SIU-SDM HAWAIIAN CRUISE

SIU-SDM SIU-SDM HAWAIIAN CRUISEHAWAIIAN CRUISE

SIU-SDM SIU-SDM HAWAIIAN CRUISEHAWAIIAN CRUISE

CONE BEAM C TCONE BEAM C T

IS IT FOR THE IS IT FOR THE GENERALIST’S GENERALIST’S

OFFICE?OFFICE?

DEBRA DIXON, DMDDEBRA DIXON, DMD

SDM GRADUATE 1993SDM GRADUATE 1993 SDM AEGD 1995SDM AEGD 1995 SDM IMPLANT FELLOW 1996SDM IMPLANT FELLOW 1996 THE UNIVERSITY OF LONDON THE UNIVERSITY OF LONDON

MSc DENTAL RADIOLOGY MSc DENTAL RADIOLOGY 20022002

SDM DIRECTOR OF RADIOLOGY SDM DIRECTOR OF RADIOLOGY

FURFUR

OUR AGENDAOUR AGENDA

HistoryHistory RadiologyRadiology Digital RadiologyDigital Radiology CTCT

Cone Beam CTCone Beam CT What it is and What it can do for meWhat it is and What it can do for me

HISTORYHISTORY

Nov 8, 1895 Wilhelm RNov 8, 1895 Wilhelm RÖÖntgen ntgen discovers the X-Raydiscovers the X-Ray

Digital radiography is more than 25 Digital radiography is more than 25 years oldyears old 11% to 30% of dentists have converted 11% to 30% of dentists have converted

to digitalto digital Financial investmentFinancial investment Complexity of computersComplexity of computers

SoftwareSoftware HardwareHardware

Simply reluctant to switch…if everything is Simply reluctant to switch…if everything is running smoothly, why change it?running smoothly, why change it?Van der Stelt 2008

BASICS OF DIGITAL BASICS OF DIGITAL IMAGINGIMAGING

Composed of pixels (picture Composed of pixels (picture elements) which are characterized by elements) which are characterized by 3 numbers3 numbers

These numbers are stored in an These numbers are stored in an image file in the computerimage file in the computer

Image processing is possibleImage processing is possible Brightness/DarknessBrightness/Darkness ContrastContrast Zoom…limited by the resolution of the Zoom…limited by the resolution of the

systemsystem


Image AnalysisImage Analysis Measurement of root length for EndoMeasurement of root length for Endo

Digital subtraction radiographyDigital subtraction radiography


AdvantagesAdvantages Immediate image with CCD sensorImmediate image with CCD sensor Ability to manipulate the imageAbility to manipulate the image Integrated storage with software systemsIntegrated storage with software systems Security of backup and off-site archiving of Security of backup and off-site archiving of

imagesimages Ease of transfer by emailEase of transfer by email Security of the original imageSecurity of the original image DICOM (Digital Imaging and DICOM (Digital Imaging and

Communications in Medicine) format Communications in Medicine) format standardsstandards


Dose Reduction?Dose Reduction? Once promoted as a “huge advantage” Once promoted as a “huge advantage”

to digital imagingto digital imaging Why the dose reduction is not as large Why the dose reduction is not as large

as often suggestedas often suggested Dose per exposureDose per exposure

Reduction of 0% to 50% as compared with “F” Reduction of 0% to 50% as compared with “F” speed filmspeed film

Increase in the number of radiographs Increase in the number of radiographs mademade

Increase in the number of retakes due to Increase in the number of retakes due to the ease of exposing additional imagesthe ease of exposing additional images

Van der Stelt 2008Van der Stelt 2008

SALLYSALLY

C TC TCOMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY

C TC T

HistoryHistory Basics of TomographyBasics of Tomography Generations of ScannersGenerations of Scanners

11stst Generation Generation 22ndnd Generation Generation 33rdrd Generation Generation 44thth Generation Generation 55thth Generation Generation

Conventional data gathering versus Conventional data gathering versus Spiral geometrySpiral geometry

C TC T

HistoryHistory The wordThe word Tomography Tomography can be traced to the can be traced to the

1920’s1920’s TomographyTomography = section, from the Greek = section, from the Greek tomostomos Dr. Godfrey HounsfieldDr. Godfrey Hounsfield

Born 1919 in Nottinghamshire, EnglandBorn 1919 in Nottinghamshire, England The inventor of clinical computed tomographyThe inventor of clinical computed tomography First patient scanned in 1972 First patient scanned in 1972

Demonstrated a suspected brain lesionDemonstrated a suspected brain lesion

Dr. Allan CormackDr. Allan Cormack Born 1924 in Johannesburg, South AfricaBorn 1924 in Johannesburg, South Africa Developed solutions for the mathematical Developed solutions for the mathematical

problems in CTproblems in CTSeeram, Computed Tomography, 2001

C TC T

HistoryHistory Dr. Robert LedleyDr. Robert Ledley

1948 1948 Doctorate in Dental SurgeryDoctorate in Dental Surgery, New , New York UniversityYork University

1949 Master’s in theoretical physics, 1949 Master’s in theoretical physics, Columbia UniversityColumbia University

Developed the first whole-body CT Developed the first whole-body CT scannerscanner

Seeram, Computed Tomography, 2001

C TC T

HistoryHistory TomographyTomography

X-ray tube and film X-ray tube and film move move simultaneously and simultaneously and in opposite in opposite directions directions

This keeps the This keeps the object of interest in object of interest in focus while blurring focus while blurring out the structures out the structures around itaround it

Panoramic Panoramic techniquetechnique


C TC T

HistoryHistory A A

1st Generation1st Generation B B

2nd 2nd GenerationGeneration

C C 3rd Generation3rd Generation

D D 4th Generation4th Generation


C TC T HistoryHistory 11stst Generation Generation

Minimum 4.5 to 5.5 Minimum 4.5 to 5.5 minute whole body minute whole body scanscan

Parallel beam, Parallel beam, Translate & RotateTranslate & Rotate

After 1 translation, After 1 translation, the tube and the tube and detector rotate by detector rotate by 1° and translate 1° and translate again, repeated for again, repeated for 180° around the 180° around the patient patient


C TC T HistoryHistory 22ndnd Generation Generation

Scan time 20 sec to Scan time 20 sec to 3.5 minutes3.5 minutes

Fan beam, Fan beam, Translate & RotateTranslate & Rotate

Fan beam = ~30 Fan beam = ~30 detectors coupled detectors coupled to the x-ray tube to the x-ray tube and multiple pencil and multiple pencil beamsbeams

Process is repeated Process is repeated for 180° for 180°


C TC T

HistoryHistory 33rdrd Generation Generation

Scan time of a Scan time of a few secondsfew seconds

Fan beam Fan beam geometry that geometry that rotates rotates continuously continuously around the around the patient for 360°patient for 360°


C TC T

HistoryHistory 44thth Generation Generation

Scan time is Scan time is very short, very short, varies by varies by manufacturermanufacturer

A rotating fan A rotating fan beam within a beam within a stationary ring stationary ring of detectorsof detectors


C TC T

HistoryHistory 55thth Generation Generation High-speed CT High-speed CT

scannersscanners EBCT Electron EBCT Electron

Beam CT Beam CT scannerscanner

DSR DSR Dynamic Spatial Dynamic Spatial

ReconstructorReconstructor Scan time of Scan time of

millisecondsmilliseconds


C TC T

HistoryHistory AA

Conventional Slice by Conventional Slice by Slice data acquisitionSlice data acquisition

The x-ray tube stops The x-ray tube stops between slices, the between slices, the patient is repositioned patient is repositioned for the next slicefor the next slice


C TC T HistoryHistory BB

Helical or spiral geometry Helical or spiral geometry The The latest development in CT latest development in CT

data acquisition (as of the data acquisition (as of the writing of the text in 2001)writing of the text in 2001)

Volume scanningVolume scanning Utilizes a narrowly collimated, Utilizes a narrowly collimated,

fan shaped x-ray beam, fan shaped x-ray beam, projected through a limited projected through a limited thickness slice through the thickness slice through the bodybody

Utilizes a linear array of Utilizes a linear array of detectorsdetectors

Patient has to be advanced Patient has to be advanced through the gantry while the x-through the gantry while the x-ray tube and detectors rotate ray tube and detectors rotate around the patientaround the patient Seeram, Computed Tomography, 2001

C TC T

Spiral ScannersSpiral Scanners Provide improved Provide improved

multiplanar image multiplanar image reconstructionsreconstructions

Reduced exam timeReduced exam time 12 seconds versus 5 12 seconds versus 5

minutes for an minutes for an incremental scanincremental scan

Reduced radiation Reduced radiation dosedose

Up to 75% of the dose Up to 75% of the dose delivered by an delivered by an incremental scannerincremental scanner

C TC T Image is recorded and displayed as matrix Image is recorded and displayed as matrix

of individual blocks called of individual blocks called voxels (volume voxels (volume elements)elements)

Voxel length (1 to 20 mm) is determined by Voxel length (1 to 20 mm) is determined by the width of the x-ray beamthe width of the x-ray beam Analogous to the tomographic layer in film Analogous to the tomographic layer in film

tomographytomography For image display, each pixel is assigned a CT For image display, each pixel is assigned a CT

numbernumber Represents densityRepresents density Also known as a Hounsfield unitAlso known as a Hounsfield unit

Air Air -1000-1000 Water Water 0 0 Dense bone +1000 Dense bone +1000

EMEM


C B C TC B C T

DefinitionDefinition IndicationsIndications ComparisonsComparisons

CBCT versus PanoramicCBCT versus Panoramic CBCT versus Plain-film CBCT versus Plain-film

TomographyTomography CBCT versus Medical CTCBCT versus Medical CT

DisadvantagesDisadvantages Currently available Currently available

unitsunits Specialized UsesSpecialized Uses

Orthodontic AnalysisOrthodontic Analysis Dolphin Imaging Dolphin Imaging

Software ProgramSoftware Program InterpretationInterpretation

C B C TC B C T Developed for Dental purposes to provide Developed for Dental purposes to provide

3D volume images of the dental and 3D volume images of the dental and craniofacial complexcraniofacial complex

Available for craniofacial imagingAvailable for craniofacial imaging Since 1999 in EuropeSince 1999 in Europe Since Since 2001 in the U.S.2001 in the U.S.

Ideally suited for craniofacial imagingIdeally suited for craniofacial imaging The compact size of the unitThe compact size of the unit Relatively low radiation doseRelatively low radiation dose Becoming the “Standard of Care” for diagnosis Becoming the “Standard of Care” for diagnosis

of the craniofacial regionof the craniofacial region Allows multiplanar viewing of the anatomical Allows multiplanar viewing of the anatomical

volume and overcomes the limitations of 2D volume and overcomes the limitations of 2D radiography radiography

www.conebeam.com

C B C TC B C T

Cone Beam Cone Beam Utilizes a cone shaped x-Utilizes a cone shaped x-

ray beamray beam Round or rectangularRound or rectangular

Utilizes an area detector Utilizes an area detector Acquires a full volume of Acquires a full volume of

images in a single rotation images in a single rotation with no need for patient with no need for patient movementmovement

Rotates 360° around the headRotates 360° around the head 360 projections 360 projections Scan time typically < 1 Scan time typically < 1

minuteminutewww.conebeam.com

C B C TC B C T

End ResultEnd Result 3-D visualization of the oral and 3-D visualization of the oral and

maxillofacial complex from any planemaxillofacial complex from any plane A stack of 360 images or exposures A stack of 360 images or exposures

compiled into a volumetric dataset compiled into a volumetric dataset through a computer process known as through a computer process known as primary reconstructionprimary reconstruction

This data volume is then converted into a This data volume is then converted into a patient-study by accompanying softwarepatient-study by accompanying software

Can be visualized asCan be visualized as 2D trans-axial, multi-planar reformatted2D trans-axial, multi-planar reformatted 3D techniques such as surface reconstruction 3D techniques such as surface reconstruction

and volume renderingand volume rendering A combination of 2D and 3D techniquesA combination of 2D and 3D techniqueswww.conebeam.com

C B C TC B C T

IndicationsIndications Evaluation of the jaw bonesEvaluation of the jaw bones

Implant placement and evaluationImplant placement and evaluation TMJTMJ PathologyPathology

Bony & Soft tissue lesionsBony & Soft tissue lesions Periodontal assessmentPeriodontal assessment Endodontic assessmentEndodontic assessment

Alveolar ridge resorptionAlveolar ridge resorption Assessment of the IAN prior to extraction of Assessment of the IAN prior to extraction of

impactionsimpactions Orthodontic evaluationOrthodontic evaluation

Airway assessmentAirway assessment Need for 3D reconstructionsNeed for 3D reconstructions

www.conebeam.com

C B C TC B C T

Evaluation of the jaw bonesEvaluation of the jaw bones Implant placement and evaluation Implant placement and evaluation

#12-13#12-13

a) a) Panoramic line and cross-Panoramic line and cross-

section line in the axial imagesection line in the axial image of of Maxilla identifiedMaxilla identified

b) b) Slices of the area in cross-Slices of the area in cross-section section

c) Reconstruction in a c) Reconstruction in a ‘panoramic-like‘panoramic-like’ layout’ layout

Araki et al. Dentomaxillofac Radiol 31 (1):51, Figure 9

C B C TC B C T

Evaluation of the jaw bones

a) Slice as seen from a ‘frontal’ view

b) Slice as seen from the side

c) Reconstructed maxilla and mandible

Dentomaxillofac Radiol (2004) 33, 285-290Dentomaxillofac Radiol (2004) 33, 285-290

C B C TC B C T

Evaluation of the jaw Evaluation of the jaw bonesbones

www.ddsgadget.comwww.ddsgadget.com

e-ssentialnetworks.com

C B C T C B C T versusversus

PANORAMICPANORAMIC

PANORAMICPANORAMIC Provides a Provides a

distorted (unequal distorted (unequal magnification) and magnification) and magnifiedmagnified image image

Image layer view Image layer view onlyonly

Structures are Structures are superimposedsuperimposed

CBCTCBCT Provides an Provides an

undistorted undistorted imageimage

Cross-sectional Cross-sectional (bucco-lingual), (bucco-lingual), axial, coronal, axial, coronal, sagittal, and sagittal, and panoramic viewspanoramic views

Structures can be Structures can be separatedseparated

www.conebeam.com

C B C TC B C Tversusversus

PLAIN-FILM TOMOGRAPHYPLAIN-FILM TOMOGRAPHY PLAIN-FILM PLAIN-FILM

TOMOGRAPHYTOMOGRAPHY Provides an Provides an

undistorted image, undistorted image, but there is but there is magnificationmagnification

Provides Provides directdirect cross-sectional, cross-sectional, sagittal, and sagittal, and coronal viewscoronal views

Scan time may be Scan time may be short, but chair short, but chair time can be lengthytime can be lengthy

CBCTCBCT Provides an Provides an

undistorted, 1:1 undistorted, 1:1 imageimage

Provides Provides reconstructedreconstructed views views

Scan timeScan time 10-40 second range, 10-40 second range,

dependent on the dependent on the region being imaged region being imaged and the desired and the desired qualityquality

Provides an Provides an indication of bone indication of bone qualityquality www.conebeam.com


Medical C TMedical C T

Med CTMed CT Conventional linear fan beamConventional linear fan beam Single row or a series (4, 8, Single row or a series (4, 8,

12, 32, 64) of solid state 12, 32, 64) of solid state detectorsdetectors

Provides a set of consecutive Provides a set of consecutive slices of the patientslices of the patient

CBCTCBCT Cone beamCone beam Square 2 dimensional Square 2 dimensional

array of detectorsarray of detectors Provides a volume of Provides a volume of

datadata

www.osseonews.com

www.conebeam.com


Medical C TMedical C T Med CTMed CT

Greater contrast Greater contrast resolutionresolution

More More discrimination discrimination between different between different tissue types (i.e. tissue types (i.e. bone, teeth, and bone, teeth, and soft tissue)soft tissue)

CBCTCBCT Equipment Equipment

Cost 3-5x less than Cost 3-5x less than MDCTMDCT

Lighter & SmallerLighter & Smaller No special electricalNo special electrical No floor No floor

strengtheningstrengthening No special coolingNo special cooling

Ease of operationEase of operation Dedicated to dentalDedicated to dental Patient sits or standsPatient sits or stands Both jaws can be imaged Both jaws can be imaged

at the same timeat the same time Lower radiation burdenLower radiation burdenwww.conebeam.com

C B C TC B C T

DisadvantagesDisadvantages Noise from radiation scatterNoise from radiation scatter Streak artifacts from metal restorationsStreak artifacts from metal restorations

Algorithms and filters try to correct for noise & Algorithms and filters try to correct for noise & artifactsartifacts

Image degradation from patient movementImage degradation from patient movement Head stabilizing devicesHead stabilizing devices

CostCost Range from $150,000 to 300,000Range from $150,000 to 300,000

TrainingTraining For maximum benefit For maximum benefit For interpretation of the volume of data & For interpretation of the volume of data &

imagesimages Within the purview of the dentistWithin the purview of the dentist Outside the purview of the dentistOutside the purview of the dentist

Howerton et. al.

C B C TC B C T

Currently available unitsCurrently available units 3D Accuitomo FPD XYZ Slice View 3D Accuitomo FPD XYZ Slice View

TomographTomograph J. Morita USA, Irvine, CAJ. Morita USA, Irvine, CA

3D X-ray CT Scanner Alphard Series3D X-ray CT Scanner Alphard Series Asahi, Kyoto, JapanAsahi, Kyoto, Japan

Quolis Alphard Alphard-3030-Cone-BeamQuolis Alphard Alphard-3030-Cone-Beam Belmont Equipment, Somerset, NJBelmont Equipment, Somerset, NJ

CB MercuRayCB MercuRay Hitachi Medical Systems America, Twinsburg, OhioHitachi Medical Systems America, Twinsburg, Ohio

Galileos 3D Galileos 3D Sirona Dental Systems, Charlotte, NCSirona Dental Systems, Charlotte, NC

i-CATi-CAT Imaging Sciences International, Hatfield, PAImaging Sciences International, Hatfield, PA

Howerton et. al.

C B C TC B C T

Currently available unitsCurrently available units Iluma Ultra Cone Beam CT ScannerIluma Ultra Cone Beam CT Scanner

Carestream, Rochester, NYCarestream, Rochester, NY NewTom 3G and VGNewTom 3G and VG

AFP Imaging, Elmsford, NYAFP Imaging, Elmsford, NY PicassoPicasso

E-woo Technology, HoustonE-woo Technology, Houston PreXion 3DPreXion 3D

TeraRecon, San Mateo, CATeraRecon, San Mateo, CA ProMax 3DProMax 3D

Planmeca USA, Roselle, ILPlanmeca USA, Roselle, IL Scanora 3DScanora 3D

Soredex, Tuusula, Finland Soredex, Tuusula, Finland Howerton et. al.

C B C TC B C T

i-CATi-CAT NewTom VGNewTom VG 3D 3D AccuitomoAccuitomo

PositionPosition SeatedSeated Stand/SeatedStand/Seated SeatedSeated

Scan Scan timetime

5, 8.9, 5, 8.9, 26.9 sec26.9 sec

20 sec20 sec 18 sec18 sec

Scan Scan HgtHgt

4,6,8,10,14,6,8,10,13 cm3 cm

9.84 inches9.84 inches 1.57-2.36 1.57-2.36 inchesinches

kVp/mAkVp/mA 120/3-5 120/3-5 60-80/1-1060-80/1-10

Rad Rad TimeTime

9 sec9 sec 5.4 sec5.4 sec Not listedNot listed

Scan Scan thickthick

0.12-0.4 0.12-0.4 mmmm

0.1-0.5 mm0.1-0.5 mm .125-2.0 mm.125-2.0 mm

CephCeph YesYes YesYes NoNo

SoftwarSoftwaree

Xoran CatXoran Cat NewTom VGNewTom VG I-DixelI-Dixel

PricePrice $170,000$170,000 $170,000$170,000 $252,000$252,000

websitewebsite imagingscimagingsciences.coiences.comm

newtomdental.conewtomdental.comm

jmorita.comjmorita.com

Inside Dentistry 1:90-93, 2007, Dental Economics August 2007, Dental Town August 2007

C B C TC B C T

All Cone Beam Units are not All Cone Beam Units are not created equal!created equal! Volume SizeVolume Size Geometric resolutionGeometric resolution Contrast resolutionContrast resolution Slice thicknessSlice thickness Radiation doseRadiation dose Ease of useEase of use Image CaptureImage Capture

C B C TC B C TEffectivEffective dose e dose (µSv) (µSv)

Dose in # Dose in # of Pansof Pans

Dose Dose in in daysdays

Dose in Dose in % Med % Med CTCT

i-Cati-Cat

12” FOV12” FOV135135 2121 1313 6.46.4

NewTom NewTom 3G 3G 12” FOV12” FOV

4545 77 44 2.12.1

PanoramiPanoramicc

66 11 11 0.30.3

CT CT Maxilla & Maxilla & MandibleMandible

2,1002,100 385385 243243 100100

Farman AG, Levato CM, Scarfe WC. A primer on cone beam CT. Inside Dentistry 1:90-93, 2007

C B C TC B C T

The i-CAT CT The i-CAT CT scanner scanner Low dose settings Low dose settings

for childrenfor children Landscape ViewLandscape View

Full resolution and Full resolution and detail obtained for detail obtained for smaller fields of smaller fields of viewview

Portrait ViewPortrait View Captures Extended Captures Extended

Field of View dataField of View data Ceph data in 8.5 Ceph data in 8.5

secondssecondswww.imagingsciences.com

C B C TC B C T

i-CATi-CAT Typical reconstruction time Typical reconstruction time

Less than 30 secondsLess than 30 seconds

www.imagingsciences.com

C B C TC B C T

i-CATi-CAT Measurem

ent Labeling Hounsfield

units Density

www.imagingsciences.com

C B C TC B C T NewTom VGNewTom VG

Features a single 8"x10" Field Of View, Features a single 8"x10" Field Of View, Most utilized by implantologists and Most utilized by implantologists and

maxillo-facial surgeons.maxillo-facial surgeons. Small focal spot = high quality imagesSmall focal spot = high quality images Volume of data captured kept to a Volume of data captured kept to a

minimumminimum Short reconstruction times (3 Short reconstruction times (3

minutes)minutes) Low doseLow dose

up to 20 - 50 times less radiation up to 20 - 50 times less radiation than conventional CTthan conventional CT

Adjusts dose to size and age of Adjusts dose to size and age of patientpatient

Unique “pulse” systemUnique “pulse” system Activates the x-ray source only when Activates the x-ray source only when

needed—delivering less than 4 needed—delivering less than 4 seconds of total exposure for a full seconds of total exposure for a full scan.scan.

www.afpimaging.com/newtomwww.afpimaging.com/newtom

C B C TC B C T

NewTomNewTom

Standard 0.5mm

Ultra-high resolution 0.2mm

www.afpimaging.com/www.afpimaging.com/newtomnewtom

C B C TC B C T 3D Accuitomo3D Accuitomo

J. Morita ManufacturingJ. Morita Manufacturing

Imaging Areas 40x40 mm & 60x60 mmImaging Areas 40x40 mm & 60x60 mm

High resolution for large imaging areaHigh resolution for large imaging area

Voxel size 0.125 mm, high resolution Voxel size 0.125 mm, high resolution (2.0(2.0 line pair/mm)line pair/mm)

Low effective doseLow effective dose

Wide dynamic range and expresive Wide dynamic range and expresive tone create brilliant images of both tone create brilliant images of both soft and hard soft and hard tissue areastissue areas

Enables the most accurate diagnosis Enables the most accurate diagnosis for implants, apical lesionsfor implants, apical lesions, , temporomandibular temporomandibular joints, impactions, etc.joints, impactions, etc. www.jmorita-www.jmorita-

mfg.commfg.com

C B C TC B C TSPECIALIZED USESSPECIALIZED USES

ISLAND OF LANAI

C B C TC B C T

Specialized UsesSpecialized Uses Orthodontic AnalysisOrthodontic Analysis

Dolphin Imaging Software ProgramDolphin Imaging Software Program Oral SurgeryOral Surgery

ImpactionsImpactions TraumaTrauma

ImplantsImplants EndodonticsEndodontics PeriodonticsPeriodontics TMJTMJ

C B C T - ORTHOC B C T - ORTHO

Ortho Evaluation and Treatment Planning www.dolphinimaging.com

The Dolphin 3D software module The Dolphin 3D software module A powerful tool that makes A powerful tool that makes

processing 3D data extremely easy, processing 3D data extremely easy, enabling dental specialists from a enabling dental specialists from a wide variety of disciplines to wide variety of disciplines to accurately diagnose and plan accurately diagnose and plan treatment. treatment.

Dolphin 3D allows visualization and Dolphin 3D allows visualization and analysis of craniofacial anatomy from analysis of craniofacial anatomy from data produced by CBCT, MRI, medical data produced by CBCT, MRI, medical CT and 3D facial camera systems. CT and 3D facial camera systems.

www.dolphinimaging.com


C B C T - ORTHOC B C T - ORTHO Dolphin Imaging SoftwareDolphin Imaging Software

Comprehensive cross sections with Multiple Planar View Comprehensive cross sections with Multiple Planar View (MPV) (MPV)

3D nerve marking3D nerve marking TMJ analysis TMJ analysis Create stunning, accurate cephalometric and panoramic Create stunning, accurate cephalometric and panoramic

radiographsradiographs Import from a variety of 3D files Import from a variety of 3D files High-quality, fast 3D rendering High-quality, fast 3D rendering Easily detect impacted teeth Easily detect impacted teeth Analyze, visualize and measure airway Analyze, visualize and measure airway Precise volume orientation Precise volume orientation Establish 3D/2D measurements Establish 3D/2D measurements Create movies Create movies Design automated image layouts Design automated image layouts Images export to other applications, including PowerPoint, Word, Images export to other applications, including PowerPoint, Word,

etc. etc. Images easily saved into Dolphin patient file Images easily saved into Dolphin patient file Export to standard file formats and Windows Clipboard Export to standard file formats and Windows Clipboard Fully embedded in Dolphin Imaging’s SQL databaseFully embedded in Dolphin Imaging’s SQL database


C B C T - ORTHOC B C T - ORTHO Dolphin Imaging SoftwareDolphin Imaging Software

Object OrientationObject Orientation

Comprehensive cross sections with Multiple Comprehensive cross sections with Multiple Planar ViewPlanar View

Instant Ceph/PanInstant Ceph/Pan Ceph TracingCeph Tracing 3D Nerve Mapping3D Nerve Mapping TMJ analysis TMJ analysis 3D Visualization3D Visualization



Object OrientationObject Orientation

To maximize the consistency of To maximize the consistency of analysis of a 3D volume, it is analysis of a 3D volume, it is crucial to establish a default crucial to establish a default orientationorientation. .

Dolphin 3D provides Dolphin 3D provides comprehensive tools for comprehensive tools for defining the mid-sagittal, axial defining the mid-sagittal, axial and coronal planes. You can and coronal planes. You can also adjust the object’s default also adjust the object’s default yaw, pitch and roll.yaw, pitch and roll.

These operations can be These operations can be performed on the CT soft performed on the CT soft tissue surface, CT hard tissue tissue surface, CT hard tissue surface or 3D photo surface.surface or 3D photo surface. www.dolphinimaging.com

C B C T - ORTHOC B C T - ORTHO Multiple Planar Multiple Planar

Views and LayoutsViews and Layouts

Choose a layout that is Choose a layout that is best suited to your task:best suited to your task:

3D volume (just the 3D 3D volume (just the 3D volume view) volume view)

Volume+3 planes (3D Volume+3 planes (3D volume and 3 cross volume and 3 cross section planes on the section planes on the side) side)

4-views (3D volume and 4-views (3D volume and the cross section planes the cross section planes in equal sized windows) in equal sized windows)

Individual orthogonal Individual orthogonal projected slices: projected slices: sagittal, coronal and sagittal, coronal and axial planes axial planes



Instant Ceph/PanInstant Ceph/Pan

Create two-Create two-dimensional dimensional radiographic images radiographic images from 3D volume from 3D volume dataset in the lateral, dataset in the lateral, panoramic (OPG), panoramic (OPG), frontal and SMV views. frontal and SMV views.

1:1 projection1:1 projection no distortion no distortion no magnificationno magnification www.dolphinimaging.com

C B C T - ORTHOC B C T - ORTHOCeph TracingCeph Tracing


C B C T - ORTHOC B C T - ORTHO Nerve MappingNerve Mapping



TMJ ViewTMJ View

Choose an area of Choose an area of interest; set center interest; set center point and axis direction, point and axis direction, designed specifically for designed specifically for analyzing the analyzing the temporomandibular temporomandibular joint joint

Choose desired slice Choose desired slice thickness, width, thickness, width, number and direction number and direction (coronal, sagittal, or (coronal, sagittal, or patent-pending circular) patent-pending circular)

View key cross-sections View key cross-sections at the chosen axes at the chosen axes



3D Visualization3D Visualization

Dolphin gives you the power Dolphin gives you the power to freely visualize the volume to freely visualize the volume in 3D. In addition to in 3D. In addition to switching switching from hard tissue and soft tissue from hard tissue and soft tissue viewsviews, you can also activate , you can also activate the see-thru hard tissue the see-thru hard tissue renderings. Adjust the factor renderings. Adjust the factor of translucency and intensity of translucency and intensity to reveal the structure you to reveal the structure you desire.desire.

Clipping tools are also very Clipping tools are also very useful for quickly visualizing useful for quickly visualizing hidden structures, or to hidden structures, or to simply eliminate portions of simply eliminate portions of the contents that are not the contents that are not relevant.relevant. www.dolphinimaging.com

C B C TC B C T

Interpretation of the Volume of ImagesInterpretation of the Volume of Images Data collected Data collected withinwithin the the Region of Interest Region of Interest

(ROI)(ROI) Within the purview of general dentists and specialistsWithin the purview of general dentists and specialists

Data collected Data collected outsideoutside of the of the Region of Interest Region of Interest A large volume of information exists that is outside of A large volume of information exists that is outside of

a dentists purviewa dentists purview Comprehensive Care of the PatientComprehensive Care of the Patient

Documented interpretation of all the data in the Documented interpretation of all the data in the volumevolume

2007 Chairman of the AAOMS advised that all volumes 2007 Chairman of the AAOMS advised that all volumes be read by a radiologistbe read by a radiologist

C B C TC B C T Interpretation of the Volume of ImagesInterpretation of the Volume of Images

AAO Council on Scientific AffairsAAO Council on Scientific Affairs Survey of RadiologistsSurvey of Radiologists

All scans should be read by a qualified person.All scans should be read by a qualified person. Panoramic can be read by the diagnostician Panoramic can be read by the diagnostician

(dentist)(dentist) Cone Beam volume by an Oral & Cone Beam volume by an Oral &

Maxillofacial Radiologist or an MD Maxillofacial Radiologist or an MD RadiologistRadiologist

The interpretation fee can be either included in The interpretation fee can be either included in the scan fee, or be billed separatelythe scan fee, or be billed separately

The entire volume of data requires The entire volume of data requires interpretation. The patient cannot deny interpretation. The patient cannot deny interpretation of ‘non-dental’ datainterpretation of ‘non-dental’ data

As in medicine, a written report is the standardAs in medicine, a written report is the standardAm J Orthod Dentofacial Orthop 2007;131:697

TIGGERTIGGER


IS IT FOR THE IS IT FOR THE GENERALIST’S GENERALIST’S

OFFICE?OFFICE?

THE BOTTOM LINETHE BOTTOM LINE Is it worth your time and effort?Is it worth your time and effort?

Physical Space in your officePhysical Space in your office TrainingTraining Computer memory to work with imagesComputer memory to work with images Storage of imagesStorage of images

THE BOTTOM LINETHE BOTTOM LINE Is it worth your time and effort?Is it worth your time and effort?

Physical Space in your officePhysical Space in your office TrainingTraining Computer memory to work with imagesComputer memory to work with images Storage of imagesStorage of images

Will it be profitable?Will it be profitable? Cost…of the equipment Cost…of the equipment Time involvedTime involved Number of patient scans x Number of patient scans x

$250-$600/scan$250-$600/scan Types of images available: Pan, Ceph, Types of images available: Pan, Ceph,

Bitewings, PeriapicalsBitewings, Periapicals

MAHALO MAHALO


ReferencesReferences Araki et al. Dentomaxillofac Radiol 31 (1):51, Figure 9 Am J Orthod Dentofacial Orthop 2007;131:697Am J Orthod Dentofacial Orthop 2007;131:697

Turpin D., Editor-in-Chief. Befriend your oral and Turpin D., Editor-in-Chief. Befriend your oral and maxillofacial radiologistmaxillofacial radiologist

Danforth RA, Miles D. Cone Beam Computed Danforth RA, Miles D. Cone Beam Computed Tomography for Dentistry (Journal unknown)Tomography for Dentistry (Journal unknown)

Dental Economics August 2007Dental Economics August 2007 Feuerstein P. Cone Beam Technology.Feuerstein P. Cone Beam Technology. Guttenberg S, Emery R. Profit in 3 dimensionsGuttenberg S, Emery R. Profit in 3 dimensions

R Baba, K Ueda and M Okabe. Using a flat-panel R Baba, K Ueda and M Okabe. Using a flat-panel detector in high resolution cone beam CT for dental detector in high resolution cone beam CT for dental imaging. Dentomaxillofacial Radiology imaging. Dentomaxillofacial Radiology 2004: 33, 2004: 33, 285-290285-290

DentalTown August 2007DentalTown August 2007 Giacobbi T. 3D Images for 21Giacobbi T. 3D Images for 21stst Century Dentistry Century Dentistry


ReferencesReferences Inside Dentistry 1:90-93, 2007

Farman AG, Levato CM, Scarfe WC. A primer on cone beam CT.

JADA supplement June 2008, Vol. 139, JADA supplement June 2008, Vol. 139, “Digital Imaging”“Digital Imaging”

A. Ruprecht. Oral and Maxillofacial Radiology: A. Ruprecht. Oral and Maxillofacial Radiology: Then and NowThen and Now

P.F. van der Stelt. Better Imaging: The P.F. van der Stelt. Better Imaging: The Advantages of Digital RadiographyAdvantages of Digital Radiography

A.G. Farman, et al. In Practice: how Going Digital A.G. Farman, et al. In Practice: how Going Digital Will Affect the Dental OfficeWill Affect the Dental Office

W.B. Howerton Jr, M.A. Mora. Advancements in W.B. Howerton Jr, M.A. Mora. Advancements in Digital Imaging: What Is New and on the Horizon?Digital Imaging: What Is New and on the Horizon?

Seeram, Euclid. Seeram, Euclid. Computed tomography: Computed tomography: physical principles, clinical applications, and physical principles, clinical applications, and quality controlquality control, 2, 2ndnd edition, 2001, Saunders. edition, 2001, Saunders.


ReferencesReferences www.afpimaging.com www.conebeam.com www.cile.co.nr www.ddsgadget.com www.dolphinimaging.com www.e-ssentialnetworks.com www.imagingsciences.com www.jmorita-mfg.com www.osseonews.com

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