The Use of Cone Beam CT in Dental, Oral, and Maxillofacial Surgery, and Otolaryngology Settings
Authors: Ndegwa Sarah , Li Yan , Severn Melissa , Ford Caitlyn 
Published: September 2021

The objective of this Environmental Scan was to determine how cone beam CT (CBCT) is being used in Canada, to identify the types of professionals conducting CBCT exams, and to identify the training requirements for CBCT operators.

This scan was informed by a literature search and survey of a sample representation from various clinical settings across Canada. Survey responses were received from Ontario, British Columbia, Manitoba, Prince Edward Island, and Alberta. More than a third of responses were received from dentists in Ontario.

Ionizing radiation has been shown to be a risk factor for the development of malignancy. Since CBCT delivers a higher dose of radiation compared to conventional 2-D imaging, it is important to ensure that the level of exposure to radiation is as low as possible.

Based on responses from the survey, CBCT scans appear to be most commonly being used for dental implantology planning in adults. CBCT also appears to be commonly used for detection of impacted teeth, detection of oral and facial cysts, tumours, and endodontic imaging in adults.

Survey feedback suggests that CBCT is rarely used in children, who are the most sensitive to the effects of ionizing radiation. With the exception of 1 respondent, survey feedback suggested that CBCT is not typically being used for infants and children younger than the age of 5. Respondents rarely used CBCT for children aged 5 to 9 years. The most common procedures used in children 5 years to 17 years of age appear to be for the detection of impacted teeth and the detection of oral and facial cysts, and tumours.

Across all age groups, respondents rarely used CBCT for caries (tooth decay) detection, gum disease detection, nasal septum imaging, and cleft palate imaging. No respondents reported using CBCT for plastic surgery, inner ear imaging, or skull and cranial imaging; however, this may be because of the responses being primarily from dentists.

A wide range of radiation dose levels associated with CBCT use were reported in the survey, depending on the age group, specific procedure, and the radiation dose metric used.

Educational provisions in place for CBCT operators to ensure safety and technical competence differs between the provinces, with some taking more structured approaches than others. The health professionals allowed to operate CBCT scanners also vary between provinces. Based on the survey results, dentists made up the bulk of health professionals currently conducting CBCT scans; however, dentists were also the most well-represented among survey respondents, which may have influenced this result.

Several CBCT scanner models are currently being used in Canada. Most respondents indicated that CBCT scanners have imaging pre-sets that they use for the procedures they perform. Approximately half of respondents indicated that they have also defined their own imaging parameters for some procedures. Most of the CBCT systems being used include exposure tables, which the majority of respondents found easy to understand.