"All that glitters is not gold": standards for cone-beam computerized tomographic imaging.

In the past few years, there have been increasing references in the dental literature to the utility of cone-beam computerized tomography (CBCT) in clinical dental practice. CBCT has been referred to as the " gold standard " and even the " standard of care " for diagnostic maxillofacial imaging. 1-4 However, as early as the 16th century, the Prince of Morocco in Act II, Scene vii of Shakespeare's The Merchant of Venice warned, " all that glitters is not gold. " Others, in more contemporary publications, have also doubted the absolute value of CBCT imaging or the misrepresentation, by some, of the role of CBCT as the new universal imaging modality of choice. 5-9 A recent front-page article in The New York Times has made the public aware of concerns about the use of CBCT in orthodontics and the associated radiation dose. 10 Some may argue that representations within that article are biased. However, in his response, the President of the America Academy of Oral and Maxillofacial Radiology (AAOMR), Professor Allan G. Farman, applauds the efforts of the authors to draw attention to important radiation safety aspects related to the use of CBCT technology, especially on the most susceptible individuals, namely children. 11 Perhaps that article may even prompt some, enamored with the allure of 3-dimensional (3D) imaging, to reinstate radiation safety and considerations of the overall benefit of CBCT as a practice priority. One aspect that has emerged from this discourse is a consideration of the concept of " standards " as applied to CBCT imaging. There are at least 5 " stakeholders " in the performance of CBCT imaging: 1) those for whom imaging is performed—patients; 2) those who perform the imaging—providers; 3) those who make, market and sell the equipment—the dental industry; 4) those involved in developing, monitoring and enforcing regulations associated with imaging—members of the health sciences professions, health physicists, state and federal regulators, the judicial system, and malpractice carriers; and 5) those who pay for the imaging—public, patient or patient guardian, and third party payers. The concept of " standard " may well mean different things to different stakeholders. It is also quite likely that some stakeholders may be confused by discussions of standards by other stakeholders with whom they have less familiarity. The purpose of the present editorial is to frame this conversation, particularly regarding current and ongoing activities related to development of dental …