
Seeram, Computed Tomography, 2001
23C T
- History
- A
- Conventional Slice by Slice data acquisition
- The x-ray tube stops between slices, the patient
is repositioned for the next slice
Seeram, Computed Tomography, 2001
24C T
- History
- B
- Helical or spiral geometry
- The latest development in CT data acquisition (as
of the writing of the text in 2001) - Volume scanning
- Utilizes a narrowly collimated, fan shaped x-ray
beam, projected through a limited thickness slice
through the body - Utilizes a linear array of detectors
- Patient has to be advanced through the gantry
while the x-ray tube and detectors rotate around
the patient
Seeram, Computed Tomography, 2001
25C T
- Spiral Scanners
- Provide improved multiplanar image
reconstructions - Reduced exam time
- 12 seconds versus 5 minutes for an incremental
scan - Reduced radiation dose
- Up to 75 of the dose delivered by an incremental
scanner
26C T
- Image is recorded and displayed as matrix of
individual blocks called voxels (volume elements) - Voxel length (1 to 20 mm) is determined by the
width of the x-ray beam - Analogous to the tomographic layer in film
tomography - For image display, each pixel is assigned a CT
number - Represents density
- Also known as a Hounsfield unit
- Air -1000
- Water 0
- Dense bone 1000
27EM
28CONE BEAM C T
29C B C T
- Definition
- Indications
- Comparisons
- CBCT versus Panoramic
- CBCT versus Plain-film Tomography
- CBCT versus Medical CT
- Disadvantages
- Currently available units
- Specialized Uses
- Orthodontic Analysis
- Dolphin Imaging Software Program
- Interpretation
30C B C T
- Developed for Dental purposes to provide 3D
volume images of the dental and craniofacial
complex - Available for craniofacial imaging
- Since 1999 in Europe
- Since 2001 in the U.S.
- Ideally suited for craniofacial imaging
- The compact size of the unit
- Relatively low radiation dose
- Becoming the Standard of Care for diagnosis of
the craniofacial region - Allows multiplanar viewing of the anatomical
volume and overcomes the limitations of 2D
radiography
www.conebeam.com
31C B C T
- Cone Beam
- Utilizes a cone shaped x-ray beam
- Round or rectangular
- Utilizes an area detector
- Acquires a full volume of images in a single
rotation with no need for patient movement - Rotates 360 around the head
- 360 projections
- Scan time typically lt 1 minute
www.conebeam.com
32C B C T
- End Result
- 3-D visualization of the oral and maxillofacial
complex from any plane - A stack of 360 images or exposures compiled into
a volumetric dataset through a computer process
known as primary reconstruction - This data volume is then converted into a
patient-study by accompanying software - Can be visualized as
- 2D trans-axial, multi-planar reformatted
- 3D techniques such as surface reconstruction and
volume rendering - A combination of 2D and 3D techniques
www.conebeam.com
33C B C T
- Indications
- Evaluation of the jaw bones
- Implant placement and evaluation
- TMJ
- Pathology
- Bony Soft tissue lesions
- Periodontal assessment
- Endodontic assessment
- Alveolar ridge resorption
- Assessment of the IAN prior to extraction of
impactions - Orthodontic evaluation
- Airway assessment
- Need for 3D reconstructions
www.conebeam.com
34C B C T
- Evaluation of the jaw bones
- Implant placement and evaluation 12-13
- a) Panoramic line and cross-section line in the
axial image of Maxilla identified - b) Slices of the area in cross-section
- c) Reconstruction in a panoramic-like layout
Araki et al. Dentomaxillofac Radiol 31 (1)51,
Figure 9
35C B C T
- Evaluation of the jaw bones
- a) Slice as seen from a frontal view
- b) Slice as seen from the side
- c) Reconstructed maxilla and mandible
Dentomaxillofac Radiol (2004) 33, 285-290
36C B C T
- Evaluation of the jaw bones
www.ddsgadget.com
e-ssentialnetworks.com
37C B C T versusPANORAMIC
- PANORAMIC
- Provides a distorted (unequal magnification) and
magnified image - Image layer view only
- Structures are superimposed
- CBCT
- Provides an undistorted image
- Cross-sectional (bucco-lingual), axial, coronal,
sagittal, and panoramic views - Structures can be separated
www.conebeam.com
38C B C TversusPLAIN-FILM TOMOGRAPHY
- PLAIN-FILM TOMOGRAPHY
- Provides an undistorted image, but there is
magnification - Provides direct cross-sectional, sagittal, and
coronal views - Scan time may be short, but chair time can be
lengthy
- CBCT
- Provides an undistorted, 11 image
- Provides reconstructed views
- Scan time
- 10-40 second range, dependent on the region being
imaged and the desired quality - Provides an indication of bone quality
www.conebeam.com
39C B C TversusMedical C T
www.osseonews.com
- Med CT
- Conventional linear fan beam
- Single row or a series (4, 8, 12, 32, 64) of
solid state detectors - Provides a set of consecutive slices of the
patient
- CBCT
- Cone beam
- Square 2 dimensional array of detectors
- Provides a volume of data
www.conebeam.com
40C B C TversusMedical C T
- Med CT
- Greater contrast resolution
- More discrimination between different tissue
types (i.e. bone, teeth, and soft tissue)
- CBCT
- Equipment
- Cost 3-5x less than MDCT
- Lighter Smaller
- No special electrical
- No floor strengthening
- No special cooling
- Ease of operation
- Dedicated to dental
- Patient sits or stands
- Both jaws can be imaged at the same time
- Lower radiation burden
www.conebeam.com
41C B C T
- Disadvantages
- Noise from radiation scatter
- Streak artifacts from metal restorations
- Algorithms and filters try to correct for noise
artifacts - Image degradation from patient movement
- Head stabilizing devices
- Cost
- Range from 150,000 to 300,000
- Training
- For maximum benefit
- For interpretation of the volume of data images
- Within the purview of the dentist
- Outside the purview of the dentist
Howerton et. al.
42C B C T
- Currently available units
- 3D Accuitomo FPD XYZ Slice View Tomograph
- J. Morita USA, Irvine, CA
- 3D X-ray CT Scanner Alphard Series
- Asahi, Kyoto, Japan
- Quolis Alphard Alphard-3030-Cone-Beam
- Belmont Equipment, Somerset, NJ
- CB MercuRay
- Hitachi Medical Systems America, Twinsburg, Ohio
- Galileos 3D
- Sirona Dental Systems, Charlotte, NC
- i-CAT
- Imaging Sciences International, Hatfield, PA
Howerton et. al.
43C B C T
- Currently available units
- Iluma Ultra Cone Beam CT Scanner
- Carestream, Rochester, NY
- NewTom 3G and VG
- AFP Imaging, Elmsford, NY
- Picasso
- E-woo Technology, Houston
- PreXion 3D
- TeraRecon, San Mateo, CA
- ProMax 3D
- Planmeca USA, Roselle, IL
- Scanora 3D
- Soredex, Tuusula, Finland
Howerton et. al.
44C B C T
i-CAT NewTom VG 3D Accuitomo
Position Seated Stand/Seated Seated
Scan time 5, 8.9, 26.9 sec 20 sec 18 sec
Scan Hgt 4,6,8,10,13 cm 9.84 inches 1.57-2.36 inches
kVp/mA 120/3-5 60-80/1-10
Rad Time 9 sec 5.4 sec Not listed
Scan thick 0.12-0.4 mm 0.1-0.5 mm .125-2.0 mm
Ceph Yes Yes No
Software Xoran Cat NewTom VG I-Dixel
Price 170,000 170,000 252,000
website imagingsciences.com newtomdental.com jmorita.com
Inside Dentistry 190-93, 2007, Dental Economics
August 2007, Dental Town August 2007
45C B C T
- All Cone Beam Units are not created equal!
- Volume Size
- Geometric resolution
- Contrast resolution
- Slice thickness
- Radiation dose
- Ease of use
- Image Capture
46C B C T
Effective dose (µSv) Dose in of Pans Dose in days Dose in Med CT
i-Cat 12 FOV 135 21 13 6.4
NewTom 3G 12 FOV 45 7 4 2.1
Panoramic 6 1 1 0.3
CT Maxilla Mandible 2,100 385 243 100
Farman AG, Levato CM, Scarfe WC. A primer on
cone beam CT. Inside Dentistry 190-93, 2007
47C B C T
- The i-CAT CT scanner
- Low dose settings for children
- Landscape View
- Full resolution and detail obtained for smaller
fields of view - Portrait View
- Captures Extended Field of View data
- Ceph data in 8.5 seconds
www.imagingsciences.com
48C B C T
- i-CAT
- Typical reconstruction time
- Less than 30 seconds
www.imagingsciences.com
49C B C T
- i-CAT
- Measurement
- Labeling
- Hounsfield units
- Density
www.imagingsciences.com
50C B C T
- NewTom VG
- Features a single 8"x10" Field Of View,
- Most utilized by implantologists and
maxillo-facial surgeons. - Small focal spot high quality images
- Volume of data captured kept to a minimum
- Short reconstruction times (3 minutes)
- Low dose
- up to 20 - 50 times less radiation than
conventional CT - Adjusts dose to size and age of patient
- Unique pulse system
- Activates the x-ray source only when
neededdelivering less than 4 seconds of total
exposure for a full scan.
www.afpimaging.com/newtom
51C B C T
www.afpimaging.com/newtom
52C B C T
- 3D Accuitomo
- J. Morita Manufacturing
- Imaging Areas 40x40 mm 60x60 mm
- High resolution for large imaging area
- Voxel size 0.125 mm, high resolution (2.0 line
pair/mm) - Low effective dose
- Wide dynamic range and expresive tone create
brilliant images of both soft and hard tissue
areas - Enables the most accurate diagnosis for implants,
apical lesions, temporomandibular joints,
impactions, etc.
www.jmorita-mfg.com
53C B C TSPECIALIZED USES
ISLAND OF LANAI
54C B C T
- Specialized Uses
- Orthodontic Analysis
- Dolphin Imaging Software Program
- Oral Surgery
- Impactions
- Trauma
- Implants
- Endodontics
- Periodontics
- TMJ
55C B C T - ORTHO
Ortho Evaluation and Treatment Planning
www.dolphinimaging.com
56C B C T - ORTHO
- The Dolphin 3D software module
- A powerful tool that makes processing 3D data
extremely easy, enabling dental specialists from
a wide variety of disciplines to accurately
diagnose and plan treatment. - Dolphin 3D allows visualization and analysis of
craniofacial anatomy from data produced by CBCT,
MRI, medical CT and 3D facial camera systems.
www.dolphinimaging.com
57C B C T - ORTHO
- Dolphin Imaging Software
- Comprehensive cross sections with Multiple Planar
View (MPV) - 3D nerve marking
- TMJ analysis
- Create stunning, accurate cephalometric and
panoramic radiographs - Import from a variety of 3D files
- High-quality, fast 3D rendering
- Easily detect impacted teeth
- Analyze, visualize and measure airway
- Precise volume orientation
- Establish 3D/2D measurements
- Create movies
- Design automated image layouts
- Images export to other applications, including
PowerPoint, Word, etc. - Images easily saved into Dolphin patient file
- Export to standard file formats and Windows
Clipboard - Fully embedded in Dolphin Imagings SQL database
www.dolphinimaging.com
58C B C T - ORTHO
- Dolphin Imaging Software
- Object Orientation
- Comprehensive cross sections with Multiple Planar
View - Instant Ceph/Pan
- Ceph Tracing
- 3D Nerve Mapping
- TMJ analysis
- 3D Visualization
-
www.dolphinimaging.com
59C B C T - ORTHO
- Object Orientation
- To maximize the consistency of analysis of a 3D
volume, it is crucial to establish a default
orientation. - Dolphin 3D provides comprehensive tools for
defining the mid-sagittal, axial and coronal
planes. You can also adjust the objects default
yaw, pitch and roll. - These operations can be performed on the CT soft
tissue surface, CT hard tissue surface or 3D
photo surface.
www.dolphinimaging.com
60C B C T - ORTHO
- Multiple Planar Views and Layouts
- Choose a layout that is best suited to your task
- 3D volume (just the 3D volume view)
- Volume3 planes (3D volume and 3 cross section
planes on the side) - 4-views (3D volume and the cross section planes
in equal sized windows) - Individual orthogonal projected slices sagittal,
coronal and axial planes
www.dolphinimaging.com
61C B C T - ORTHO
- Instant Ceph/Pan
- Create two-dimensional radiographic images from
3D volume dataset in the lateral, panoramic
(OPG), frontal and SMV views. - 11 projection
- no distortion
- no magnification
www.dolphinimaging.com
62C B C T - ORTHOCeph Tracing
www.dolphinimaging.com
63C B C T - ORTHO Nerve Mapping
www.dolphinimaging.com
64C B C T - ORTHO
- TMJ View
- Choose an area of interest set center point and
axis direction, designed specifically for
analyzing the temporomandibular joint - Choose desired slice thickness, width, number and
direction (coronal, sagittal, or patent-pending
circular) - View key cross-sections at the chosen axes
www.dolphinimaging.com
65C B C T - ORTHO
- 3D Visualization
- Dolphin gives you the power to freely visualize
the volume in 3D. In addition to switching from
hard tissue and soft tissue views, you can also
activate the see-thru hard tissue renderings.
Adjust the factor of translucency and intensity
to reveal the structure you desire.Clipping
tools are also very useful for quickly
visualizing hidden structures, or to simply
eliminate portions of the contents that are not
relevant.
www.dolphinimaging.com
66C B C T
- Interpretation of the Volume of Images
- Data collected within the Region of Interest
(ROI) - Within the purview of general dentists and
specialists - Data collected outside of the Region of Interest
- A large volume of information exists that is
outside of a dentists purview - Comprehensive Care of the Patient
- Documented interpretation of all the data in the
volume - 2007 Chairman of the AAOMS advised that all
volumes be read by a radiologist
67C B C T
- Interpretation of the Volume of Images
- AAO Council on Scientific Affairs
- Survey of Radiologists
- All scans should be read by a qualified person.
- Panoramic can be read by the diagnostician
(dentist) - Cone Beam volume by an Oral Maxillofacial
Radiologist or an MD Radiologist - The interpretation fee can be either included in
the scan fee, or be billed separately - The entire volume of data requires
interpretation. The patient cannot deny
interpretation of non-dental data - As in medicine, a written report is the standard
Am J Orthod Dentofacial Orthop 2007131697
68TIGGER
69CONE BEAM C T IS IT FOR THE GENERALISTS OFFICE?
70- THE BOTTOM LINE
- Is it worth your time and effort?
- Physical Space in your office
- Training
- Computer memory to work with images
- Storage of images
71- THE BOTTOM LINE
- Is it worth your time and effort?
- Physical Space in your office
- Training
- Computer memory to work with images
- Storage of images
- Will it be profitable?
- Costof the equipment
- Time involved
- Number of patient scans x 250-600/scan
- Types of images available Pan, Ceph, Bitewings,
Periapicals
72 MAHALO
73CONE BEAM C T
- References
- Araki et al. Dentomaxillofac Radiol 31 (1)51,
Figure 9 - Am J Orthod Dentofacial Orthop 2007131697
- Turpin D., Editor-in-Chief. Befriend your oral
and maxillofacial radiologist - Danforth RA, Miles D. Cone Beam Computed
Tomography for Dentistry (Journal unknown) - Dental Economics August 2007
- Feuerstein P. Cone Beam Technology.
- Guttenberg S, Emery R. Profit in 3 dimensions
- R Baba, K Ueda and M Okabe. Using a flat-panel
detector in high resolution cone beam CT for
dental imaging. Dentomaxillofacial Radiology
2004 33, 285-290 - DentalTown August 2007
- Giacobbi T. 3D Images for 21st Century Dentistry
74CONE BEAM C T
- References
- Inside Dentistry 190-93, 2007
- Farman AG, Levato CM, Scarfe WC. A primer on
cone beam CT. - JADA supplement June 2008, Vol. 139, Digital
Imaging - A. Ruprecht. Oral and Maxillofacial Radiology
Then and Now - P.F. van der Stelt. Better Imaging The
Advantages of Digital Radiography - A.G. Farman, et al. In Practice how Going
Digital Will Affect the Dental Office - W.B. Howerton Jr, M.A. Mora. Advancements in
Digital Imaging What Is New and on the Horizon? - Seeram, Euclid. Computed tomography physical
principles, clinical applications, and quality
control, 2nd edition, 2001, Saunders.
75CONE BEAM C T
- References
- www.afpimaging.com
- www.conebeam.com
- www.cile.co.nr
- www.ddsgadget.com
- www.dolphinimaging.com
- www.e-ssentialnetworks.com
- www.imagingsciences.com
- www.jmorita-mfg.com
- www.osseonews.com