Basic Principles Of

CT And CBCT

SALMA EIID – ASSOCIATE PROFESSOR – OMFR

MASTERS S1 717-18-19
▪ Main differences between CT and CBCT
▪ Optimization of CBCT scan
▪ Review on some CBCT applications
PRESENTATION TITLE

AGENDA

INTRODUCTION

PRIMARY GOALS

AREAS OF GROWTH

TIMELINE

SUMMARY

3
PRESENTATION TITLE

PREVIOUSLY…..
Traditional dental x-ray imaging has for decades applied 2D
image acquisition and panoramic mode. However,
superimposition of true volumetric anatomy in
these overlaid 2D images conceals potentially important
clinical findings that would require multiplanar visualization
to reveal local and typically focal findings in any possible
orientation

4
IT ALL BEGAN IN 1995 AND THE FIRST LAUNCH WAS IN 1999.”
6
PRESENTATION TITLE

CT vs. CBCT
7
PRESENTATION TITLE
The foot print
 CBCT MULTI SLICE SPIRAL CT
The machine rotates around the patient one The gantry rotates around the patient
time (the x-ray tube exposes the patient from one side and multiples times to cover the area of interest
an imaging detector measures the attenuated x-rays on the (spiral movement).
other side of the patient, while both the x-ray tube and
detector rotate around the patient)
 CBCT MULTI SLICE SPIRAL CT
The forming unit of any digital image is called a pixel

The numerical data in CBCT is not accurate The numerical data in this image is called the
because of scattered radiation in this system CT number or Hounsfield unit
from partially exposed areas

Relative Density

9
 CBCT MULTI SLICE SPIRAL CT
The forming unit of the image is called a pixel

The numerical data in CBCT is not accurate The numerical data in this image is called the
because of scattered radiation in this system CT number or Hounsfield unit
from partially exposed areas

Relative Density

MSCT has better soft

tissue contrast
resolution with accurate
10
HU
 MULTI SLICE SPIRAL CT
The numerical data in this image is called the CT number or Hounsfield
unit

Bone Window Soft tissue Window

CBCT MULTI SLICE SPIRAL CT
Radiation dose
 justification

(Kaasalainen et al.
2022).
 Optimization

(Kaasalainen et al. 2022).

ALARA ALADA ALADAIP

As low as diagnostically achievable –
As low as reasonably achievable Indication oriented and patient specific
As low as Diagnostically achievable
PRESENTATION TITLE

The main advantages of CBCT over medical CT are the size of the scanner, the
cost and its ease of use for dental applications along with lower effective
radiation doses
CBCT User friendly
Pros
1- Provide interrelational images in
(axial, sagittal, and coronal)
2- Multi-planar reformation

3- Geometrically images with elimination of

anatomic noise

4- Enhancement tools and on-screen measurements

Coronal Sagittal

Axial

1- Provide interrelational images in

(axial, sagittal, and
coronal)
2- Serial Cross sections
2- Multi-planar reformation
 CBCT OPTIMIZATION

HAYASHI
Voxel size
NILSSON
Field of View
Chief
BERGGREN
Chief
Milliampere
SANTOSHI
1. Field of View
 Field of View
▪ The size of the field of view (FOV), describes the scan volume of CBCT
machines and is dependent on the detector size and shape, beam
projection geometry and the ability to collimate the beam.

▪ Beam collimation limits the x-radiation exposure to the region of

interest and ensures that an optimal FOV can be selected based on
disease presentation
 According to the problem, the field of view will be selected!
But with changing the FOV, another parameter should be thought of!
 2. Voxel size
3D representation of the pixel
We need to improve the Signal to noise ratio
3. mA…
Still under investigation

Low & Ultralow dose

protocols!
CBCT Technical tips
The smaller the scan volume, the higher the spatial
resolution of the image!!!!!!!! ( )

The optimal resolution of the any CBCT imaging system

used in delicate structures/fine observations should
(the average width of the periodontal
ligament space)
CBCT Technical tips

Advantages of small FOV CBCT units

① High-resolution images (with a spatial resolution down

to isotropic voxel size - very low exposure to
ionizing radiation - without extensive reconstruction
times)

② Reduces the volume examined

Small FOV will not be
compatible with

Maxillofacial surgies
Implant/Prosthetic situations
 Reading CBCT

Software
Manipulation
Viewing
mode
Volume
orientation
Anatomy
 Applications

There is still a controversy in the use of CBCT in multiple

specialties

CBCT OR MULTI SLICE SPIRAL CT!

CBCT OR MULTI SLICE SPIRAL CT!

Small FOV
Small voxel size
High mA

CBCT
CBCT OR MULTI SLICE SPIRAL CT!

CBCT
Maxillofacial Surgeries
 Trauma

▪ Diagnostic imaging of the patient with maxillofacial trauma is most often an essential
component in the proper evaluation and treatment, as history and physical examination alone
is typically inadequate.

▪ It helps in categorization of fractures, planning of definitive treatment, intraoperative and

postoperative assessment of surgical outcome and subsequent healing
CBCT IS PREFERRED FOR DOSE REDUCTION
 Orbital fractures

In orbital floor fractures, although CBCT can demonstrate orbital content

herniation, it lacks the contrast resolution to differentiate the tissue
composition of the herniated materials
 Maxillary Sinus/Nasal
Pathology
▪ Diagnostic imaging of the patient with maxillofacial trauma is most often an essential
component in the proper evaluation and treatment, as history and physical examination alone
is typically inadequate.

▪ It helps in categorization of fractures, planning of definitive treatment, intraoperative and

postoperative assessment of surgical outcome and subsequent healing
MSCT IS PREFERRED
 Orthodontics
Cephalometrics

Impactions

Growth evaluation using cervical vertebrae

TMJ

Airway

Planning and Treatment Assessment

 The examination of choice for the BONY changes

Normal TMJ in the closed position

Axial Parasagittal Paracoronal

CBCT IS PREFERRED FOR DOSE REDUCTION
 CBCT IS PREFERRED FOR DOSE REDUCTION
HOWEVER, IT IS STILL SKEPTICAL THE EFFICACY OF CBCT IN AIRWAY VOLUME ANALYSIS
Implantology
Beam hardening
 Periodontics

Although periodontal bony defects are well visualized with CBCT, conventional
radiography still affords higher quality bony contrast and delineation of fine
details
CBCT CONS
Motion Artifact
CT/CBCT Cons

Metallic artifacts
CT/CBCT Cons

Metallic artifacts
Thank you