A reject analysis of cone-beam CTs in under-aged patients.

OBJECTIVES:: The main objective of this study was to perform a retrospective reject analysis (or audit) of 79 cone-beam CTs (CBCTs) taken in under-aged patients at the Ghent University hospital over a 2-year timespan. METHODS:: Observer agreement between two oral radiologists and two senior year Master students in Paediatric Dentistry was performed for quality, diagnostic and therapeutic value. The senior year Master Students followed appropriate modules of an online course. Descriptive and comparative statistics were performed. RESULTS:: For the oral radiologists, all intra rater reliabilities were moderate to good (Gwet's AC1 = 0.41-0.75). For the senior students in Paediatric dentistry, these varied highly from fair to very good (Gwet's AC1 = 0.28-0.95). There was a high level of disagreement between oral radiologists and students (Gwet's AC1 = 0.16-0.45) and in-between students concerning observed quality (Gwet's AC1 = 0.29). A total of 16 CBCTs (20%) was rejected, 24 images (30%) were acceptable and 39 images (50%) had an excellent quality. 50 CBCTs were perceived to have a diagnostic advantage. 13 of the images would have no influence on the therapy, according to the oral radiologists. A significant correlation was found between unacceptable quality, absence of perceived diagnostic advantage (p = 0.004, RR = 2.4) and influence on therapy (p < 0.0005, RR = 1.8). A small field of view (FOV) was positively correlated to an excellent quality of the image (p = 0.011, RR = 2.8). CONCLUSIONS:: Image quality did not reach the proposed boundary of 10% according to the European Guidelines on Radiation Protection in Dental Radiology. This is the first published audit on an overall database of under-age children for CBCT.

Cone-beam computed tomography in pediatric dentistry, a retrospective observational study.

OBJECTIVES: The aim of this study was to find the reasons for referral and their correlation with age, gender, field of view, and resolution for all patients under the age of 18 who underwent a cone-beam computed tomography (CBCT) scan between 1 May 2010 and 1 May 2012 in the dental out-patient clinic of the University Hospital Ghent. MATERIAL AND METHODS: From the local CBCT database, 79 pediatric patients gave their consent. Subsequently age, gender, reason for referral, external or internal referral, field of view (FOV), and resolution data were collected. Descriptive and comparative statistical analysis was performed. RESULTS: There seemed to be a correlation between orthodontic referrals and female patients. The majority of patients referred for trauma follow-up were 12 years and older. Fourteen percent of referrals were for dento-alveolar trauma, 18 % for other dento-alveolar reasons, 4 % for developing dentition-generalized, 36 % for developing dentition-localized, 10 % for endodontics, 1 % for periodontics, 16 % for surgical applications, and 1 % was for the visualization of the TMJ. Eighty percent of the CBCTs were taken at a FOV 50 × 55 mm. Larger FOV was used for surgical planning or follow-up reasons. The majority of the CBCTs was taken at a resolution of 200 µm, while a resolution of 150 µm was used for endodontic issues. From these results, a classification system for referral was developed. CONCLUSIONS: From the present study, it can be concluded that a referral pattern could be detected which was correlated with gender, age group, FOV, and resolution. These results can help practitioners make the decision to refer for CBCT when extra three dimensional imaging is expected to have a benefit in therapeutic value for a pediatric or adolescent patient. CLINICAL RELEVANCE: This study can guide dental professionals referring pediatric and adolescent patients for CBCT.