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Huang H, Yan Y, Jiang D, Zhao X, Cao D, She D. Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar. Clin Oral Investig 2024; 28:256. [PMID: 38630324 DOI: 10.1007/s00784-024-05649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.
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Affiliation(s)
- Hao Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Yalan Yan
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Dongmei Jiang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Xiance Zhao
- Philips Healthcare, Shanghai, 200000, People's Republic of China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
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Klingler S, Biel P, Tschanz M, Schulze R. CBCTs in a Swiss university dental clinic: a retrospective evaluation over 5 years with emphasis on radiation protection criteria. Clin Oral Investig 2023; 27:5627-5636. [PMID: 37522991 PMCID: PMC10492752 DOI: 10.1007/s00784-023-05184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To retrospectively evaluate all cone-beam computed tomography (CBCT) scans acquired from 2017 to 2022 in a Swiss university dental clinic with particular emphasis on radiation protection aspects. MATERIAL AND METHODS Radiological databases at the dental clinic of the University of Bern, Switzerland, were explored using a self-developed search algorithm. Data of all acquired CBCT from 01.01.2017 to 27.06.2022 were screened. Exposure parameters (exposure time, exposure angle, milliampere (mA), kilovoltage (kV), field of view (FOV) size), dose area product (DAP), age, and sex of the patient were recorded anonymously. The collected data were analyzed mainly descriptively. Correlations measured the statistical relationships between the variables. RESULTS A total of 10,348 CBCT datasets were analyzed. Patient age ranged from 5 to 96 years (mean: 49.4 years, SD: 21.6 years). The number of CBCTs in patients under 25 years was around 20% each year. In total, 10,313 (99.7%) CBCTs were acquired in small to medium FOV (FOV up to 10 cm of height), and 35 (0.3%) in large FOV (height > 10 cm). DAPs of small FOVs were 518.3 ± 233.2 mGycm2 (mean ± SD), of medium FOV 1233 ± 502.2 mGycm2, and of large FOV 2189 ± 368.7 mGycm2. DAP (ρ = 0.4048, p < 0.0001) and kV (ρ = 0.0210, p = 0.0327) correlated positively with age. Reduced scan angle correlated with young age (rpb 0.2729, p < 0.001). mA did not correlate with age (p = 0.3685). CONCLUSIONS This study demonstrates that certain well-known radiation protection aspects as the reduction of FOV, mA, kV, and scan angle were only partly considered. CLINICAL RELEVANCE Known radiation protection aspects, especially in young patients, should be fully applied in regular clinical practice.
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Affiliation(s)
- Samuel Klingler
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Philippe Biel
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Moses Tschanz
- Information Technology (IT) Group, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Ralf Schulze
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Division of Oral Diagnostic Sciences, Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Sarıbal GŞ, Canger EM, Yaray K. Evaluation of the radiation protection effectiveness of a lead-free homopolymer in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:91-101. [PMID: 37002015 DOI: 10.1016/j.oooo.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/26/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The objective was to compare the radiation protection effectiveness of a lead-free thermoplastic homopolymer (Anti-RAD) to conventional lead shielding in cone beam computed tomography (CBCT) exposures. STUDY DESIGN Thermoluminescent dosimeters were placed on a human bone- and soft tissue-equivalent phantom to record equivalent doses in the thyroid gland, thyroid skin, and breast areas. CBCT images were obtained with the following 3 protocols: (1) without radiation shielding; (2) with 0.5-mm lead equivalent lead-containing shielding; and (3) with 0.5-mm lead equivalent Anti-RAD shielding. Independent t tests were used to evaluate the results. RESULTS Compared with exposures without shielding, both lead and Anti-RAD protective devices reduced thyroid gland equivalent doses by approximately 40%, thyroid skin doses by approximately 75%, right breast skin doses by approximately 80%, and left breast skin doses by 75%. The differences in equivalent dose for both types of shielding compared with exposure with no shielding were statistically significant (P ≤ .042). However, there were no significant differences in dose reduction at any site between lead and Anti-RAD shielding (P ≥ .135). CONCLUSIONS Radiation protection equivalent to lead can be provided with the Anti-RAD shield. With the use of this material, disadvantages such as damage to the aprons, lead toxicity, weight of lead aprons, and microbial contamination can be reduced.
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Affiliation(s)
- Gamze Şirin Sarıbal
- Research Assistant, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
| | - Emin Murat Canger
- Associate Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University-Kayseri, Turkey
| | - Kadir Yaray
- Department of Radiation Oncology, University of Erciyes Faculty of Medicine, Kayseri, Turkey
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Van Gorp G, Maes A, Lambrechts M, Jacobs R, Declerck D. Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study. BMC Oral Health 2023; 23:270. [PMID: 37165416 PMCID: PMC10170728 DOI: 10.1186/s12903-023-03013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Proper skills in radiographic diagnosis are essential for optimal management of dental trauma. AIM To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs. METHODS Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests. RESULTS Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D. CONCLUSION Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.
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Affiliation(s)
- Gertrude Van Gorp
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium.
| | - Arno Maes
- KU Leuven Department of Oral Health Sciences, Master in Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Marjan Lambrechts
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominique Declerck
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 7, Leuven, PO box 7001, B-3000, Belgium
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Flügge T, Gross C, Ludwig U, Schmitz J, Nahles S, Heiland M, Nelson K. Dental MRI-only a future vision or standard of care? A literature review on current indications and applications of MRI in dentistry. Dentomaxillofac Radiol 2023; 52:20220333. [PMID: 36988090 PMCID: PMC10170172 DOI: 10.1259/dmfr.20220333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
MRI is increasingly used as a diagnostic tool for visualising the dentoalveolar complex. A comprehensive review of the current indications and applications of MRI in the dental specialities of orthodontics (I), endodontics (II), prosthodontics (III), periodontics (IV), and oral surgery (V), pediatric dentistry (VI), operative dentistry is still missing and is therefore provided by the present work.The current literature on dental MRI shows that it is used for cephalometry in orthodontics and dentofacial orthopaedics, detection of dental pulp inflammation, characterisation of periapical and marginal periodontal pathologies of teeth, caries detection, and identification of the inferior alveolar nerve, impacted teeth and dentofacial anatomy for dental implant planning, respectively. Specific protocols regarding the miniature anatomy of the dentofacial complex, the presence of hard tissues, and foreign body restorations are used along with dedicated coils for the improved image quality of the facial skull.Dental MRI poses a clinically useful radiation-free imaging tool for visualising the dentoalveolar complex across dental specialities when respecting the indications and limitations.
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Affiliation(s)
- Tabea Flügge
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ute Ludwig
- Medical Physics, Department of Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna Schmitz
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Susanne Nahles
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Max Heiland
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Brasil DM, Merken K, Binst J, Bosmans H, Haiter-Neto F, Jacobs R. Monitoring cone-beam CT radiation dose levels in a University Hospital. Dentomaxillofac Radiol 2023; 52:20220213. [PMID: 36802857 PMCID: PMC9944015 DOI: 10.1259/dmfr.20220213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To present patient dose levels for different CBCT scanners, acquired by a dose monitoring tool in a University Hospital, as a function of field of view (FOV), operation mode, and patient age. METHODS An integrated dose monitoring tool was used to collect radiation exposure data [type of CBCT unit, dose-area product (DAP), FOV size, and operation mode] and patient demographic information (age, referral department) performed on a 3D Accuitomo 170 and a Newtom VGI EVO unit. Effective dose conversion factors were calculated and implemented into the dose monitoring system. For each CBCT unit, the frequency of examinations, clinical indications, and effective dose levels were obtained for different age and FOV groups, and operation modes. RESULTS A total of 5163 CBCT examinations were analyzed. Surgical planning and follow-up were the most frequent clinical indications. For the standard operation mode, effective doses ranged from 35.1 to 300 µSv and 9.26-117 µSv using 3D Accuitomo 170 and Newtom VGI EVO, respectively. In general, effective doses decreased with increasing age and FOV size reduction. CONCLUSIONS Effective dose levels varied notably between systems and operation modes.Operation mode selection and FOV size were indication-oriented, with larger FOV sizes election serving surgical planning and follow-up. Seeing the influence of FOV size on effective dose levels, manufacturers could be advised to move toward patient-specific collimation and dynamic FOV selection. Systematically monitoring patient doses could be recommended for steering future CBCT optimization.
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Affiliation(s)
| | - Karen Merken
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium
| | - Joke Binst
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | | | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Hilgenfeld T, Saleem MA, Schwindling FS, Ludwig U, Hövener JB, Bock M, Flügge T, Eisenbeiss AK, Nittka M, Mente J, Jende JME, Heiland S, Bendszus M, Juerchott A. High-Resolution Single Tooth MRI With an Inductively Coupled Intraoral Coil-Can MRI Compete With CBCT? Invest Radiol 2022; 57:720-727. [PMID: 35640007 DOI: 10.1097/rli.0000000000000890] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to quantify T1/T2-relaxation times of the dental pulp, develop a realistic tooth model, and compare image quality between cone-beam computed tomography (CBCT) and high-resolution magnetic resonance imaging (MRI) of single teeth using a wireless inductively coupled intraoral coil. METHODS T1/T2-relaxometry was performed at 3 T in 10 healthy volunteers (283 teeth) to determine relaxation times of healthy dental pulp and develop a realistic tooth model using extracted human teeth. Eight MRI sequences (DESS, CISS, TrueFISP, FLASH, SPACE, TSE, MSVAT-SPACE, and UTE) were optimized for clinically applicable high-resolution imaging of the dental pulp. In model, image quality of all sequences was assessed quantitatively (contrast-to-noise ratio) and qualitatively (visibility of anatomical structures and extent of susceptibility artifacts using a 5-point scoring scale). Cone-beam computed tomography served as the reference modality for qualitative assessment. Statistical analysis was performed using 2-way analysis of variance, Fisher exact test, and Cohen κ. RESULTS In vivo, relaxometry of dental pulps revealed T1/T2 relaxation times at 3 T of 738 ± 100/171 ± 36 milliseconds. For all sequences, an isotropic resolution of (0.21 mm) 3 was achieved, with acquisition times ranging from 6:19 to 8:02 minutes. In model, the highest contrast-to-noise ratio values were observed for UTE, followed by TSE and CISS. The best image/artifact quality, however, was found for DESS (mean ± SD: 1.3 ± 0.3/2.2 ± 0.0), FLASH (1.5 ± 0.3/2.4 ± 0.1), and CISS (1.5 ± 0.4/2.5 ± 0.1), at a level comparable to CBCT (1.2 ± 0.3/2.1 ± 0.1). CONCLUSIONS Optimized MRI protocols using an intraoral coil at 3 T can achieve an image quality comparable to reference modality CBCT within clinically applicable acquisition times. Overall, DESS revealed the best results, followed by FLASH and CISS.
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Affiliation(s)
| | | | | | - Ute Ludwig
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel University, Kiel
| | - Michael Bock
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Tabea Flügge
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Anne-Katrin Eisenbeiss
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel
| | | | - Johannes Mente
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
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Zidan M, Schwindling FS, Juerchott A, Mente J, Gehrig H, Nittka M, Hosseini Z, Jende JME, Heiland S, Bendszus M, Hilgenfeld T. Endodontic working length measurements of premolars and molars in high-resolution dental MRI: a clinical pilot study for assessment of reliability and accuracy. Clin Oral Investig 2022; 26:6765-6772. [PMID: 35861757 DOI: 10.1007/s00784-022-04636-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To prospectively assess the reliability and accuracy of high-resolution, dental MRI (dMRI) for endodontic working length (WL) measurements of premolars and molars under clinical conditions. MATERIALS AND METHODS Three-Tesla dMRI was performed in 9 subjects who also had undergone cone-beam computed tomography (CBCT) (mean age: 47 ± 13.5 years). A total of 34 root canals from 12 molars (4/8, upper/lower jaw; 22 root canals) and 11 premolars (2/9 upper/lower jaw; 12 root canals) were included. CBCT and dMRI datasets were reconstructed to visualize the root canal in one single slice. Subsequently, two radiologists measured the root canal lengths in both modalities twice in blinded fashion. Reliability and accuracy for both modalities were assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analysis, respectively. RESULTS Reliability (intra-rater I/II; inter-rater) of dental MRI measurements was excellent and comparable to CBCT for premolars (0.993/0.900; 0.958 vs. 0.993/0.956; 0.951) and for molars (0.978/0.995; 0.986 vs. 0.992/0.996; 0.989). Bland-Altman analysis revealed a mean underestimation/bias (95% confidence interval) of dMRI measurements of 0.8 (- 1.44/3.05) mm for premolars and 0.4 (- 1.55/2.39) mm for molars. In up to 59% of the cases, the accuracy of dMRI for WL measurements was within the underestimation margin of 0 to 2 mm short of the apical foramen AF. CONCLUSIONS In vivo demonstration and measurement of WL are feasible using dMRI. The reliability of measurements is high and equivalent to CBCT. Nonetheless, due to lower spatial resolution and longer acquisition time, the accuracy of dMRI is inferior to CBCT, impeding its current use for clinical treatment planning. CLINICAL RELEVANCE dMRI is a promising radiation-free imaging technique. Its reliability for endodontic working length measurements is high, but its accuracy is not satisfactory enough yet.
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Affiliation(s)
- Mousa Zidan
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Franz S Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes Mente
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Holger Gehrig
- Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Mathias Nittka
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Zahra Hosseini
- Magnetic Resonance R&D Collaborations, Siemens Medical Solutions, Atlanta, GA, USA
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Dhondt R, Quirynen M, Tarce M, Teughels W, Temmerman A, Jacobs R. The accuracy of probing, ultrasound and cone-beam CT scans for determining the buccal bone plate dimensions around oral implants - A systematic review. J Periodontal Res 2022; 57:754-767. [PMID: 35612409 DOI: 10.1111/jre.12998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this review was to assess the accuracy of available means of determining the BBT (buccal bone thickness) and/or BBL (buccal bone level). This was translated into the following research question: What is the accuracy of the available means of visualizing the BBP (buccal bone plate) to establish the BBT and/or the BBL, when compared to control measurements? As control measurements histomorphometric measurements, direct measurements and cone-beam computed tomography (CBCT) measurements in the absence of metal are accepted. BACKGROUND DATA METHODS: The literary search was performed by searching the databases of MEDLINE, Embase, and Web of Science, up to July 13, 2021. Types of studies included were clinical, in vitro and animal trials, specifically looking into the bone level and/or bone thickness of the buccal bone plate at oral implants. Reference lists were hand searched for relevant articles. Two reviewers performed the data extraction and analysis. Only studies using reliable control measurements to evaluate the accuracy of the tested means of visualizing BBT and/or BBL were included for analysis. The QUADAS-2 tool was used to perform bias analysis on the relevant studies. Extracted data was tabulated to show the differences between test and control measurements for BBT and BBL. For in vitro studies on CBCT measurements of BBT meta-analysis could be performed. RESULTS A total of 1176 papers were identified in the search. Twenty-two articles were used for data extraction and qualitative analysis. Of these studies nine were animal studies, 9 were in vitro studies and four were human studies. Six animal studies and three human studies provided data on probing. CBCT and sonography as techniques for visualizing the buccal bone plate. Probing at implant sites seems to provide data that correlates with a consistent distance from the BBP. Meta-analysis for probing studies could not be performed due to heterogeneity in the setups of these studies. Eleven studies on CBCT were eligible for inclusion. Of these three were animal studies, the remaining 8 studies were all in vitro studies. Meta-analysis was performed on the accuracy of CBCT for in vitro studies, finding a significant underestimation of the BBT when compared to control measurements by a mean difference of -0.15 mm with 95%CI [-0.26,-0.03]. Three studies were identified on measurement of BBT and/or BBL by sonography. This included one human study and two in vitro studies. The identified studies show a low error when determining the buccal bone level or thickness using sonography. All included studies possess a high risk of bias according to risk of bias analysis, mostly due to selection of the patient. CONCLUSION A strong limitation of this systematic review is the inclusion of different studies with heterogeneous designs. Within the limits of this analysis it cannot be concluded that probing is an accurate way of visualizing the BBP. CBCT cannot yet be recommended as a standard diagnostic tool for follow-up of the BBP at oral implants. The application of sonography as a diagnostic tool to visualize the BBP needs further scientific validation.
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Affiliation(s)
- Rutger Dhondt
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marc Quirynen
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Mihai Tarce
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Wim Teughels
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Andy Temmerman
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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10
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Merdietio Boedi R, Shepherd S, Mânica S, Franco A. CBCT in dental age estimation: A systematic review and meta analysis. Dentomaxillofac Radiol 2022; 51:20210335. [PMID: 34995103 PMCID: PMC9499196 DOI: 10.1259/dmfr.20210335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the reproducibility of dental age estimation methods in cone beam computed tomography (CBCT) and the correlation between dental (DA) and chronological (CA) ages. METHODS The scientific literature was searched in six databases (PubMed, Scopus, LILACS, Web of Science, SciELO, and OATD). Only observational studies were selected. Within each study, the outcomes of interest were (I) the quantified reproducibility of the method (κ statistics and Intraclass correlation coefficient); and (II) the correlation (r) between the dental and chronological ages. A random-effect three-level meta-analysis was conducted alongside moderator analysis based on methods, arch (maxillary/mandibular), population, and number of roots. RESULTS From 671 studies, 39 fulfilled the inclusion criteria, with one study reporting two different methods. The methods used in the studies were divided into metric (n = 17), volumetric (n = 20), staging (n = 2), and atlas (n = 1). All studies reported high examiner reproducibility. Group 1 (metric and volumetric) provided a high inverse weighted r ([Formula: see text] = -0.71, CI [-0.79,-0.61]), and Group 2 (staging) provided a medium-weighted r ([Formula: see text] = 0.49, CI [0.44, 0.53]). Moderator analysis on Group one did not show statistically significant differences between methods, tooth position, arch, and number of roots. An exception was detected in the analysis based on population (Southeast Asia, [Formula: see text] = -0.89, CI [-0.94,-0.81]). CONCLUSION There is high evidence that CBCT methods are reproducible and reliable in dental age estimation. Quantitative metric and volumetric analysis demonstrated better performance in predicting chronological age than staging. Future studies exploring population-specific variability for age estimation with metric and volumetric CBCT analysis may prove beneficial.
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Affiliation(s)
- Rizky Merdietio Boedi
- Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Dundee, UK.,Department of Dentistry, Universitas Diponegoro, Semarang, Indonesia
| | - Simon Shepherd
- Oral Surgery, School of Dentistry, University of Dundee, Dundee, UK
| | - Scheila Mânica
- Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Dundee, UK
| | - Ademir Franco
- Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Dundee, UK
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11
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Abstract
Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.
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Affiliation(s)
- Arthur B Schneider
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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12
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Benn DK. Reply to "Details Matter when Estimating Radiation Risk"). Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:254-255. [PMID: 34753696 DOI: 10.1016/j.oooo.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Douglas K Benn
- Dental and Maxillofacial Radiology Omaha, Omaha, NE, USA.
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13
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Jha N, Kim YJ, Lee Y, Lee JY, Lee WJ, Sung SJ. Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment. Korean J Orthod 2021; 51:189-198. [PMID: 33984226 PMCID: PMC8133899 DOI: 10.4041/kjod.2021.51.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults. Methods We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients. Results For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period. Conclusions The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.
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Affiliation(s)
- Nayansi Jha
- Department of Dentistry, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Ji Kim
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang-Jin Sung
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Van Gorp G, Lambrechts M, Jacobs R, Declerck D. Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging. Eur Arch Paediatr Dent 2021; 22:699-705. [PMID: 33713318 DOI: 10.1007/s40368-021-00611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries. AIM To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed. MATERIAL AND METHODS Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images. RESULTS Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D. CONCLUSIONS Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.
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Affiliation(s)
- G Van Gorp
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium.
| | - M Lambrechts
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Declerck
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
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15
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Van Acker JWG, Pauwels NS, Cauwels RGEC, Rajasekharan S. Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review. Eur Arch Paediatr Dent 2020; 21:463-508. [PMID: 32557182 DOI: 10.1007/s40368-020-00544-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination. METHODS A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed. RESULTS Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies. CONCLUSION The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.
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Affiliation(s)
- J W G Van Acker
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium.
| | - N S Pauwels
- Knowledge Center Ghent, Ghent University Hospital, C. Heymanslaan 10 (K3), 9000, Ghent, Belgium
| | - R G E C Cauwels
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium
| | - S Rajasekharan
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium
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16
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Quantification of DNA Double Strand Breaks and Oxidation Response in Children and Adults Undergoing Dental CBCT Scan. Sci Rep 2020; 10:2113. [PMID: 32034200 PMCID: PMC7005754 DOI: 10.1038/s41598-020-58746-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/03/2020] [Indexed: 01/22/2023] Open
Abstract
Assessing the possible biological effects of exposure to low doses of ionizing radiation (IR) is one of the prime challenges in radiation protection, especially in medical imaging. Today, radiobiological data on cone beam CT (CBCT) related biological effects are scarce. In children and adults, the induction of DNA double strand breaks (DSBs) in buccal mucosa cells and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) and antioxidant capacity in saliva samples after CBCT examination were examined. No DNA DSBs induction was observed in children nor adults. In children only, an increase in 8-oxo-dG levels was observed 30 minutes after CBCT. At the same time an increase in antioxidant capacity was observed in children, whereas a decrease was observed in adults. Our data indicate that children and adults react differently to IR doses associated with CBCT. Fully understanding these differences could lead to an optimal use of CBCT in different age categories as well as improved radiation protection guidelines.
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17
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In vivo comparison of MRI- and CBCT-based 3D cephalometric analysis: beginning of a non-ionizing diagnostic era in craniomaxillofacial imaging? Eur Radiol 2019; 30:1488-1497. [PMID: 31802215 DOI: 10.1007/s00330-019-06540-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate whether magnetic resonance imaging (MRI) can serve as an alternative diagnostic tool to the "gold standard" cone-beam computed tomography (CBCT) in 3D cephalometric analysis. METHODS In this prospective feasibility study, 12 patients (8 males, 4 females; mean age ± SD, 26.1 years ± 6.6) underwent 3D MRI and CBCT before orthognathic surgery. 3D cephalometric analysis was performed twice by two independent observers on both modalities. For each dataset, 27 cephalometric landmarks were defined from which 35 measurements (17 angles, 18 distances) were calculated. Statistical analyses included the calculation of Euclidean distances, intraclass correlation coefficients (ICCs), Bland-Altman analysis, and equivalence testing (linear mixed effects model) with a predefined equivalence margin of ± 1°/1 mm. RESULTS Analysis of reliability for CBCT vs. MRI (intra-rater I/intra-rater II/inter-rater) revealed Euclidean distances of 0.86/0.86/0.98 mm vs. 0.93/0.99/1.10 mm for landmarks, ICCs of 0.990/0.980/0.986 vs. 0.982/0.978/0.980 for angles, and ICCs of 0.992/0.988/0.989 vs. 0.991/0.985/0.988 for distances. Bland-Altman analysis showed high levels of agreement between CBCT and MRI with bias values (95% levels of agreement) of 0.03° (- 1.49; 1.54) for angles and 0.02 mm (- 1.44; 1.47) for distances. In the linear mixed effects model, the mean values of CBCT and MRI measurements were equivalent. CONCLUSION This feasibility study indicates that MRI enables reliable 3D cephalometric analysis with excellent agreement to corresponding measurements on CBCT. Thus, MRI could serve as a non-ionizing alternative to CBCT for treatment planning and monitoring in orthodontics as well as oral and maxillofacial surgery. KEY POINTS • Clinically established 3D cephalometric measurements performed on MRI are highly reliable and show an excellent agreement with CBCT (gold standard). • The MRI technique applied in this study could be used as a non-ionizing diagnostic tool in orthodontics as well as oral and maxillofacial surgery. • Since most patients benefiting from 3D cephalometry are young in age, the use of MRI could substantially contribute to radiation protection and open up new possibilities for treatment monitoring.
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18
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In vivo reliability of 3D cephalometric landmark determination on magnetic resonance imaging: a feasibility study. Clin Oral Investig 2019; 24:1339-1349. [DOI: 10.1007/s00784-019-03015-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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19
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Stratis A, Zhang G, Jacobs R, Bogaerts R, Bosmans H. The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice. Eur Radiol 2019; 29:7009-7018. [DOI: 10.1007/s00330-019-06287-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/21/2019] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
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20
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Minimum size and positioning of imaging field for CBCT scans of impacted maxillary canines. Clin Oral Investig 2019; 24:897-905. [DOI: 10.1007/s00784-019-02904-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
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21
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Halve the dose while maintaining image quality in paediatric Cone Beam CT. Sci Rep 2019; 9:5521. [PMID: 30940872 PMCID: PMC6445070 DOI: 10.1038/s41598-019-41949-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/20/2019] [Indexed: 11/08/2022] Open
Abstract
Cone beam CT (CBCT) for dentomaxillofacial paediatric assessment has been widely used despite the uncertainties of the risks of the low-dose radiation exposures. The aim of this work was to investigate the clinical performance of different CBCT acquisition protocols towards the optimization of paediatric exposures. Custom-made anthropomorphic phantoms were scanned using a CBCT unit in six protocols. CT slices were blinded, randomized and presented to three observers, who scored the image quality using a 4-point scale along with their level of confidence. Sharpness level was also measured using a test object containing an air/PMMA e,dge. The effective dose was calculated by means of a customized Monte Carlo (MC) framework using previously validated paediatric voxels models. The results have shown that the protocols set with smaller voxel size (180 µm), even when decreasing exposure parameters (kVp and mAs), showed high image quality scores and increased sharpness. The MC analysis showed a gradual decrease in effective dose when exposures parameters were reduced, with an emphasis on an average reduction of 45% for the protocol that combined 70 kVp, 16 mAs and 180 µm voxel size. In contrast, both "ultra-low dose" protocols that combined a larger voxel size (400 µm) with lower mAs (7.4 mAs) demonstrated the lowest scores with high levels of confidence unsuitable for an anatomical approach. In conclusion, a significant decrease in the effective dose can be achieved while maintaining the image quality required for paediatric CBCT.
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22
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Dose estimate for cone beam CT equipment protocols using Monte Carlo simulation in computational adult anthropomorphic phantoms. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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23
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Ghanbarnezhad Farshi R, Mesbahi A, Johari M, Kara Ü, Gharehaghaji N. Dosimetry of Critical Organs in Maxillofacial Imaging with Cone-beam Computed Tomography. J Biomed Phys Eng 2019; 9:51-60. [PMID: 30881934 PMCID: PMC6409370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/21/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND While the benefits of cone-beam computed tomography (CBCT) are well known in maxillofacial imaging, the use of this modality is not risk-free. OBJECTIVE The aim of this study was to evaluate the exposure doses received by patients during maxillofacial imaging with CBCT. METHODS Entrance surface dose (ESD) was measured by using thermoluminescent dosimeters (TLDs) attached to the eyes lids, parotid glands and thyroid of 64 patients in two imaging centers (A and B). Phantom dosimetry was performed by a cylindrical poly-methyl methacrylate (PMMA) head-size phantom and an ionization chamber for different exposure parameters. NewTom VGi and Planmeca Promax 3D CBCT scanners were used at centers A and B, respectively. RESULTS The mean ESD of the eyes, parotid glands and thyroid were 2.57, 2.33 and 0.28 mGy in center A, 0.35, 2.11 and 0.37 mGy in center B, respectively. ESD of the eyes revealed a significant difference in two centers; in center B, it was 86.4% lower than center A. In the phantom dosimetry, the measured doses of NewTom VGi were 2.63 and 2.08 mGy, respectively by changing field of view (FOV) size from 8×8 cm2 (height × diameter) to 6×6 cm2. For Planmeca Promax 3D, it ranged from 0.98 to 3.24 mGy depending on exposure parameters. CONCLUSION There is a wide range of radiation doses dependent on the units, patients and selected scan parameters. Inappropriate selection of exposure settings, especially FOV size, can seriously increase patient dose.
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Affiliation(s)
- R Ghanbarnezhad Farshi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Mesbahi
- Medical Physics Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Johari
- Department of Oral & Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ü Kara
- Vocational School of Health Services, Suleyman Demirel University, Isparta, Turkey
| | - N Gharehaghaji
- Radiology Department, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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24
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Malik DES, Fida M, Sukhia RH. Correlation between radiographic parameters for the prediction of palatally impacted maxillary canines. J Orthod 2019; 46:6-13. [DOI: 10.1177/1465312518823012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to identify radiographic parameters on routine orthopantomograms to aid in early diagnosis of palatally impacted canines. Design: Split-mouth case-control study. Setting: Single-centre university dental hospital. Methods: Thirty-three individuals with palatally impacted canines and non-impacted contra-lateral teeth were recruited. Radiographic variables angle A, angle B, angle C, distance D, sector class and depth of vertical impaction were measured for both groups. Mann–Whitney U test and Spearman’s correlation coefficient were used to analyse significant differences and association between variables with sector class and depth of vertical impaction, respectively. Logistic regression analysis determined radiographic parameters as predictors of palatal impaction. Results: Significant differences were seen between sector class, depth of vertical impaction and the radiographic parameters between cases and controls ( P ⩽ 0.001). For cases, strong correlation was found for angle C between the impacted canine and occlusal plane (r = −0.28, P = 0.022) and perpendicular distance D of impacted canine to the occlusal plane (r = 0.81, P ⩽ 0.001) with the depth of vertical impaction. Logistic regression analysis showed the odds of canine impaction increase with an increase in angle B and angle C. Conclusions: Our study showed that greater depth of vertical impaction, sector class, increased perpendicular distance and reduced angulation from occlusal plane resulted in palatal impaction of permanent maxillary canines. The odds of palatal canine impaction increase nearly twofold with every 10 increase in angle B and angle C.
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Affiliation(s)
- Durr e Shahwar Malik
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mubassar Fida
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Rashna Hoshang Sukhia
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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25
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De Mulder D, Cadenas de Llano‐Pérula M, Willems G, Jacobs R, Dormaar JT, Verdonck A. An optimized imaging protocol for orofacial cleft patients. Clin Exp Dent Res 2018; 4:152-157. [PMID: 30386636 PMCID: PMC6203823 DOI: 10.1002/cre2.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/09/2022] Open
Abstract
The objective was to present an optimized imaging protocol for orofacial cleft (OFC) patients, which might be used as an international recommendation for OFC care programs. The present radiological protocol has been structured by the OFC team of the University Hospitals Leuven based on a combined approach of clinical experience and scientific evidence. The development was based on careful monitoring of the existing needs for radiological diagnosis by the involved disciplines. Needs were revised by expert consensus and radiological optimization. Effective doses were converted to panoramic equivalents (professional conversion) and background radiation (patient conversion). At the age of 6, a panoramic radiograph is taken for the evaluation of dental anomalies. For the preoperative planning of secondary alveolar bone, grafting a low-resolution cone beam computer tomography (CBCT) of a limited field of the maxilla is taken at the age of 7 to 9. At the age of 10, 15, and 20, a low-resolution CBCT of both jaws with the smallest possible field is taken serving as conventional, presurgical, and end of treatment records, respectively. Two-dimensional images are reconstructed out of 3D ones. There are currently no international guidelines concerning the imaging protocol for OFC patients. It is clear that a multidisciplinary approach plays a key role in radiation hygiene. In this article, we presented an optimized imaging protocol for OFC patients based on European guidelines to accomplish the concepts of justification and optimization, which might be used as an international recommendation for OFC care programs.
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Affiliation(s)
- Dries De Mulder
- Department of Oral Health Sciences‐Orthodontics, KU Leuven and DentistryUniversity Hospitals LeuvenBelgium
| | | | - Guy Willems
- Department of Oral Health Sciences‐Orthodontics, KU Leuven and DentistryUniversity Hospitals LeuvenBelgium
| | - Reinhilde Jacobs
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, University Leuven and Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
- Department of Dental MedicineKarolinska InstitutetSweden
| | - Jakob Titiaan Dormaar
- OMFS IMPATH, Department of Imaging & Pathology, Faculty of Medicine, University Leuven and Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenBelgium
| | - Anna Verdonck
- Department of Oral Health Sciences‐Orthodontics, KU Leuven and DentistryUniversity Hospitals LeuvenBelgium
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26
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Virag P, Hedesiu M, Soritau O, Perde-Schrepler M, Brie I, Pall E, Fischer-Fodor E, Bogdan L, Lucaciu O, Belmans N, Moreels M, Salmon B, Jacobs R. Low-dose radiations derived from cone-beam CT induce transient DNA damage and persistent inflammatory reactions in stem cells from deciduous teeth. Dentomaxillofac Radiol 2018; 48:20170462. [PMID: 30168750 DOI: 10.1259/dmfr.20170462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Cone-beam CT (CBCT), a radiographic tool for diagnosis, treatment, and follow-up in dental practice, was introduced also in pediatric radiology, especially orthodontics. Such patients subjected to repetitive X-rays examinations may receive substantial levels of radiation doses. Ionizing radiation (IR), a recognized carcinogenic factor causing DNA double-strand breaks (DSBs) could be harmful to undifferentiated cells such as dental pulp stem cells (DPSCs) since inaccurately repaired or unrepaired DSBs may lead to malignant transformation. The H2AX and MRE11 proteins generated following DSBs formation and pro-inflammatory cytokines (CKs) secreted after irradiation are relevant candidates to monitor the cellular responses induced by CBCT. METHODS DPSCs were extracted from human exfoliated deciduous teeth and their phenotype was assessed by immunocytochemistry and flow-cytometry. Cells were exposed to IR doses: 5.4-107.7 mGy, corresponding to 0.5-8 consecutive skull exposures, respectively. H2AX and MRE11 were detected in whole cells, while IL-1α, IL-6, IL-8, TNFα in supernatants, using enzyme-linked immunosorbent assay (ELISA) at different time points after exposure. RESULTS The phosphorylation level of H2AX in DPSCs increased considerably at 0.5 h after exposure (p < 0.001 for 3, 5, 8 skull exposures and p < 0.05 for 1 skull exposure, respectively). MRE11 response could only be detected for the highest IR dose (p < 0.001) in the same interval. CKs secretion increased upon CBCT exposure according to doses and time. CONCLUSIONS The DPSCs exposure to CBCT induces transient DNA damage and persistent inflammatory reaction in DPSCs drawing the attention on the potential risks of IR exposures and on the importance of dose monitoring in pediatric population.
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Affiliation(s)
- Piroska Virag
- The Oncology Institute "Prof.Dr.Ion Chiricuta", Laboratory of Radiotherapy, Radiobiology and Tumor Biology, Cluj-Napoca, Romania
| | - Mihaela Hedesiu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Oral and Maxillofacial Radiology, Cluj-Napoca, Romania
| | - Olga Soritau
- The Oncology Institute "Prof.Dr.Ion Chiricuta", Laboratory of Radiotherapy, Radiobiology and Tumor Biology, Cluj-Napoca, Romania
| | - Maria Perde-Schrepler
- The Oncology Institute "Prof.Dr.Ion Chiricuta", Laboratory of Radiotherapy, Radiobiology and Tumor Biology, Cluj-Napoca, Romania
| | - Ioana Brie
- The Oncology Institute "Prof.Dr.Ion Chiricuta", Laboratory of Radiotherapy, Radiobiology and Tumor Biology, Cluj-Napoca, Romania
| | - Emoke Pall
- University of Agricultural Sciences and Veterinary Medicine, Cluj- Napoca, Romania
| | - Eva Fischer-Fodor
- The Oncology Institute "Prof.Dr.Ion Chiricuta", Laboratory of Radiotherapy, Radiobiology and Tumor Biology, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Medfuture Research Center for Advanced Medicine, Cluj-Napoca, Romania
| | - Loredana Bogdan
- Radiation Hygiene Department, National Institute of Public Health, Regional Center of Public Health Cluj-Napoca, Cluj-Napoca, Romania
| | - Ondine Lucaciu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Oral and Maxillofacial Radiology, Cluj-Napoca, Romania
| | - Niels Belmans
- Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Hasselt, Belgium.,Radiobiology Unit, Interdisciplinary Biosciences, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre, SCK·CEN, Boeretang, Belgium
| | - Marjan Moreels
- Radiobiology Unit, Interdisciplinary Biosciences, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre, SCK·CEN, Boeretang, Belgium
| | - Benjamin Salmon
- EA2496, Orofacial Pathologies, Imaging and Biotherapies, Dental School Paris Descartes University, Sorbonne Paris Cité, France.,Department of Odontology, AP-HP, Nord Val de Seine Hospital (Bretonneau), Paris, France
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, University of Leuven, Leuven, Belgium
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3D cephalometric analysis using Magnetic Resonance Imaging: validation of accuracy and reproducibility. Sci Rep 2018; 8:13029. [PMID: 30158656 PMCID: PMC6115428 DOI: 10.1038/s41598-018-31384-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/19/2018] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to validate geometric accuracy and in vivo reproducibility of landmark-based cephalometric measurements using high-resolution 3D Magnetic Resonance Imaging (MRI) at 3 Tesla. For accuracy validation, 96 angular and 96 linear measurements were taken on a phantom in 3 different positions. In vivo MRI scans were performed on 3 volunteers in five head positions. For each in vivo scan, 27 landmarks were determined from which 19 angles and 26 distances were calculated. Statistical analysis was performed using Bland-Altman analysis, the two one-sided tests procedure and repeated measures one-way analysis of variance. In comparison to ground truth, all MRI-based phantom measurements showed statistical equivalence (p < 0.001) and an excellent agreement in Bland-Altman analysis (bias ranges: -0.090-0.044°, -0.220-0.241 mm). In vivo cephalometric analysis was highly reproducible among the five different head positions in all study participants, without statistical differences for all angles and distances (p > 0.05). Ranges between maximum and minimum in vivo values were consistently smaller than 2° and 2 mm, respectively (average ranges: 0.88°/0.87 mm). In conclusion, this study demonstrates that accurate and reproducible 3D cephalometric analysis can be performed without exposure to ionizing radiation using MRI.
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Yeh JK, Chen CH. Estimated radiation risk of cancer from dental cone-beam computed tomography imaging in orthodontics patients. BMC Oral Health 2018; 18:131. [PMID: 30075771 PMCID: PMC6091080 DOI: 10.1186/s12903-018-0592-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/16/2018] [Indexed: 12/03/2022] Open
Abstract
Background Radiation dose evaluation is important to cone-beam computed tomography (CBCT) for routine orthodontic treatment planning, especially for a significant proportion of children in orthodontic patients. This study evaluated the patient radiation dose and estimated the radiation cancer risk on dental CBCT according to the calculations by the Monte Carlo simulation method. Methods The dental CBCT scanner evaluated in this project was the i- CAT® (Imaging Sciences International Inc., PA, U.S.A.) device. Organ doses and effective doses were calculated by using personal computer-based Monte Carlo simulation (PCXMC 2.0 Rotation) software. The cancer risk resulting from the exposure to ionizing radiation was estimated by using the BEIR VII (Biologic Effects of Ionizing Radiation VII) report model, and the risk of exposure-induced death (REID) was assessed by PCXMC 2.0 Rotation software. Results The largest contribution to the organ dose and effective dose at Zref 83 cm positioned in the dental CBCT x-ray beam centerline was from the salivary glands (738.29μGy, 7.38 μSv). The different organ doses showed the maximum values at the different Zref locations, and the largest contribution to the organ dose and effective dose of all simulated positions was from the thyroid (928.77μGy, 37.5 μSv). The REID values in the 10-year olds (22.6 × 10− 7, female; 19 × 10− 7, male) were approximately double than those in 30-year olds (10.4 × 10− 7, female; 8.88 × 10− 7, male) for all cancers. The highest change during age range from 10 to 30 was shown in breast cancer of females. Conclusions Although individual cancer risk estimates as a function of gender and age are small, the concern about the risks from dental CBCT is related to the rapid increase in its use for orthodontic practice, especially in children patients.
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Affiliation(s)
- Jih-Kuei Yeh
- Division of Family Medicine, Kaohsiung Municipal United Hospital, No.976, Jhonghua 1st Rd., Gushan Dist, Kaohsiung City, 804, Taiwan
| | - Chia-Hui Chen
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, No.666, Buzih Road, Beitun District, Taichung City, 40601, Taiwan. .,College of Photonics National Chiao Tung University, No.301, Gaofa 3rd Rd., Guiren Dist, Tainan City, 711, Taiwan.
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Bornstein MM, Horner K, Jacobs R. Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research. Periodontol 2000 2018; 73:51-72. [PMID: 28000270 DOI: 10.1111/prd.12161] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.
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Greenberg AM. Advanced dental implant placement techniques. J Istanb Univ Fac Dent 2017; 51:S76-S89. [PMID: 29354312 PMCID: PMC5750831 DOI: 10.17096/jiufd.17594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/28/2017] [Indexed: 11/15/2022] Open
Abstract
The availability of in office Cone Beam CT (CBCT) scanners, dental implant planning software, CAD CAM milling, and rapid printing technologies allow for the precise placement of dental implants and immediate prosthetic temporization. These technologies allow for flapless implant placement, or open flap bone reduction for "All on 4" techniques with improved preoperative planning and intraoperative performance. CBCT permits practitioners in an office setting with powerful diagnostic capabilities for the evaluation of bone quality and quantity, as well as dental and osseous pathology essential for better informed dental implant treatment. CBCT provides the convenience of in office imaging and decreased radiation exposure. Rapid printing technologies provide decreased time and high accuracy for bone model and surgical guide fabrication.
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Affiliation(s)
- Alex M Greenberg
- Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, Attending, The New York Presbyterian Hospital, The Mount Sinai Hospital, Mount Sinai Beth Israel Medical Center, and Mount West Hospital, New York, NY,USA
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Pediatric cleft palate patients show a 3- to 5-fold increase in cumulative radiation exposure from dental radiology compared with an age- and gender-matched population: a retrospective cohort study. Clin Oral Investig 2017; 22:1783-1793. [PMID: 29188451 DOI: 10.1007/s00784-017-2274-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to compare estimates of pediatric cumulative exposure and lifetime attributable risk (LAR) of radiation-induced cancer from dental radiology between cleft palate (CP) subjects and age- and gender-matched controls (non-CP), with and without orthodontic treatment. MATERIALS AND METHODS The radiation exposure frequency of CP subjects and non-CP controls with and without orthodontic treatment was compared for two-dimensional radiography (intra-oral, panoramic and cephalometric radiography), computed tomography (CT), and cone-beam CT (CBCT) using cumulative radiation dose as an estimate. From this dose estimate, the age- and gender-dependent risk for radiation-induced stochastic effects was calculated for each patient group. RESULTS CP patients received more radiographic examinations than non-CP controls, with the exception of intra-oral radiographs. The cumulative dose to CP patients was considerably higher (1963 μSv at the age of 20 years) than non-CP patients with (597 μSv) and without (383 μSv) orthodontic treatment, primarily due to the higher frequency of CT scanning. Accordingly, CP patients had a three to five times higher LAR than non-CP patients. CONCLUSIONS This study suggests a significantly higher lifetime radiation exposure to CP patients than non-CP controls from dental radiographic procedures. Diagnostic benefits from the use of CT and CBCT in children must be justified and appropriate dose optimization strategies implemented. CLINICAL RELEVANCE The present study indicates the need for proper justification and optimization of pediatric exposures in dentistry, with a special focus on high-risk groups.
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Abstract
NICE guidance for mandibular third molars has been available since 2000. This was set up to limit the surgical treatment of these teeth to symptomatic patients. There are numerous risks involved with surgical treatment of mandibular third molars and these should be explained in detail to the patient. Common and serious complications of mandibular third molar surgery are damage to the inferior alveolar and lingual nerve. Predicting the risk of inferior alveolar nerve injury is useful for treatment planning. The orthopantomogram (OPT) is the baseline special test for assessing this and numerous signs on an OPT can predict an increased risk of injury to the nerve. Cone beam computed tomography (CBCT) is being more frequently used to assess this relationship further and can influence treatment planning. Coronectomy is a technique whereby the crown of the tooth is sectioned and removed leaving the roots in situ. This has proven to be a useful technique in high risk cases, but is not without its own complications. The increase in availability of CBCT imaging and the recent resurgence of coronectomy as a treatment modality can increase the number of treatment options available to patients. We have proposed an algorithm to aid the treatment planning and informed consent processes associated with mandibular third molar surgery. Clinical relevance: This article is relevant to primary and secondary care dental practitioners as it will aid the investigation, treatment planning, correct referral and management of patients with problematic mandibular third molars.
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Watanabe T, Miyazawa K, Fujiwara T, Kawaguchi M, Tabuchi M, Goto S. Insertion torque and Periotest values are important factors predicting outcome after orthodontic miniscrew placement. Am J Orthod Dentofacial Orthop 2017; 152:483-488. [PMID: 28962732 DOI: 10.1016/j.ajodo.2017.01.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 01/01/2017] [Accepted: 01/01/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 14% of orthodontic anchor screws (miniscrews) become dislodged regardless of the accuracy of placement. It is therefore important to investigate the factors causing dislodgement. We evaluated the stability of miniscrews after placement to identify factors influencing outcome in orthodontic treatment using miniscrews. METHODS We investigated 120 miniscrews (Dual-top Auto Screw III; Jeil Medical, Seoul, Korea) (diameter, 1.4 mm; length, 6 mm) placed on the buccal or lingual side between the maxillary second premolar and the first molar in women. Patient age and rate and time of screw dislodgement were examined. Insertion torque values and Periotest (Tokyo Dental Industrial, Tokyo, Japan) measurements indicating horizontal and vertical mobility of the inserted screws were compared between groups with and without dislodgement (failure and success groups, respectively). RESULTS Mean insertion torque values were 10.7 ± 1.9 N·cm and 8.5 ± 2.1 N·cm in the failure and success groups, respectively. Cortical bone thickness measurements (success group, 1.34 ± 0.35 mm; failure group, 0.99 ± 0.09 mm) were significantly higher, whereas Periotest values at placement (success group, horizontal, 4.9 ± 1.4; vertical, 4.7 ± 1.3; failure group, horizontal, 7.0 ± 0.8; vertical, 7.1 ± 0.9) were significantly lower in the success group than in the failure group. CONCLUSIONS The Periotest value, together with insertion torque and cortical bone thickness, could serve as an index of initial stability for predicting the outcome of miniscrew placement.
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Affiliation(s)
- Takashi Watanabe
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan; private practice, Aichi, Japan.
| | - Ken Miyazawa
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Takuya Fujiwara
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Misuzu Kawaguchi
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Masako Tabuchi
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Shigemi Goto
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Dersot JM. La chirurgie parodontale de la canine maxillaire incluse au service de l’orthodontiste. Proposition d’un arbre de décision chirurgicale. Int Orthod 2017; 15:221-237. [DOI: 10.1016/j.ortho.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dersot JM. Periodontal surgery of the maxillary impacted canine for orthodontic purposes: Proposal for a surgical decision tree. Int Orthod 2017; 15:221-237. [PMID: 28457915 DOI: 10.1016/j.ortho.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a private practice, between January 2010 and December 2015, 621 impacted teeth were exposed for orthodontic purposes. The majority were maxillary canines (464=74.71%), followed by maxillary central incisors (36=5.80%), mandibular canines (32=5.15%) and, finally, second premolars (30=4.83%). The 464 maxillary canines were present in 356 patients with a mean age, at the time of the intervention, of 15 years and 3 months (7 years and 10 months to 45 years and one month). The gender distribution was 60.7% (F) to 39.3% (M); 32.8% of maxillary canines were buccal and 67.2% were palatal. Only 6 canines did not move, with a success rate of 98.7%. At the pretreatment interview, the orthodontists explained that orthodontic-surgical placement of an impacted canine lengthened treatment time by an average 6 months, but in some cases by 12 months or more. The purpose of this surgery is to help the orthodontist to position the impacted tooth in the dental arch with all the periodontal structures and with the best possible integration esthetics. The objective of this article is to illustrate the periodontal orthodontic surgery of the maxillary canine and to propose a surgical decision tree.
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Eslami E, Barkhordar H, Abramovitch K, Kim J, Masoud MI. Cone-beam computed tomography vs conventional radiography in visualization of maxillary impacted-canine localization: A systematic review of comparative studies. Am J Orthod Dentofacial Orthop 2017; 151:248-258. [DOI: 10.1016/j.ajodo.2016.07.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/25/2022]
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Pauwels R, Jacobs R, Bogaerts R, Bosmans H, Panmekiate S. Determination of size-specific exposure settings in dental cone-beam CT. Eur Radiol 2016; 27:279-285. [PMID: 27108296 DOI: 10.1007/s00330-016-4353-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/15/2016] [Accepted: 04/05/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate the possible reduction of tube output as a function of head size in dental cone-beam computed tomography (CBCT). METHODS A 16 cm PMMA phantom, containing a central and six peripheral columns filled with PMMA, was used to represent an average adult male head. The phantom was scanned using CBCT, with 0-6 peripheral columns having been removed in order to simulate varying head sizes. For five kV settings (70-90 kV), the mAs required to reach a predetermined image noise level was determined, and corresponding radiation doses were derived. Results were expressed as a function of head size, age, and gender, based on growth reference charts. RESULTS The use of 90 kV consistently resulted in the largest relative dose reduction. A potential mAs reduction ranging from 7 % to 50 % was seen for the different simulated head sizes, showing an exponential relation between head size and mAs. An optimized exposure protocol based on head circumference or age/gender is proposed. CONCLUSIONS A considerable dose reduction, through reduction of the mAs rather than the kV, is possible for small-sized patients in CBCT, including children and females. Size-specific exposure protocols should be clinically implemented. KEY POINTS • Fixed exposure settings in CBCT results in overexposure for smaller patients • For children, considerable dose reduction is possible without compromising image quality • A reduction in mAs is more dose-efficient than a kV reduction • An optimized exposure protocol was proposed based on phantom measurements • This protocol should be validated in a clinical setting.
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Affiliation(s)
- Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Rd, Patumwan, 10330, Bangkok, Thailand. .,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Ria Bogaerts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Hilde Bosmans
- Medical Physics & Quality Assessment, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Rd, Patumwan, 10330, Bangkok, Thailand
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Greenberg AM. Cone beam computed tomography scanning and diagnosis for dental implants. Oral Maxillofac Surg Clin North Am 2016; 27:185-202. [PMID: 25951956 DOI: 10.1016/j.coms.2015.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cone beam computed tomography (CBCT) has become an important new technology for oral and maxillofacial surgery practitioners. CBCT provides improved office-based diagnostic capability and applications for surgical procedures, such as CT guidance through the use of computer-generated drill guides. A thorough knowledge of the basic science of CBCT as well as the ability to interpret the images correctly and thoroughly is essential to current practice.
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Affiliation(s)
- Alex M Greenberg
- Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 W. 168th Street, New York, NY 10032, USA; Private Practice Limited to Oral and Maxillofacial Surgery, 18 East 48th Street Suite 1702, New York, NY 10017, USA.
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Kiljunen T, Kaasalainen T, Suomalainen A, Kortesniemi M. Dental cone beam CT: A review. Phys Med 2015; 31:844-860. [PMID: 26481816 DOI: 10.1016/j.ejmp.2015.09.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 11/17/2022] Open
Abstract
For the maxillofacial region, there are various indications that cannot be interpreted from 2D images and will benefit from multiplanar viewing. Dental cone beam CT (CBCT) utilises a cone- or pyramid-shaped X-ray beam using mostly flat-panel detectors for 3D image reconstruction with high spatial resolution. The vast increase in availability and amount of these CBCT devices offers many clinical benefits, and their ongoing development has potential to bring various new clinical applications for medical imaging. Additionally, there is also a need for high quality research and education. European guidelines promote the use of a medical physics expert for advice on radiation protection, patient dose optimisation, and equipment testing. In this review article, we perform a comparison of technical equipment based on manufacturer data, including scanner specific X-ray spectra, and describe issues concerning CBCT image reconstruction and image quality, and also address radiation dose issues, dosimetry, and optimisation. We also discuss clinical needs and what type of education users should have in order to operate CBCT systems safely. We will also take a look into the future and discuss the issues that still need to be solved.
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Affiliation(s)
- Timo Kiljunen
- Docrates Cancer Center, Saukonpaadenranta 2, 00180 Helsinki, Finland.
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Anni Suomalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Mika Kortesniemi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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Pauwels R, Seynaeve L, Henriques JCG, de Oliveira-Santos C, Souza PC, Westphalen FH, Rubira-Bullen IRF, Ribeiro-Rotta RF, Rockenbach MIB, Haiter-Neto F, Pittayapat P, Bosmans H, Bogaerts R, Jacobs R. Optimization of dental CBCT exposures through mAs reduction. Dentomaxillofac Radiol 2015; 44:20150108. [PMID: 26090934 DOI: 10.1259/dmfr.20150108] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the effect of tube current-exposure time (mAs) reduction on clinical and technical image quality for different CBCT scanners, and to determine preliminary minimally acceptable values for the mAs and contrast-to-noise ratio (CNR) in CBCT. METHODS A polymethyl methacrylate (PMMA) phantom and an anthropomorphic skull phantom, containing a human skeleton embedded in polyurethane, were scanned using four CBCT devices, including seven exposure protocols. For all protocols, the mAs was varied within the selectable range. Using the PMMA phantom, the CNRAIR was measured and corrected for voxel size. Eight axial slices and one coronal slice showing various anatomical landmarks were selected for each CBCT scan of the skull phantom. The slices were presented to six dentomaxillofacial radiologists, providing scores for various anatomical and diagnostic parameters. RESULTS A hyperbolic relationship was seen between CNRAIR and mAs. Similarly, a gradual reduction in clinical image quality was seen at lower mAs values; however, for several protocols, image quality remained acceptable for a moderate or large mAs reduction compared with the standard exposure setting, depending on the clinical application. The relationship between mAs, CNRAIR and observer scores was different for each CBCT device. Minimally acceptable values for mAs were between 9 and 70, depending on the criterion and clinical application. CONCLUSIONS Although noise increased at a lower mAs, clinical image quality often remained acceptable at exposure levels below the manufacturer's recommended setting, for certain patient groups. Currently, it is not possible to determine minimally acceptable values for image quality that are applicable to multiple CBCT models.
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Affiliation(s)
- R Pauwels
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,2 OMFS-IMPATH Research Group, Oral Imaging Center, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - L Seynaeve
- 2 OMFS-IMPATH Research Group, Oral Imaging Center, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - J C G Henriques
- 2 OMFS-IMPATH Research Group, Oral Imaging Center, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - C de Oliveira-Santos
- 3 Department of Stomatology, Public Health and Forensic Dentistry, University of São Paulo, School of Dentistry of Ribeirão Preto of Dentistry, São Paulo, Brazil
| | - P C Souza
- 4 School of Dentistry, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - F H Westphalen
- 4 School of Dentistry, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - I R F Rubira-Bullen
- 5 Stomatology Department, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - R F Ribeiro-Rotta
- 6 Department of Oral Medicine, School of Dentistry, Federal University of Goiás, Goiás, Brazil
| | - M I B Rockenbach
- 7 Department of Surgery, Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - F Haiter-Neto
- 8 Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - P Pittayapat
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,2 OMFS-IMPATH Research Group, Oral Imaging Center, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - H Bosmans
- 9 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - R Bogaerts
- 10 Department of Experimental Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- 1 Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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41
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Batista WO, Soares MR, de Oliveira MVL, Maia AF, Caldas LVE. Assessment of protocols in cone-beam CT with symmetric and asymmetric beams usingeffective dose and air kerma-area product. Appl Radiat Isot 2015; 100:16-20. [PMID: 25620114 DOI: 10.1016/j.apradiso.2015.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/22/2014] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
This study aims to evaluate and compare protocols with similar purposes in a cone beam CT scanner using thermoluminescent dosimeter (TLD) and the air kerma-area product (PKA) as the kerma index. The measurements were performed on two protocols used to obtain an image of the maxilla-mandible using the equipment GENDEX GXCB 500: Protocol [GX1] extended diameter and asymmetric beam (14cm×8.5cm-maxilla/mandible) and protocol [GX2] symmetrical beam (8.5cm×8.5cm-maxillary/mandible). LiF dosimeters inserted into a female anthropomorphic phantom were used. For both protocols, the value of PKA was evaluated using a PTW Diamentor E2 meter and the multimeter Radcal Rapidose system. The results obtained for the effective dose/PKA were separated by protocol image. [GX1]: 44.5µSv/478mGycm(2); [GX2]: 54.8µSv/507mGycm(2). Although the ratio of the diameters (14cm/8.5cm)=1.65, the ratio of effective dose values (44.5µSv/54.8µSv)=0.81, that is, the effective dose of the protocol with extended diameter is 19% smaller. The PKA values reveal very similar results between the two protocols. For the cases where the scanner uses an asymmetric beam to obtain images with large diameters that cover the entire face, there are advantages from the point of view of reducing the exposure of patients when compared to the use of symmetrical beam and/or to FOV images with a smaller diameter.
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Affiliation(s)
- Wilson Otto Batista
- Federal Institute of Bahia, IFBA, Rua Emídio dos Santos, s/n. Barbalho, CEP: 40301-015, Salvador, BA, Brazil.
| | - Maria Rosangela Soares
- Federal University of Sergipe, UFS, NPGFI, Rod. Marechal Rondon s/n, Jardim Rosa Elze,CEP: 49.100-000, São Cristóvão, SE, Brazi
| | - Marcus V L de Oliveira
- Federal Institute of Bahia, IFBA, Rua Emídio dos Santos, s/n. Barbalho, CEP: 40301-015, Salvador, BA, Brazil
| | - Ana F Maia
- Federal University of Sergipe, UFS, NPGFI, Rod. Marechal Rondon s/n, Jardim Rosa Elze,CEP: 49.100-000, São Cristóvão, SE, Brazi
| | - Linda V E Caldas
- Nuclear and Energy Research Institute, IPEN, Av. Lineu Prestes 2242, Cidade Universitária, CEP: 05508-000 São Paulo, SP, Brazil
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