Comparison of Swedish and Norwegian Use of Cone-Beam Computed Tomography: a Questionnaire Study.

OBJECTIVES: Cone-beam computed tomography in dentistry can be used in some countries by other dentists than specialists in radiology. The frequency of buying cone-beam computed tomography to examine patients is rapidly growing, thus knowledge of how to use it is very important. The aim was to compare the outcome of an investigation on the use of cone-beam computed tomography in Sweden with a previous Norwegian study, regarding specifically technical aspects. MATERIAL AND METHODS: The questionnaire contained 45 questions, including 35 comparable questions to Norwegian clinics one year previous. Results were based on inter-comparison of the outcome from each of the two questionnaire studies. RESULTS: Responses rate was 71% in Sweden. There, most of cone-beam computed tomography (CBCT) examinations performed by dental nurses, while in Norway by specialists. More than two-thirds of the CBCT units had a scout image function, regularly used in both Sweden (79%) and Norway (75%). In Sweden 4% and in Norway 41% of the respondents did not wait for the report from the radiographic specialist before initiating treatment. CONCLUSIONS: The bilateral comparison showed an overall similarity between the two countries. The survey gave explicit and important knowledge of the need for education and training of the whole team, since radiation dose to the patient could vary a lot for the same kind of radiographic examination. It is essential to establish quality assurance protocols with defined responsibilities in the team in order to maintain high diagnostic accuracy for all examinations when using cone-beam computed tomography for patient examinations.

Right main bronchus perforation detected by 3D-image.

A male metal worker, who has never smoked, contracted debilitating dyspnoea in 2003 which then deteriorated until 2007. Spirometry and chest x-rays provided no diagnosis. A 3D-image of the airways was reconstructed from a high-resolution CT (HRCT) in 2007, showing peribronchial air on the right side, mostly along the presegmental airways. After digital subtraction of the image of the peribronchial air, a hole on the cranial side of the right main bronchus was detected. The perforation could be identified at the re-examination of HRCTs in 2007 and 2009, but not in 2010 when it had possibly healed. The occupational exposure of the patient to evaporating chemicals might have contributed to the perforation and hampered its healing. A 3D HRCT reconstruction should be considered to detect bronchial anomalies, including wall-perforation, when unexplained dyspnoea or other chest symptoms call for extended investigation.