iCat Scan for Pregnant Women?

While there probably will be no problem, you might want to put off elective dentistry until after the birth of the child. there is no great studies to actually test radiation and pregnacy (imagine 100 woman in a room and telling them "OK ladies, we're going to x-ray 50 of you and see if there are any problems with your babies"), but this is your child and your wife can live without a tooth for a year. She may want a "flipper" to maintain space, she may need a bone graft, soft tissue graft or a sinus lift later, but never risk a lot to gain a little. I always remember something I learned in my residency - "could" doesn't aways mean "should"

JW: What great advice. I don't have to know much else about you to know that your patients are quite fortunate.

Agreed. While there has been much written in the literature regarding low exsposure dose of iCat scans. We recently had a few gentlemen from the D.E.P. visit our office to perform some testing. The dose comparisons were higher than any of the written information that I gathered from the manufacturer or the internet. The dose of a single arch scan was not significantly higher than a full mouth series of periapical dental xrays, and was much less than that of a traditional medical CT. We have made it our practice, not to scan a patient if there is a chance that they are pregnant. It is not worth the risk for the child.

Question to Diana: What were the values the gentlemen from the D.E.P. measured when performing the dose measurements? Conventional scanners can deliver as low as 3mGy (CTDI) for dental scans or 15 mGy.cm (DLP).

Ithink the the American Academy of radiologists now recommend counselling patietn on hazard of radiation as well as dose exposure for a specific procedure.

There is no harm in waiting... There is absolutely no reason to rush this ELECTIVE procedure. She can get by in the meantime with a temporary prosthesis. If waiting a few more months means the possibility of needing a bone-graft, then so be it. Its a much smaller price to pay knowing you didn't intentionally risk the health of a developing fetus over an ELECTIVE CT scan.

Keep in mind there is no such thing as an established 'safe' radiation dose for a pregnant woman.

Just no risks!

Simple implant placement patients can benefit greatly from 2-D radiographs with traditional surgical guides. These benefits include less surgery cost and decreased treatment time. This simple approach is best suited for patients presenting with no anatomical limitations in regards to bone height and density, pathology, spatial arrangement, and/or any anatomical constraints that may compromise proper implant placement. However, the 2-D representation is a limiting factor for anatomical interpretation and surgical planning for advanced implant cases. Advanced implant cases can benefit greatly from modern computer technology, rapid model prototyping, or computerized drilling. These advances have given dentists highly sophisticated tools to improve implant placement in challenging and complex cases. Indications for CAD/CAM surgical guides include complex anatomical limitations, such as pathology, inadequate bone height, or proximity to adjacent teeth. These are a few of the many limitations that necessitate the use of CT and CAD/CAM technology, providing predictable results in advanced implant cases. Advantages of rapid prototyping (3-D modeling) and computer drilling systems include the use of software for virtual implant placement, which allows the dentist to view the field 3-dimensionally, as well as transfer planning to the surgical field.For a pregnant woman,the cone beam technology seems to be a safer imaging modality,nevertheless, everybody prefers to wait for a time after delivery.

Radiation exposure decreases by the square of the distance from the source. Therefore imaging head and neck generates an estimated conceptus dose of zero. Chest CT imaging exposes the conceptus to .2 mGy. Current recommendations suggest

Is there any concern for scatter radiation? rlr

Simpy put: No. Scatter from CBCT or conventional CT is 0 mGy

I distribute SimPlant in Australia. I'm also, like most of us, a dental patient. It has always surprised me that discussions about risk/benefit of tomographic imaging seem to focus on dosimetry of imaging modalities RELATIVE TO ONE ANOTHER, and without a benchmark to allow patients to make an informed decision. Microsieverts, microschmieverts, what does it mean to me? One readily available benchmark is that of ambient radiation, the daily dose we receive simply by walking around. Others might be an hour at the beach in midsummer, or a 10hr aeroplane flight. What these measures might lack in accuracy they more than make up for in truthfulness. No doubt all the advice given by the clinical contributors is sound, and I don't propose to challenge it, but if you tell a pregnant woman to postpone dental treatment that requires tomographic imaging, should you not also remark that if she spends her summer leisure time on the beach, or flies frequently long-haul, for instance, she's probably rendering your advice nugatory? This would help her put the matter into a meaningful, absolute context and allow her to judge for herself whether it's worth saving that bit of buccal plate or postponing, with the likely need of a more invasive procedure to restore it. Many patients, properly advised, don't want "no risks" dental care, because we understand that in the real world there is no such thing. What we want is a clinician with a fine appreciation of the risk/benefit equation in any circumstance and the ability to convey it meaningfully to us, allowing us to take an appropriate level of responsibility for our own treatment. Lastly, even as a layman, but with a vague reccollection of high-school physics, I was battling to see how a dose from a CB, delivered in the head/neck region, could reach the patient's uterus a couple of feet away without being attenuated to almost zero. EssDiag seems to vindicate my scepticism. But maybe there's some means of circulatory delivery?

How far along the pregnancy is is an important factor. The histologic age of the fetus determines greater or less risk. XRAYS bounce off structures and produce "scatter" radiation. This scatter is a risk. Are you aware of ALARA?

I am a diagnostic radiologist who interprets both dental CBCT and conventional CT. Radiation exposure during pregnancy from head and neck imaging either with CBCT or CT is near zero. The concept is not only scatter and distance from source but conceptus dose (intra-abdominal and pelvic structures have lower dose given radiation attenuation from more superficial structures). Therefore, with CBCT, which has a fraction of radiation dose of conventional CT there is no risk. If you are interested I recommend this article from Radiographics, volume 27, # 4 from July-Aug 2007 "Radiation Exposure and Pregnancy: When Should We Be Concerned?" Dan Reidman, DO

Dr. Reidman- thank you for your advice. Will pass it on to other dentists reluctant to expose pregnant patients to dental radiographs.