Title	Cone-Beam Computed Tomography (CBCT) Use in Routine Orthodontic Evaluation Exposes Patients to Higher Levels of Radiation Than Lateral Cephalometric Radiography and/or Digital Panoramic Radiography
Clinical Question	Is there a significant increase in radiation exposure for individuals undergoing routine orthodontic evaluation when Cone-Beam Computed Tomography is used as opposed to lateral cephalometric radiography and/or digital panoramic radiography?
Clinical Bottom Line	Cone-Beam Computed Tomography use in routine orthodontic evaluation exposes patients to higher levels of radiation than lateral cephalometric radiography and/or digital panoramic radiography. This has been demonstrated by two comparative studies that utilized radiation sensors in anthropomorphic phantoms to measure the effective radiation doses of each imaging method. In each study, it was shown that the use of Cone-Beam Computed Tomography results in a significantly larger effective radiation dose to the patient than traditional cephalometric and/or digital panoramic radiography.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22464525 Grunheid/2012 Head and neck phantom Laboratory Key results In this comparative study, the effective radiation doses for several orthodontic imaging methods were examined. It was found that lateral cephalometric radiography and digital panoramic radiography exposed patients to the lowest effective radiation doses (4.5 μSv and 21.5 μSv, respectively.) One Cone-Beam Computed Tomography device (i-CAT) was likewise assessed using various settings. The effective radiation doses for the i-CAT unit ranged from 64.7 μSv to 134.2 μSv depending on the voxel size, resolution, and field-of-view setting. 18456133 Silva/2008 Anthropomorphic phantom Laboratory Key results In this comparative study, the effective radiation doses for several orthodontic imaging methods were examined. It was found that panoramic/lateral cephalometric radiography had the lowest effective radiation dose (10.4 μSv). Two Cone-Beam Computed Tomography devices (i-CAT and NewTom 9000) were likewise assessed and had effective radiation doses of 61.1 μSv and 56.2 μSv, respectively. Multi-slice CT imaging had the highest effective radiation dose (429.7 μSv).
Evidence Search	"Cone-Beam Computed Tomography/instrumentation"[Mesh] AND "Radiography, Panoramic"[Mesh] AND "Cephalometry"[Mesh] AND "Radiation Dosage"[Mesh]
Comments on The Evidence	Each study used an anthropomorphic phantom and thermoluminescent dosimeters. Neither study mentioned the presence or absence of competing interests
Applicability	The use of Cone-Beam Computed Tomography in routine orthodontic evaluations exposes patients to higher levels of radiation than do traditional lateral cephalometric and digital panoramic radiographic techniques. Use of Cone-Beam Computed Tomography in uncomplicated orthodontic cases may therefore not be warranted, especially in patients who, for medical or personal reasons, are concerned by the increased levels of radiation exposure. In most cases, the use of lateral cephalometric and digital panoramic radiographs will provide a comparatively safe and sufficient alternative to Cone-Beam Computed Tomography for use in orthodontic diagnosis and treatment planning.
Specialty	(Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics)
Keywords	Cone beam computed tomography, cephalometric imaging, Radiation, Orthodontics, Radiology
ID#	2673
Date of submission	03/25/2014
E-mail	flandersb@livemail.uthscsa.edu
Author	Bethany Flanders
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Birgit J. Glass, DDS, MS
Faculty mentor e-mail	glass@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available