What is CBCT?

To better explain what Cone Beam CT ( CBCT ) is, we should first explain what regular CT is: Computed tomography (CT) imaging, also referred to as a computed axial tomography (CAT) scan, involves the use of rotating x-ray equipment, combined with a digital computer, to obtain images of the body. Using CT imaging, cross sectional images of body organs and tissues can be produced. Though there are many other imaging techniques, CT imaging has the unique ability to offer clear images of different types of tissue. CT imaging can provide views of soft tissue, bone, muscle, and blood vessels, without sacrificing clarity. Other imaging techniques are much more limited in the types of images they can provide. To understand the difference between CT imaging and other techniques, consider an xray of the head. Using basic x-ray techniques, the bone structures of the skull can be viewed. With magnetic resonance imaging (MRI), blood vessels and soft tissue can be viewed, but clear, detailed images of bony structures cannot be obtained. On the other hand, x-ray angiography can provide a look at the blood vessels of the head, but not soft tissue. CT imaging of the head can provide clear images not only of soft tissue, but also of bones and blood vessels. CT imaging is commonly used for diagnostic purposes. In fact, it is a chief imaging method used in diagnosing a variety of cancers, including those affecting the lungs, pancreas, and liver. Using CT imaging, not only can physicians confirm that tumors exist, but they can also pinpoint their locations, accurately measure the size of tumors, and determine whether or not theyve spread to neighboring tissues. In addition to the diagnosis of certain cancers, CT imaging is used for planning and administering radiation cancer treatments, as well as for planning certain types of surgeries. It is useful for guiding biopsies and a range of other procedures categorized as minimally invasive. Thanks to its ability to provide clear images of bone, muscle, and blood vessels, CT imaging is a valuable tool for the diagnosis and treatment of musculoskeletal disorders and injuries. It is often used to measure bone mineral density and to detect injuries to internal organs. CT imaging is even used for the diagnosis and treatment of certain vascular diseases that, undetected and untreated, have the potential to cause renal failure, stroke, or death. Watch the video below for a better idea of how CT scanners work: So, what exactly is Cone Beam CT? In layman's terms, CBCT is a compact, faster and safer version of the regular CT. Through the use of a cone shaped X-Ray beam, the size of the scanner, radiation dosage and time needed for scanning are all dramatically reduced. A typical CBCT scanner can fit easily into any dental ( or otherwise ) practice and is easily accessible by patients. The time needed for a full scan is typically under one

minute and the radiation dosage is up to a hundred times less than that of a regular CT scanner.

CBCT Basics Interpretation of images in Cone Beam CT

Introduction
Cone beam CT is a tomographic scanning technology that can scan and acquire a specified volume of the patient head and generate a 3D data set at much lower radiation doses than their medical CT counterparts. In effect, Cone Beam CT represents the latest generation in medical imaging scanning machines ascending from conventional x-ray to panoramic and cephalometric x-ray to medical spiral CT. It provides numerous advantages over the other imaging modalities in favor for its accuracy, speed and safety. Above all, its an economical and cost effective system that can supplant to a huge extent the existing modalities to be the standard of health care. Cone Beam CT scanners have been employed in clinical practice for several years till now and mostly it is used for diagnosis and treatment planning in diverse dental specialties such maxillofacial surgery, implantology and oral pathology. Up till now, however, no single system has been developed to illustrate the radiographic appearance of anatomical landmarks in Cone Beam CT images. And thus, it is the scope of this module to teach you how to identify and describe the anatomical landmarks as they appear on the maxilla and mandible when examining them on MPR (Multi-planar reformatted, Surface and Volume rendered).

Principle of action
Image reconstruction: The end result of the acquisition process is a stack of 360 images or exposures that are compiled into a volume of data called volumetric data set through a computer process known as the primary reconstruction. The data volume generated from the primary reconstruction process is then converted into a patient-study where, by using the CBCT system accompanying software, any number of diagnostic images can be generated. The compiled volumetric data set can then be visualized in standardized 2D trans-axial, multi-planar reformatted or by using 3D visualization techniques such as surface reconstruction and volume rendering or any combination of 2D and 3D visualization techniques. Also, the data set can be exported in standardized 2D or 3D file formats for visualization and further processing in 3D party software.

OPG

What is an OPG? OPG is an abbreviation of OrthoPanTomoGram. 'Ortho' as in orthodontics refers to the teeth. 'Pan' refers to the panoramic display of the teeth produced by the technique. A 'Tomogram' is an X-ray image that is focussed in a single plane of the patient. The OPG machine is specifically designed to produce panoramic tomographic X-rays of the teeth, jaws and temperomandibular joints. The physical principles are similar to conventional tomograms however with an OPG the plane of focus is curved to match the curve of the jaws. The images provide an overview of the state of the dentition as well as information regarding the bones of the jaw (the mandible and maxilla), the sinuses in the upper jaw and the joints between the jaw and the skull (the temperomandibular joints). The OPG machines can also perform a 'lateral cephalogram' which is a standard lateral view of the skull. The information assists dentists, dental and medical specialists in diagnosing abnormalities and in planning treatment for known problems. At QDI the images are interpreted by a specialised reporting team headed by Dr. Paul Monsour. A detailed report is provided for the referring clinician. At the Holy Spirit branch, a specialised OPG unit known as a Com Cat has been installed. This machine is designed to allow cross sectional imaging of the mandible and maxilla with a view to assessing patients requiring dental implants. Similar information can be obtained with a 'Dentascan' which is

a specialised CT technique for imaging the jaws in dental implant patients. The image to the right is the 'Com Cat' unit at Holy Spirit Hospital. The procedure The patient's chin is placed on a chin rest situated within the center of the 'C' arm between the X-ray tube and the film cassette holder. The jaws are held in place by biting down on a small disposable plastic guide. Most OPGs are performed with the patient standing. During the exposure, the X-ray tube and film cassette rotate around the jaws. An exposure lasts a few seconds during which time the patient must remain still. The film cassette is then removed to allow development of the exposed X-ray film. If a lateral cephalogram is required, the head is placed in a special support on the end of the lateral cephalogram attachment for accurate positioning and an X-ray obtained. The X-ray dose is small. Lead gowns and thyroid shields are available where required if X-ray exposure is an issue. The procedure is painless.

The OPG Room

The OPG room houses the OPG machine and the lateral cephalogram attachment. The generator, X-ray tub and control panel are all housed within the self contained OPG unit. The machines may be situated within a general X-ray room or may be placed in a specific OPG room. The X-ray tube is mounted on a rotating 'C' a on the opposite end of which is the film cassette holder.

Link to frequently asked questions in OPG Preparation No preparation is required for an OPG, lateral cephalogram, dentascan or Com Cat scan.

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