Advertisement

Clinical Oral Investigations

, Volume 23, Issue 6, pp 2573–2581 | Cite as

Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities

  • Andy W. K. Yeung
  • Reinhilde Jacobs
  • Michael M. BornsteinEmail author
Review

Abstract

Objectives

A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines.

Materials and methods

Google Scholar was searched using the words “low-dose CBCT”. Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words “pedo,” “ortho,” “endo,” “implant,” “perio,” and “oral surgery.” Furthermore, references of included articles were examined to identify further relevant articles.

Results

After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine.

Conclusions

Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction.

Clinical relevance

Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.

Keywords

CBCT Low-dose protocol Indications Limitations ALARA ALADA 

Notes

Funding

This study has been funded by departmental funds only. No external funding has been received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.

Informed consent

Not applicable.

References

  1. 1.
    Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IB (1998) A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 8:1558–1564CrossRefGoogle Scholar
  2. 2.
    Scarfe WC, Farman AG, Sukovic P (2006) Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc 72:75–80Google Scholar
  3. 3.
    Nemtoi A, Czink C, Haba D, Gahleitner A (2013) Cone beam CT: a current overview of devices. Dentomaxillofac Radiol 42:20120443CrossRefGoogle Scholar
  4. 4.
    Horner K, Islam M, Flygare L, Tsiklakis K, Whaites E (2009) Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 38:187–195CrossRefGoogle Scholar
  5. 5.
    Dula K, Bornstein MM, Buser D, Dagassan-Berndt D, Ettlin DA, Filippi A, Gabioud F, Katsaros C, Krastl G, Lambrecht JT (2014) SADMFR guidelines for the use of cone-beam computed tomography/digital volume tomography. Swiss Dent J 124:1169–1183Google Scholar
  6. 6.
    Dula K, Benic GI, Bornstein M, Dagassan-Berndt D, Filippi A, Hicklin S, Kissling-Jeger F, Luebbers H-T, Sculean A, Sequeira-Byron P (2015) SADMFR guidelines for the use of cone-beam computed tomography/digital volume tomography. Swiss Dent J 125:945–953Google Scholar
  7. 7.
    European Commission (2012) Cone beam CT for dental and maxillofacial radiology (evidence-based guidelines). Radiation Protection No 172. https://ec.europa.eu/energy/sites/ener/files/documents/172.pdf. Accessed 8 June 2018
  8. 8.
    Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B, Group DR (2018) Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 48:308–316CrossRefGoogle Scholar
  9. 9.
    Evans CA, Scarfe WC, Ahmad M, Cevidanes LH, Ludlow JB, Palomo JM, Simmons KE, White SC (2013) Clinical recommendations regarding use of cone beam computed tomography in orthodontics. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 116:238–257CrossRefGoogle Scholar
  10. 10.
    Patel S, Durack C, Abella F, Roig M, Shemesh H, Lambrechts P, Lemberg K (2014) European Society of Endodontology position statement: the use of CBCT in endodontics. Int Endod J 47:502–504CrossRefGoogle Scholar
  11. 11.
    Fayad MI, Nair M, Levin MD, Benavides E, Rubinstein RA, Barghan S, Hirschberg CS, Ruprecht A (2015) AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 120:508–512CrossRefGoogle Scholar
  12. 12.
    Kim DM, Bassir SH (2017) When is cone-beam computed tomography imaging appropriate for diagnostic inquiry in the management of inflammatory periodontitis? An American Academy of Periodontology best evidence review. J Periodontol 88:978–998CrossRefGoogle Scholar
  13. 13.
    Harris D, Horner K, Gröndahl K, Jacobs R, Helmrot E, Benic GI, Bornstein MM, Dawood A, Quirynen M (2012) E.A.O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res 23:1243–1253CrossRefGoogle Scholar
  14. 14.
    Benavides E, Rios HF, Ganz SD, An C-H, Resnik R, Reardon GT, Feldman SJ, Mah JK, Hatcher D, Kim M-J (2012) Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report. Implant Dent 21:78–86CrossRefGoogle Scholar
  15. 15.
    Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R (2014) Cone beam computed tomography in implant dentistry: a systematic review focusing on guidelines, indications, and radiation dose risks. Int J Oral Maxillofac Implants 29:55–77CrossRefGoogle Scholar
  16. 16.
    White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, Law CS, Levin MD, Sauer RA, Valachovic RW (2014) The image gently in dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 118:257–261CrossRefGoogle Scholar
  17. 17.
    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263CrossRefGoogle Scholar
  18. 18.
    Hendee WR, Edwards FM (1986) ALARA and an integrated approach to radiation protection. Semin Nucl Med 16:142–150CrossRefGoogle Scholar
  19. 19.
    Pauwels R, Beinsberger J, Collaert B, Theodorakou C, Rogers J, Walker A, Cockmartin L, Bosmans H, Jacobs R, Bogaerts R (2012) Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 81:267–271CrossRefGoogle Scholar
  20. 20.
    Jacobs R, Salmon B, Codari M, Hassan B, Bornstein MM (2018) Cone beam computed tomography in implant dentistry: recommendations for clinical use. BMC Oral Health 18:88CrossRefGoogle Scholar
  21. 21.
    Guerrero ME, Jacobs R, Loubele M, Schutyser F, Suetens P, van Steenberghe D (2006) State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clin Oral Investig 10:1–7CrossRefGoogle Scholar
  22. 22.
    Van der Molen A, Schilham A, Stoop P, Prokop M, Geleijns J (2013) A national survey on radiation dose in CT in the Netherlands. Insights Imaging 4:383–390CrossRefGoogle Scholar
  23. 23.
    Qu X, Li G, Zhang Z, Ma X (2012) Thyroid shields for radiation dose reduction during cone beam computed tomography scanning for different oral and maxillofacial regions. Eur J Radiol 81:e376–e380CrossRefGoogle Scholar
  24. 24.
    Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefGoogle Scholar
  25. 25.
    Jacobs R, Pauwels R, Scarfe WC, De Cock C, Dula K, Willems G, Verdonck A, Politis C (2018) 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 22:1783–1793CrossRefGoogle Scholar
  26. 26.
    McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, LeRoy AJ (2007) Radiation exposure and pregnancy: when should we be concerned? Radiographics 27:909–917CrossRefGoogle Scholar
  27. 27.
    Kelaranta A, Ekholm M, Toroi P, Kortesniemi M (2015) Radiation exposure to foetus and breasts from dental X-ray examinations: effect of lead shields. Dentomaxillofac Radiol 45:20150095CrossRefGoogle Scholar
  28. 28.
    Marcu M, Hedesiu M, Salmon B, Pauwels R, Stratis A, Oenning ACC, Cohen ME, Jacobs R, Baciut M, Roman R (2018) Estimation of the radiation dose for pediatric CBCT indications: a prospective study on ProMax3D. Int J Paediatr Dent 28:300–309CrossRefGoogle Scholar
  29. 29.
    Hidalgo Rivas JA, Horner K, Thiruvenkatachari B, Davies J, Theodorakou C (2015) Development of a low-dose protocol for cone beam CT examinations of the anterior maxilla in children. Br J Radiol 88:20150559CrossRefGoogle Scholar
  30. 30.
    Widmann G, Bischel A, Stratis A, Bosmans H, Jacobs R, Gassner E-M, Puelacher W, Pauwels R (2017) Spatial and contrast resolution of ultralow dose dentomaxillofacial CT imaging using iterative reconstruction technology. Dentomaxillofac Radiol 46:20160452CrossRefGoogle Scholar
  31. 31.
    McGuigan M, Duncan H, Horner K (2018) An analysis of effective dose optimization and its impact on image quality and diagnostic efficacy relating to dental cone beam computed tomography (CBCT). Swiss Dent J 128:297–316Google Scholar
  32. 32.
    Pauwels R, Zhang G, Theodorakou C, Walker A, Bosmans H, Jacobs R, Bogaerts R, Horner K, Consortium SP (2014) Effective radiation dose and eye lens dose in dental cone beam CT: effect of field of view and angle of rotation. Br J Radiol 87:20130654CrossRefGoogle Scholar
  33. 33.
    Ludlow J, Timothy R, Walker C, Hunter R, Benavides E, Samuelson D, Scheske M (2015) Effective dose of dental CBCT—a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 44:20140197CrossRefGoogle Scholar
  34. 34.
    Stratis A, Zhang G, Lopez-Rendon X, Politis C, Hermans R, Jacobs R, Bogaerts R, Shaheen E, Bosmans H (2017) Two examples of indication specific radiation dose calculations in dental CBCT and multidetector CT scanners. Phys Med 41:71–77CrossRefGoogle Scholar
  35. 35.
    Jones D, Mannocci F, Andiappan M, Brown J, Patel S (2015) The effect of alteration of the exposure parameters of a cone-beam computed tomographic scan on the diagnosis of simulated horizontal root fractures. J Endod 41:520–525CrossRefGoogle Scholar
  36. 36.
    Neves F, Vasconcelos T, Vaz S, Freitas D, Haiter-Neto F (2012) Evaluation of reconstructed images with different voxel sizes of acquisition in the diagnosis of simulated external root resorption using cone beam computed tomography. Int Endod J 45:234–239CrossRefGoogle Scholar
  37. 37.
    EzEldeen M, Stratis A, Coucke W, Codari M, Politis C, Jacobs R (2017) As low dose as sufficient quality: optimization of cone-beam computed tomographic scanning protocol for tooth autotransplantation planning and follow-up in children. J Endod 43:210–217CrossRefGoogle Scholar
  38. 38.
    Brown AA, Scarfe WC, Scheetz JP, Silveira AM, Farman AG (2009) Linear accuracy of cone beam CT derived 3D images. Angle Orthod 79:150–157CrossRefGoogle Scholar
  39. 39.
    Cook V, Timock A, Crowe J, Wang M, Covell D (2015) Accuracy of alveolar bone measurements from cone beam computed tomography acquired using varying settings. Orthod Craniofacial Res 18:127–136CrossRefGoogle Scholar
  40. 40.
    Kusnoto B, Kaur P, Salem A, Zhang Z, Galang-Boquiren MT, Viana G, Evans CA, Manasse R, Monahan R, BeGole E (2015) Implementation of ultra-low-dose CBCT for routine 2D orthodontic diagnostic radiographs: Cephalometric landmark identification and image quality assessment. Semin Orthod 21:233–247CrossRefGoogle Scholar
  41. 41.
    Ludlow JB, Walker C (2013) Assessment of phantom dosimetry and image quality of i-CAT FLX cone-beam computed tomography. Am J Orthod Dentofac Orthop 144:802–817CrossRefGoogle Scholar
  42. 42.
    Bechara B, McMahan CA, Nasseh I, Geha H, Hayek E, Khawam G, Raad M, Noujeim M (2013) Number of basis images effect on detection of root fractures in endodontically treated teeth using a cone beam computed tomography machine: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol 115:676–681CrossRefGoogle Scholar
  43. 43.
    Durack C, Patel S, Davies J, Wilson R, Mannocci F (2011) Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption. Int Endod J 44:136–147CrossRefGoogle Scholar
  44. 44.
    Hashem D, Brown JE, Patel S, Mannocci F, Donaldson AN, Watson TF, Banerjee A (2013) An in vitro comparison of the accuracy of measurements obtained from high-and low-resolution cone-beam computed tomography scans. J Endod 39:394–397CrossRefGoogle Scholar
  45. 45.
    Lennon S, Patel S, Foschi F, Wilson R, Davies J, Mannocci F (2011) Diagnostic accuracy of limited-volume cone-beam computed tomography in the detection of periapical bone loss: 360° scans versus 180° scans. Int Endod J 44:1118–1127CrossRefGoogle Scholar
  46. 46.
    Al-Ekrish AA (2012) Effect of exposure time on the accuracy and reliability of cone beam computed tomography in the assessment of dental implant site dimensions in dry skulls. Saudi Dent J 24:127–134CrossRefGoogle Scholar
  47. 47.
    Dawood A, Brown J, Sauret-Jackson V, Purkayastha S (2012) Optimization of cone beam CT exposure for pre-surgical evaluation of the implant site. Dentomaxillofac Radiol 41:70–74CrossRefGoogle Scholar
  48. 48.
    de-Azevedo-Vaz SL, de Faria Vasconcelos K, Neves FS, Melo SLS, Campos PSF, Haiter-Neto F (2013) Detection of periimplant fenestration and dehiscence with the use of two scan modes and the smallest voxel sizes of a cone-beam computed tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol 115:121–127CrossRefGoogle Scholar
  49. 49.
    El Sahili N, David-Tchouda S, Thoret S, Nasseh I, Berberi A, Fortin T (2018) Effect of milliamperage reduction on pre-surgical implant planning using cone beam computed tomography by surgeons of varying experience. J Maxillofac Oral Surg 17:520–530CrossRefGoogle Scholar
  50. 50.
    Liljeholm R, Kadesjö N, Benchimol D, Hellén-Halme K, Shi X-Q (2017) Cone-beam computed tomography with ultra-low dose protocols for pre-implant radiographic assessment: an in vitro study. Eur J Oral Implantol 10:351–359Google Scholar
  51. 51.
    Neves FS, Vasconcelos TV, Campos PS, Haiter-Neto F, Freitas DQ (2014) Influence of scan mode (180/360) of the cone beam computed tomography for preoperative dental implant measurements. Clin Oral Implants Res 25:e155–e158CrossRefGoogle Scholar
  52. 52.
    Parsa A, Ibrahim N, Hassan B, Motroni A, Van der Stelt P, Wismeijer D (2013) Influence of cone beam CT scanning parameters on grey value measurements at an implant site. Dentomaxillofac Radiol 42:79884780CrossRefGoogle Scholar
  53. 53.
    Sur J, Seki K, Koizumi H, Nakajima K, Okano T (2010) Effects of tube current on cone-beam computerized tomography image quality for presurgical implant planning in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:e29–e33CrossRefGoogle Scholar
  54. 54.
    Vasconcelos TV, Neves FS, de Freitas DQ, Campos PSF, Watanabe PCA (2014) Influence of the milliamperage settings on cone beam computed tomography imaging for implant planning. Int J Oral Maxillofac Implants 29:1364–1368CrossRefGoogle Scholar
  55. 55.
    Waltrick KB, de Abreu Junior MJN, Corrêa M, Zastrow MD, D'Avila Dutra V (2013) Accuracy of linear measurements and visibility of the mandibular canal of cone-beam computed tomography images with different voxel sizes: an in vitro study. J Periodontol 84:68–77CrossRefGoogle Scholar
  56. 56.
    Al-Okshi A, Theodorakou C, Lindh C (2017) Dose optimization for assessment of periodontal structures in cone beam CT examinations. Dentomaxillofac Radiol 46:20160311CrossRefGoogle Scholar
  57. 57.
    de Melo LPL, Oenning ACC, Nadaes MR, Nejaim Y, Neves FS, Oliveira ML, Freitas DQ (2017) Influence of acquisition parameters on the evaluation of mandibular third molars through cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 124:183–190CrossRefGoogle Scholar
  58. 58.
    Neves FS, de Camargo Souza T, de-Azevedo-Vaz SL, Campos PSF, Bóscolo FN (2014) Influence of cone-beam computed tomography milliamperage settings on image quality of the mandibular third molar region. Oral Radiol 30:27–31CrossRefGoogle Scholar
  59. 59.
    Yadav S, Palo L, Mahdian M, Upadhyay M, Tadinada A (2015) Diagnostic accuracy of 2 cone-beam computed tomography protocols for detecting arthritic changes in temporomandibular joints. Am J Orthod Dentofac Orthop 147:339–344CrossRefGoogle Scholar
  60. 60.
    da Silva Moura W, Chiqueto K, Pithon GM, Neves LS, Castro R, Henriques JFC (2018) Factors influencing the effective dose associated with CBCT: a systematic review. Clin Oral Investig 23:1319–1330Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of DentistryThe University of Hong KongHong Kong SARChina
  2. 2.OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity of LeuvenLeuvenBelgium
  3. 3.Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department Dental MedicineKarolinska InstitutetStockholmSweden

Personalised recommendations