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GUIDELINES FOR DENTISTS IN QUEBEC, GENERAL PRACTITIONERS OR SPECIALISTS
USE OF CONE BEAM COMPUTED TOMOGRAPHY
(CBCT) IN DENTAL OFFICES
Radiological imaging plays an essential role in dentistry, as a way of determining the presence and extent
of disorders of the dentoalveolar or craniofacial system. CBCT scanners complement existing radiological tools
and offer recognized advantages.
J
T
HE ALARA (As Low As Reasonably Achievable)
principle has long applied to radiological protection. In fact,
the International Commission on Radiological Protection
has developed a new concept intended to promote better
control of patient exposure, and to reduce the doses to which they are
exposed, collective doses and risks.
In dentistry, this means avoiding unnecessary imaging procedures,
optimizing the operating parameters of imaging equipment, using
techniques suited to the type of patient (adult or child) and protecting
patients from unnecessary exposure during prescribed procedures.
CLASSIFICATION OF CBCT SCANNERS
1. Small field of view: dentoalveolar CBCT with a field of view
of 8 cm x 8 cm or less.
2. Large field of view: craniofacial CBCT with a field of view
of more than 8 cm x 8 cm.
CBCT radiation doses are greater than those from conventional dental
radiology (with silver films or digital sensors), but less than from
medical CT (computed tomography) scans for studying the mandible
and maxilla.
QUALIFICATIONS REQUIRED FOR
GENERAL PRACTITIONERS OR SPECIALISTS
Dentists, general practitioners or specialists, using CBCT must have
the proper qualifications for taking dentoalveolar or craniofacial CBCT
scans, as applicable, and have an attestation of the appropriate technical and theory training (see sidebar) giving them the required skills
to operate the scanner safely and to interpret and prepare a written
report on the images obtained.
RESPONSIBILITIES OF PERMIT HOLDERS
Permit holders are also responsible for the quality of all the work done at
a dental radiology laboratory. They must also ensure that the staff operating
a CBCT device have the required skills. In addition, permit holders are
responsible for drawing up the radiology protocols to be used depending
on the examination in question and the patient (e.g., adult or child).
RESPONSIBILITIES OF THE DENTISTS
USING THE EQUIPMENT
As soon as the CBCT equipment is installed, the dentists and staff
using the equipment must receive training on its safe operation and
on the accompanying reconstruction software.
WRITTEN REPORT ON THE IMAGES OBTAINED
Dentists, general practitioners or specialists, using a CBCT scanner
must prepare a report on all the structures scanned and place it in the
patient’s record. Dentists who offer external radiology services for other
dentists must attach a written report on all the structures in the images
and attach it to the images obtained. If necessary, dentists must call on
the services of a person with the appropriate expertise for this purpose.
CURRENT OWNERS OF CBCT SCANNERS
Dentists, whether general practitioners or specialists, who are already
using CBCT equipment will have 12 months, as of October 1st, 2013,
to comply with these requirements.
The Ordre des dentistes du Québec suggests that 15 hours of training
be given to dentists, general practitioners or specialists, using CBCT
equipment with a small field of view (8 cm x 8 cm or less), and 30
hours to those using CBCT equipment with a large field of view (more
than 8 cm x 8 cm).
INSTALLATION OF EQUIPMENT
REVISED MAY 2013
When planning for and installing a new CBCT scanner, and under the
Act respecting medical laboratories,1 dentists, general practitioners or
specialists, must be sure that they can obtain a valid operating permit
for a radiology laboratory specific to dentistry, if this has not already
been done.
Dental radiology facilities must be verified by a physicist before
use and before obtaining a new operating permit (adequate shielding
plans, inspections and work required). This also applies to CBCT
equipment.
The program should include theory and practical aspects covering:
n the physics of radiation
n operating principles of CBCT equipment
n indications and contra-indications for CBCT examinations
n the pathology of maxillaries and other structures scanned
n patient protection
n patient positioning
n the selection and influence of different exposure parameters
(kV, mAs, FOV, resolution)
n calibrating equipment
n preparing and applying examination protocols
n reconstructing images
n saving and interpreting images, including artifacts,
and preparing a report •
Act respecting medical laboratories, organ and tissue conservation
and the disposal of human bodies, RSQ, L-0.2.
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