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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
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Bone surface
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Bone marrow
Bone marrow
Bone surface
Bone surface
Parotid gl.
Parotid gl.
Parotid gl.
Parotid gl.
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Parotid gl.
Bone surface
EffectivedoseforCBCT
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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