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Correcte diagnosestelling door cone beam CT Reinhilde Jacobs Oral Imaging Center KU Leuven

Correcte diagnose door Conebean scan Reinhilde Jacobs

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Correcte diagnosestelling door cone beam CT Reinhilde Jacobs Oral Imaging Center KU Leuven . Parachute approach to evidence based medicine Potts et al BMJ. 2006; 333: 701–703 Known? • Parachutes are widely used to prevent death and major injury after gravitational challenge • Parachute use is associated with adverse effects due to failure of the intervention and iatrogenic injury • Studies of free fall do not show 100% mortality

Citation preview

  • Correcte diagnosestelling door cone beam CT

    Reinhilde JacobsOral Imaging Center

    KU Leuven

  • .

    Parachute approach to evidence based medicinePotts et al BMJ. 2006; 333: 701703

  • Known?

    Parachutes are widely used to prevent death and major injury after gravitational challenge

    Parachute use is associated with adverse effects due to failure of the intervention and iatrogenic injury

    Studies of free fall do not show 100% mortality

  • New?

    No randomised controlled trials of parachute use have been undertaken

    The basis for parachute use is purely observational, and its apparent efficacy could potentially be explained by a healthy cohorteffect

    Individuals who insist that all interventions need to be validated by a randomisedcontrolled trial need to come down to earth with a bump

  • We think that everyone might benefit if the mostradical protagonists of evidence based medicineorganised and participated in a double blind,randomised, placebo controlled, crossover trial of the parachute.

  • Planning

    CAD/CAM

    Navigation

    Diagnosis

  • Optimisation: dosimetry vs image quality

    www.sedentexct.eu

  • 10

    9

    8

    7

    6

    5

    4

    3

    2

    1 14

    13

    12

    11

    S1

    S2

    S3

    S4

    S5

    S6

    Slice 51

    2

    34

    56

    7 89 10

    1112

    13

    14

    S1

    S2

    S3

    S4

    S5

    S6

    Bone surface

    Skin

    Skin

    Skin

    Skin

    Skin

    Skin

    Bone surface

    Bone surface

    Bone marrow

    Bone marrow

    Bone surface

    Bone surface

    Parotid gl.

    Parotid gl.

    Parotid gl.

    Parotid gl.

    Parotid gl.

    Parotid gl.

    Bone surface

  • EffectivedoseforCBCT

    0

    50

    100

    150

    200

    250

    300

    350

    400

    Galile

    os28

    mAs

    Galile

    os35

    mAs

    iCAT

    Nex

    tGen

    erat

    ion13

    cm

    Iluma

    Koda

    k900

    0upp

    erfr

    ont

    Koda

    k900

    0low

    erm

    olar

    Koda

    k950

    0lar

    gefie

    ld

    Koda

    k950

    0sma

    llfiel

    d

    NewT

    omVG

    ilarg

    efiel

    d

    NewT

    omVG

    ism

    allfie

    ldHR

    PaxU

    ni3D

    fron

    t

    Picas

    soTr

    iohig

    hdos

    e

    Picas

    soTr

    iolow

    dose

    ProM

    ax3D

    high

    dose

    ProM

    ax3D

    low

    dose

    Scan

    ora3

    Dex

    tend

    edfie

    ld

    Scan

    ora3

    Dup

    per

    Scan

    ora3

    Dlow

    er

    Scan

    ora3

    Dup

    per+

    lower

    SkyV

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    viewe

    pocs

    3DE

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    e

    c

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    v

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    s

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    )

  • Liang et al 2010

  • Accuracy: 200-400 m Radiation dose 2-5 days eq Costs balanced

    ? 1 CBCT replacing series conventional diagnostics

  • Sanderink 1999

  • X-ray

    source

    7 upward: changing relationships between structures

  • Info dimensions+morphology +neurovascularisation

  • Anteriorjawboneneurovascularisationhassignficantsize/diameter

  • 1 2 3 4

  • Sensory dysfunction!

    50y, Female

    Case from Dr. Livia Corpas

  • OsteodentOsteodent

  • OsteodentOsteodent

    Jaw Bone Osteoporosis

  • OsteodentOsteodent Workpackage 3 (Athens)

    Quantitative index: PMI

    Benson et al. (1991)

  • OsteodentOsteodent Workpackage 3 (Athens)

    Qualitative index:

    Klemetti et al. (1994)

  • Densehomogenous

    Heterogeneous

    Sparsehomogenous

    Lindh et al. 1996

  • DXA

  • Osteodent: LeuvenOsteodent: Leuven

    UJ LJ

  • Roberts et al Osteop Int 2010

  • Correcte diagnosestelling door cone beam CT. Known?New?OsteodentOsteodentOsteodentOsteodentOsteodent: LeuvenRoberts et al Osteop Int 2010