Cone-beam computed tomography usage: An alert to the field of dentistry

Sir, Cone-beam computed tomography (CBCT) is a relatively novel technique for visualizing an individual tooth or dentition in relation to the surrounding skeletal tissues and for generating a three-dimensional image of the area to be studied. Since CBCT is extensively used in dental and maxillofacial imaging for the treatment planning of dental implants, endodontics, maxillofacial surgery, and ortho-dontics, it is imperative for operators and referring practitioners to comprehend the basic concepts of this imaging modality. 3 Its widespread use and the fact that it involves greater radiation doses has given rise to numerous concerns regarding the rationalization and optimization of CBCT exposure, the training of CBCT operators, quality assurance for CBCT scanners, variations in image quality, differences in radiation doses in equipment made by different manufacturers, the inappropriate referral of patients for CBCT, and the need to safeguard staff from radiation exposure. Therefore, we absolutely agree with Jaju and Jaju's article 6 entitled " Cone-beam computed tomography: time to move from ALARA to ALADA, " that is, moving from a paradigm of " as low as reasonably achievable " to the goal of " as low as diagnostically acceptable. " However, due to the absence of strict guidelines and the lack of experience regarding the role of CBCT in dentistry, CBCT has become an alternative to conventional radiography, including periapical, bitewing, and panoramic radiographs. The dosage delivered by CBCT results from several factors, such as the region of the jaw that is scanned, the exposure settings of the CBCT scanner, the size of the field of view (FOV), the exposure time (s), the tube current (mA), and the energy/potential (kV). Bearing in mind the greater radiation dose in comparison to conventional radio-graphs, it is essential that the potential benefits of CBCT outweigh the risks incurred through exposure to ionizing radiation. 11 Dentists must respect their principal ethical obligation to protect patients, and therefore indications for CBCT should be justified appropriately and its usage for screening purposes alone should be strictly avoided. Essentially, CBCT should be considered as an adjunct to standard oral imaging modalities rather than as an alternative. Unfortunately, guidelines on the clinical usage of CBCT are frequently poorly presented. Prospectively, guideline development panels must aim to carry out and report their work using the AGREE II tool as a means of raising standards and avoiding bias. 5 Guideline creators should be certain to bring together a multidisciplinary team …