Should an MD be required to read Cone Beam Scans?

Please start to cull the wacky questions from what is posted, such as this one.

Not an MD but an Oral And Maxillofacial Radiologist would be the appropriate person to have them interpreted if ther are any issues. If you take a CBCT you need to be qualified to interpret the images. If you are not qualified or have some doubts regarding the interpretation it would be appropriate and sensible to have an Oral Radioloist look at the images and provide a report.

Sure...and panoramic films and why not PA’s and BW’s.....and intraoral photos too....we need real doctors to do the important stuff. We will have more time then to assist the mid level providers.

What are they going to overlook? Do you read panorex's? Does this pathology show up on other radiographs. Missed pathology can occur in any radio graphic modality. If we are considered the physicians of the oral and maxillofacial region, it is incumbent upon us to take courses updating our knowledge of radiographic interpretation, regardless of modality. I keep hearing this canard every time we talk about CBCT. What are the legal precedents for this. Has there actually been a case of a clinician being sued for missing pathology? And if you can point to a clinician who has been negligent in reading a scan, is that sufficient to ban ALL non specialists from interpreting scans from their own practices? This is politically motivated, and nothing more. RJM

It is pitiful what dentistry is becoming. Any well trained dentist should be able to read a CT. This has turn in to a turf war. Of course they are going to tell you to send the panorex to be read by a Radiologist. The main reason is that they need to be able to make a leaving. Money Money Money. Sorry if I have offended any one. It is harder to diagnose from a panorex than from a CT CBCT.

My thoughts are is a limited FOV we are well within our training to interpret the images. Where we might get in trouble is when the field is extended to the base of the skull and spine areas. Where is get this question is when a local dentist asks our office to provide them with a CBCT for one of their patients. They expect a report to accompany the CD we provide. I think there is the area where we could find tricky. This begets the next question, if we write a report are we able to charge for that interpretation separate from the images themselves????

Really..? Well we do have issues to discuss because Dental school curriculum has generally been deficient in training clinicians to read and interact with CBCT scans. Likewise most MD radiologists are not trained to appreciate Dental pathology, or ideal implant receptor sites. Therefore, I agree that the OMR is the correct specialty to review CBCT images by dentists. Our profession needs far more education in 3-D Imaging and how we now combine technologies to fully diagnose, treatment plan, and link to 3-D printing and CAD CAM applications... Some of us have dedicated our careers to pushing this agenda ... which has become increasingly more important each year. But bringing in an MD...? Not the right discussion in my opinion.

It is illegal in the State of California to take a CBCT scan for a referring dentist unless the patient is “your” patient too. When you are taking scans for any other office “You” are responsible for the scan. If you miss pathology it falls on you and not the doctor who requested the scan because now you have become a scanning lab. Oral Maxillofacial Radiologists are well educated and this is what they do for a living. In Medical Radiology the Radiologist is not well trained in Oral interpretation. One of my referring Dentists acquired a full height scan (FOV 13cm) on a patient from a lab that gave him a great price but too large of a FOV and was subsequently sued for missing a squamous cell carcinoma in the right maxillary sinus. I never take scans larger than 6cm high for upper or lower arches. In Radiology we are taught to collimate to the area of interest which everyone should be doing. Protocol will vary depending on manufacturer and person taking the scan. I can read scan pathology better than most of the doctors who send to me, so don’t assume that just because you are a Dentist you should be able or are able to interpret these scans. I vehemently believe that if you were to request a Radiologist Report on each of your scans you will have a better understanding of what you do not know and also how metal artifacts interfere with interpretation. Unless you’ve studied artifacts and have seen scan after scan you will never really understand how artifacts affect 3d images.

You can diagnose a squamous cell carcinoma from a CBCT scan? I thought that required a biopsy? Failure to REFER a suspicious lesion on a CBCT scan to a clinician who can diagnose/treat the case is certainly a breach. But I submit that a single anecdotal case does not serve as grounds to deny the right of a clinician to diagnose from their own CBCT scan. In fact, on a panorex conversion from my scans, I find that it is far more difficult to diagnose pathology than when I look at both the panorex AND sectional tomographs. Additionally, when we take our scans we only expose the area in question for diagnosis and treatment planning. We do not extend to the base of the skull, occipital or spinal areas. This mitigates out many of the potential problems from "missed" pathology (i.e. calcified carotid arteries). RJM

"BUYER BEWARE !!!!!" Cone beam technology has revolutionized dentistry in a very positive way...... however, remember, wherever you have new technology...you also have lawyers and " wise guy ignorant bureaucrats " working for the local licencing bodies lurking in the background who's job it is to find some minute detail you might not have noticed, and to make a federal case out of it. Protect yourself....when ordering or taking a scan, have the patient sign a consent form mentioning that you preferred to have this scan reviewed by a medical radiologist, and that this was not done because the patient refuses to pay an additional fee..... this way if you did not pick up something serious on the scan, that may or not be related to dentistry, it is not your fault.

I agree with Dr. Miller, Dr. Rudick , We need to protect ourselves from many angles. 1 Attorneys 2 Colleagues that are always ready to be critical of members of their own profession without regard to clinical results. 3 Some Specialist trying to corner every corner of the Dental Turf 4 Equipment manufacturers that want to promote their equipment with scarring tactics. 5 Dental Schools teaching below the standard of care. If you want to obtain a CBCT consent from the patient, it should be a simple and practical consent . Have the patient sign a consent that the only purpose of the CBCT is for diagnosing Dental Conditions , of course the consent should not be limited to that only sentence. Lets not be part of the spreading philosophy that GPs should only be doing Bonding, Bleaching, and Soft Tissue Management. Raul R. Mena DMD Diplomate ABOI-ID Oral-Cranio-Maxillofacial Implant

To my knowledge you are only responsible for anything that shows up in the FOV. I have had a cbct machine for about a year and it opens up a whole different view of things once you learn how to use it and understand the slicing. Getting an MD or a Radiologist involved is kind of like saying you cant read the images or other x rays, its another thing you have to learn! If you are too incompetent to learn or understand cbct imaging maybe you shouldn't be doing implants and relegate yourself to simple fillings, prophys,exams and referral to other specialists.

I'm an Oral Surgeon and I can read a CT only when it relates to my area of expertise. If I am unsure I will show the scan to my radiology colleagues or my dental colleagues. I feel the tone of this thread is not to utilize referrals or another set of eyes to interpret. Unfortunately in dentistry with the exception of OMS, folks are for some reason uncomfortable with consultations. The pathology could be missed I see it daily in my office even with a simple panorex. I have an ENT colleague who helps me also. It is not a weakness to consult everyone benefits. As soon as I see a lot of credentials and courses posted I ask what that has to do with the advice. If you want to grow and learn, do the best thing for your patient and your practice work with someone you trust and that can give you an honest answer not their ego. I try to learn from many sources also have been fooled with some of the dental artifacts on CBCT that's when I ask a dentist who knows more than me. We had a saying in residency "if the radiologist says there is a fracture, then there isn't!" Anyway I can't read a chest film to save my soul and periapicals confuse me too! Take care be safe and wise, a lawyer would love to nail a missed diagnosis!

CRS, Can you give a good example of a CBCT taken for placing implants that you have referred to a Dental Radiologist?