Ce trebuie sa stim despre CBCT (tomografia computerizata cu fascicul conic)?

1. Ce este CBCT?

In traducere libera, CBCT - Cone Beam Computer Tomography - inseamna tomografie computerizata cu fascicul conic. Aceasta tehnologie a aparut in anul 2001 si a insemnat un salt imens în imagistica medicala, imbunatatind atat diagnosticarea, cat si planificarea tratamentului stomatologic, oferind maximum de informatii cu o doza minima de radiatie. Este o investigatie foarte simpla, ce nu necesita o pregatire speciala in prealabil, se desfasoara rapid, in cateva secunde, este accesibila ca pret si usor de utilizat.

2. Cum se realizeaza imaginea si analiza 3D?

Aparatul tomografului CBCT arata exact ca un aparat pentru radiografii panoramice, efectuarea tomografiei devenind astfel mult mai comoda decat in cazul tomografelor volumetrice traditionale, cu fascicul in evantai.

CBCT foloseste un singur fascicul mic de raze, acesta avand forma conica si o arie de interes precis, aleasa de operator in functie de recomandarea medicului stomatolog (scanarea unui grup de dinti, a unei hemiarcade sau arcade, a intregii danturi). Scannerul are nevoie de doar cateva secunde si de o singura rotatie in jurul capului pacientului pentru a obtine o imagine 3D foarte buna, din punct de vedere calitativ. Utilizarea fasciculul conic, delimitarea ariei de interes si timpul scurt de iradiere efectiva a pacientului fac ca doza de radiatii in cazul tehnologiei CBCT sa fie de 10 - 20 de ori mai mica decat cea utilizata in cazul tomografiilor volumetrice (clasice) cu fascicul in evantai.

Prelucrarea si analiza tomografiei se realizeaza cu soft-ul de vizualizare si editare Romexis Viewer 3D, cu ajutorul caruia se cumuleaza informatii numeroase si precise ale structurii dentare si elementelor anatomice invecinate (sinusuri maxilare, canal mandibular).

Cu acest soft se pot obtine:

- masuratori foarte precise (scala 1:1) ale osului sau ale diferitelor zone de interes (se pot masura atat distante, cat si unghiuri);

- sectiuni in orice directie sau in orice axa aleasa de medic (foarte util pentru masuratorile necesare implantologilor, vizualizarea ATM, endodontie);

- reprezentarea spatiala (reconstructia volumetrica) a zonei de interes;

- posibilitatea marcarii curburii arcadei investigate si crearea unei imagini pseudo-panoramice. Slice-urile vor fi, astfel, perpendiculare pe creasta osoasa marcata (foarte util pentru efectuarea unor masuratori cat mai exacte);

- determinarea densitatii osoase;

- editarea si modificarea imaginii din punct de vedere al contrastului, luminozitatii, marimii, etc;

- posibilitatea salvarii masuratorilor sau imaginilor de interes in format jpg sau pdf.

Pe langa softul Romexis Viewer oferit gratuit, cu care medicul poate usor explora si efectua analiza tomografiei, YTS - Dental View va ofera, la fiecare CT, analiza efectuata de catre echipa noastra de profesionisti.

Pentru că însemnăm mai mult decât o simplă denumire!

Dr. Valentina Boantă, Director Executiv YTS-Dental View

Tomografii dentare in Centrele YTS - Dental View - calitate maxima, cu doze minime de radiatii

Centrele YTS-Dental View sunt utilate cu cele mai performante tomografe din Romania:

· Planmeca ProMax 3D MID in Centrul Piata Muncii
· Morita Veraviewepocs 3D in Centrul Aviatorilor
· Planmeca ProMax 3D in Centrul Lujerului

Aceste computere tomograf cu fascicul conic (CBCT-uri) va ofera:

· Cea mai mare rezolutie a imaginii
· Cea mai mica doza de radiatii
· Tomografii dentare cu volum pana la 200 x 170 cm
· Tomografii ORL (cai aeriene, sinusuri, urechi, nas, os temporal)
· Pro Face Sistem – reconstructia 3D a structurilor moi ale fetei
· Modul de endodontie cu sectiuni din 0,1 in 0,1 mm
· Modul de ortodontie cu analiza teleradiografiei
· Modul de implantologie cu simulare de implant si librarie de implanturi
· Soft Romexis Viewer actualizat cu culori diferite ale diametrelor osoase.

Va asteptam cu drag in oricare dintre Centrele noastre si va multumim ca aţi ales serviciile noastre!

Dr. Valentina Boantă, Director Executiv YTS-Dental View

Ghidurile Europene pentru CBCT - partea a II - a

2: RADIATION DOSE AND RISK

2.1: X-rays

X-rays are a type of electromagnetic (EM) radiation. EM radiation also includes visible light, radio waves, microwaves, cosmic radiation, and several other varieties of “rays”. All can be considered as “packets” of energy, called photons, which have wave properties, most importantly a wavelength and frequency. EM radiation can vary in wavelength from 10-13 to 103 m with X-rays having a small wavelength of 10-9 to 10-13m. The importance of this is that small wavelengths mean high energy, deeper penetration though matter and high energy transfer to the matter. When X-rays hit atoms this energy can be transferred, producing ionisation of atoms. Other examples of ionising radiation are alpha, beta and gamma radiation, which are mostly associated with the decay of radioactive materials. All ionising radiations have the capability cause harm to the organs and tissues of the body of exposed persons.

2.2: Radiation damage

When patients undergo X-ray examinations, millions of photons pass through their bodies. These can damage any molecule by ionisation, but damage to the DNA in the chromosomes is of particular importance. Most DNA damage is repaired immediately, but rarely a portion of a chromosome may be permanently altered (a mutation). This may lead ultimately to the formation of a tumour. The latent period between exposure to X-rays and the clinical diagnosis of a tumour may be many years. The risk of a tumour being produced by a particular X-ray dose can be estimated; therefore, knowledge of the doses received by radiological techniques is important. While doses and risks for dental radiology are small, a number of epidemiological studies have provided some limited evidence of an increased risk of brain (Longstreth et al, 1993; Preston-Martin & White, 1990), salivary gland (Preston-Martin & White, 1990; Horn-Ross et al, 1997) and thyroid (Hallquist et al, 1994; Wingren et al, 1997; Memon et al, 2010) tumours for dental radiography.

Ghidurile Europene pentru CBCT - partea a III - a

4: JUSTIFICATION AND REFERRAL CRITERIA

As with any X-ray exposure, CBCT entails a risk to the patient. It is essential that any X-ray examination should show a net potential benefit to the patient, weighing the total potential diagnostic benefits it produces against the individual detriment that the exposure might cause. The efficacy, benefits and risk of available alternative techniques having the same objective but involving less (or no) exposure to X-rays should be taken into account. A record of the justification process must be made in the patient‟s clinical records.

All CBCT examinations must be justified on an individual basis by demonstrating that the potential benefits to the patients outweigh the potential risks. CBCT examinations should potentially add new information to aid the patient‟s management. A record of the Justification process must be maintained for each patient ED BP

In order that the justification process can be carried out, it is essential that selection of dental CBCT is based on the individual patient‟s history and a clinical examination. The “routine” use of dental CBCT on patients based on a generalised approach rather than individual prescription is unacceptable. A “routine” (or “screening”) examination is defined as one in which a radiograph is taken regardless of the presence or absence of clinical signs and symptoms.

Ghidurile Europene pentru CBCT - partea a V - a

5:     CBCT EQUIPMENT FACTORS IN THE REDUCTION OF RADIATION RISK

        TO PATIENTS

The literature review in section 2.5 showed that the effective dose may vary significantly between different CBCT equipment. In this section, the significance of selection of appropriate exposure settings in limiting doses while maintaining the image quality at acceptable clinical levels (optimisation) is reviewed. Due account was given to any available national recommendations on CBCT optimisation (Haute Autorité de Santé, 2009; Health Protection Agency, 2010; Statens strålevern, 2010).

5.1: X-ray tube voltage and mAs

The kilovoltage (kVp) of an X-ray tube is the potential difference between anode and cathode during operation. The tube voltage determines the energy of the X-rays. Lower tube voltages give lower energy X-rays and thus increase the dose to the skin of the patient (Horner 1994). Increasing the kVp may result in a decrease in skin and effective dose (Geijer et al 2009) but an increase in scatter. Higher kVp, however, reduces the beam hardening effect (Ludlow 2011). More research is needed to explore the optimisation of kVp in CBCT. The product of the tube current measured in milliamperes (mA) and the exposure time measured in seconds (s) only affects the number of photons emitted by the X-ray tube and not their energy. Increased mAs increases dose, but the beam penetration and image contrast remain the same. The kVp and mA in dental CBCT equipment is either fixed or can be varied depending on the CBCT unit (Ludlow et al 2006; Lofthag-Hansen et al 2008; Silva et al 2008; Okano et al 2009; Roberts et al 2009). Fixed kVp and mA preclude optimisation.

Lansare Blog YTS - Dental View

Calitate, Claritate, Profesionalism, Încredere, Grijă, Zâmbete fericite - acestea sunt cuvintele care ne definesc!

Cea mai performantă aparatură radiologică, investigaţii radiologice digitale la cea mai înaltă rezoluţie şi calitate, radiografii şi tomografii dentare obţinute cu cele mai mici doze de radiaţii, grija pentru pacienţii noştri şi profesionalismul personalului nostru ne fac prima alegere a medicilor şi clinicilor stomatologice din Bucureşti!

Preocuparea noastră principală este PACIENTUL, fapt ce se poate distinge şi din motto-ul companiei "Priveşte-ţi pacienţii mai clar", care exprimă calitatea şi claritatea serviciilor oferite, dar şi aportul pe care îl aducem medicilor în obţinerea unor zâmbete luminioase, pentru fiecare pacient.

YTS - Dental View este cea mai modernă reţea exclusivă de centre de radiologie şi tomografie dentară din Bucureşti, având servicii şi echipamente ce răspund celor mai înalte standarde europene. Pe lângă aparatura ultramodernă de care dispune, YTS - Dental View lucrează o echipă de profesionişti, orientată spre confortul pacienţilor.