What’s the best CBCT for my practice? Part 2 – 2D + 3D vs 3D only?

7 Rating(s).


Posted on By Wisam Al-Rawi In CBCT & CAD/CAM

In part 1, we talked about the field of view (FOV) and why it’s one of the most important factors for choosing the right CBCT for your practice.
In part 2, we will talk about the different imaging options for a potential CBCT machine.
So let’s get started.

2D + 3D imaging or 3D only?
Some CBCT machines come with the option to have a 2D panoramic and a lateral ceph arm to acquire cephalometric images. These will add to the cost of the machine as opposed to a 3D only option.
So one might wonder well if I have a 3D imaging CBCT why do I still need 2D imaging? After all, the software that comes with the machine will allow me to generate a 2D pan out of the CBCT image volume.
To answer this question, we will have to address different things:
The logic behind acquiring a 3D volume is to use the full data set in cross-sections as opposed to the generation of a 2D image. Acquiring 3D volume takes more time than a few seconds pan or less than a second ceph. Also the acquired volume needs to be processed from RAW data to an image volume in DICOM or other formats, and depending on the scan type (normal vs high resolution) and the voxel (volumetric pixel) size selected it can take minutes before the volume is ready to be viewed. In addition to generate a pan, you’ll have to manually draw the image curve in the software. Moral of the story, it takes a heck a lot of time to do this compared to a conventional pan.
The second issue is that the image quality of a CBCT pan is inferior to a conventional pan. There are many reasons for that but the conventional pan is sharper and more detailed even with the superimposition of structures.
Third is liability. When you acquire a 3D volume you’re responsible for reading ‘the entire’ image volume or finding an oral radiologist to read for you. Just taking a slice from the 3D volume to look at the pan does not cover you in case you missed a lesion or pathology outside the selected area.
Fourth is price. Are you willing to charge the patient a pan fee for taking all the time to generate the 3D volume vs few seconds to generate a conventional pan?
Lastly radiation dose. The radiation dose for a conventional pan or ceph is much less than a CBCT image volume. It’s important to follow ALARA principle every time you acquire a radiograph.

Comments? Feel free to write below and we’ll be happy to help. If you need a professional consultation to help you choose which CBCT machine is good for your practice needs, drop us a line in the contact us form on www.marcilan.com and one of our radiologists will be happy to assist you with that.


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3 Comments

Wisam,
let me share with you some consideration on words you say:

'In addition to generate a pan, you’ll have to manually draw the image curve in the software. Moral of the story, it takes a heck a lot of time to do this compared to a conventional pan.'
IME, it takes few second to generate a panorex.

'The second issue is that the image quality of a CBCT pan is inferior to a conventional pan.'
IME, the quality is overall better considering that you can change the focus accordingly to your need.

'Third is liability. When you acquire a 3D volume you’re responsible for reading ‘the entire’ image volume or finding an oral radiologist to read for you. '
You are responsible for OPT also and I don't understand why someone is able to read a OPT and not able to read a volume, that is a 2D detailed.

'Lastly radiation dose. The radiation dose for a conventional pan or ceph is much less than a CBCT image volume. It’s important to follow ALARA principle every time you acquire a radiograph.'
ALARA principle relate to dose, but here you should also refer to structure hit by Xray beam as the eye and the Hypofisys. Considering Ceph is perfmormed on young people and there are little advances on 3D cephalometry, there is a large consensus not to perform such an extensive 3D x-ray.
Armando

stent on carotid
stapes implant on middle ear


Reply

I meant by time is total time from starting the procedure till the pan is generated. Obviously it's much shorter for a conventional pan.

I have looked at both and you tend to miss on resolution most notably in the teeth area. New pan machines with adjustable focus on front teeth look much crisper.

With liability the doctor should read the entire pan for sure. I should have clarified that a bit more. Thanks for bringing it up.

From what I've seen some doctors take a 3D scan for the purpose of generating a pan. They take a focal trough layer and read that. The trough is a subset from the full scan data.

I agree with you on the orthodontics part. I heard of a campaign called gentle imaging at ADEA just because of that.

Thanks for sharing your thoughts.


Reply

THANK YOU FOR YOUR CONTRIBUTION
CAN I ASK WHICH MACHINE WOULD YOU BUY TODAY ?
PLANMECA
SIRONA XG3D
MORITA VERAVIEW X800?


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