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Ethical and Medicolegal Issues Related to CBCT

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Maxillofacial Cone Beam Computed Tomography

Abstract

Evidence-based, good clinical practice usually satisfies a medicolegal standard. It is in this spirit and through this prism that practitioners should view medicolegal issues. To comprehend the application of good clinical practice as applied to CBCT imaging, one must consider the concept of “standards” in regard to at least five “stakeholders”; patients whom we serve, health care professionals who provide care, the dental Industry; the legal system, and payers who are financially responsible. Therefore, the concept of standard may well mean different things to different stakeholders. In the broadest sense, standards may be considered in ethical, moral, and medicolegal context.

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Notes

  1. 1.

    American Dental Association; American Academy of Oral and Maxillofacial Radiology; American Association of Oral and Maxillofacial Surgeons; American Association of Endodontists; American Academy of Oral and Maxillofacial Pathology; American Academy of Pediatric Dentistry; American Academy of Periodontology; American Dental Education Association; Canadian Association of Oral and Maxillofacial Radiology; and the European Academy of DentoMaxilloFacial Radiology.

References

  • Academy of Osseointegration (2010) 2010 guidelines of the Academy of Osseointegration for the provision of dental implants and associated patient care. Int J Oral Maxillofac Implants 25:620–627

    Google Scholar 

  • Advies van de Hoge Gezondheidsraad nr. 8705 (2011) Dentale cone beam computed tomography. Hoge Gezondheidsraad, Brussels. www.health.belgium.be/internet2Prd/groups/public/@public/@shc/documents/ie2divers/19068321_en.pdf. Accessed 1 Aug 2016

  • American Academy of Oral and Maxillofacial Radiology (2013) Clinical recommendations regarding use of cone beam computed tomography in orthodontics. [corrected]. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surge Oral Med Oral Pathol Oral Radiol 116:238–257

    Article  Google Scholar 

  • American Academy of Oral and Maxillofacial Radiology (AAOMR) (2016). Basic CBCT level 1 course. http://www.aaomr.org/?page=CBCTcourse. Accessed 24 June 2016

  • American Association of Endodontists (2013) Recommended guidelines of the AAE for the treatment of traumatic dental injuries (revised 2013). http://www.aae.org/guidelines/

  • American Dental Association (2011a) ADA Technical Report No. 1048 for Attachment of DICOM Datasets Using Email in Dentistry. http://ebusiness.ada.org/productcatalog/554/Informatics/ADA-Technical-Report-No-1048-for-Attachment-of-DICOM-Dataset/ADA1048-2011D. Accessed 4 Aug 2016

  • American Dental Association (2011b) ADA Technical Report No. 1048 for Attachment of DICOM Datasets Using Email in Dentistry. Available at : http://ebusiness.ada.org/productcat-alog/554/Informatics/ADA-Technical-Report-No-1048-for-Attachment-of-DICOM-Dataset/ADA1048-2011D. Accessed August 4, 2016

  • American Dental Association (2011c) ADA Technical Report No. 1023 for DICOM Requirements for Dentistry. http://ebusiness.ada.org/productcatalog/1058/Informatics/ADA-Technical-Report-No-1023-for-Implementation-Requirements/ADA1023. Accessed 4 Aug 2016

  • American Dental Association (2015) Comprehensive statement on Teledentistry. American Dental Association House of Delegates, ratified, November, 2015

    Google Scholar 

  • American Dental Association Council on Scientific Affairs (2012) The use of cone-beam computed tomography in dentistry: an advisory statement from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 43:899–902

    Google Scholar 

  • American Dental Association House of Delegates (2015) Resolution 45H-2015, Comprehensive ADA Policy Statement on Teledentistry. http://www.ada.org/en/publications/ada-news/2015-archive/december/house-passes-guidelines-on-teledentistry. Accessed 4 Aug 2016

  • Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2013) s2k-Leitlinie Dentale digitale Volumentomographie Version Nr. 9 vom 5 August 2013. AWMF-Register-Nummer: 083–05. AWMF, D¨usseldorf. http://www.awmf.org/uploads/tx_szleitlinien/083-005l_S2k_Dentale_Volumentomographie_2013-10.pdf

  • Benavides E, Rios HF, Ganz SD, An CH, Resnik R, Reardon GT, Feldman SJ, Mah JK, Hatcher D, Kim MJ, Sohn DS, Palti A, Perel ML, Judy KW, Misch CE, Wang HL (2012) Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report. Implant Dent 21:78–86

    Article  PubMed  Google Scholar 

  • Bowlin J (2010) Cone beam technology: legal caveats. Bull Am Assoc Orthodontists 28:24–25

    Google Scholar 

  • Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  • Brown J, Jacobs R, Levring Jäghagen E, Lindh C, Baksi G, Schulze D, Schulze R, European Academy of DentoMaxilloFacial Radiology (2012) Basic training requirements for the use of dental CBCT by dentists: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology. Dentomaxillofac Radiol 43:20130291

    Article  Google Scholar 

  • Carter L, Farman AG, Geist J, Scarfe WC, Angelopoulos C, Nair MK, American Academy of Oral and Maxillofacial Radiology et al (2008) Executive statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:561–562

    Article  PubMed  Google Scholar 

  • Council Directive 93/42/EC of 14 June 1993 (1993) concerning medical devices. OJ L 169,12.7.1993, p. 1

    Google Scholar 

  • Council Directive 2007/47/EC of the European Parliament and of the Council of 5 September 2007 (2007) amending Council Directive 90/385/EEC on the approximation of the laws of the Member States relating to active implantable medical devices, Council Directive 93/42/ECC concerning medical devices and Directive 98/8/EC concerning the placing of biocidal products on the market, OJ L247, 21.9.2007, p.21–55

    Google Scholar 

  • Curley A, Hatcher DC (2009) Cone beam CT—anatomic assessment and legal issues: the new standards of care. J Calif Dent Assoc 37:653–662

    PubMed  Google Scholar 

  • Curley A, Hatcher DC (2010) Cone beam CT—anatomic assessment and legal issues: the new standards of care. Todays FDA 22:52–55, 57–9, 61–3

    PubMed  Google Scholar 

  • Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A et al (2012) International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 28:2–12

    Article  PubMed  Google Scholar 

  • Dula K, Bornstein MM, Buser D, Dagassan-Berndt D, Ettlin DA, Filippi A, Gabioud F, Katsaros C, Krastl G, Lambrecht JT, Lauber R, Luebbers HT, Pazera P, Türp JC, SADMFR (2014) SADMFR guidelines for the use of cone-beam computed tomography/digital volume tomography. Swiss Dent J 124:1169–1183

    PubMed  Google Scholar 

  • Dula K, Benic GI, Bornstein M, Dagassan-Berndt D, Filippi A, Hicklin S, Kissling-Jeger F, Luebbers HT, Sculean A, Sequeira-Byron P, Walter C, Zehnder M (2015) SADMFR guidelines for the use of cone-beam computed tomography/digital volume tomography. Swiss Dent J 125:945–953

    PubMed  Google Scholar 

  • Durchführung der Röntgenverordnung (RöV) (2005) Fachkunde und Kenntnisse im Strahlenschutz bei dem Betrieb von Röntgeneinrichtungen in der Medizin oder Zahnmedizin [Specialist skills and knowledge in radiological protection when operating X-ray units for dental or general medical use]. https://www.bfs.de/SharedDocs/Downloads/BfS/DE/rsh/3-bmub/3_92_1112.pdf?__blob=publicationFile&v=1. Accessed 24 June 2016

  • European Commission (2012) Radiation protection 172. Evidence based guidelines on cone beam CT for dental and maxillofacial radiology. Office for Official Publications of the European Communities, Luxembourg. http://ec.europa.eu/energy/nuclear/radiation_protection/doc/publication/172.pdf. Accessed 1 Aug 2016

  • European Council (1997) Council Directive 97/43/EURATOM of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing directive 84/466/EURATOM. EC, Luxembourg. http://ec.europa.eu/energy/nuclear/radioprotection/doc/legislation/9743_en.pdf. Accessed 24 June 2016

  • European Society of Endodontology, Patel S, Durack C, Abella F, Roig M, Shemesh H, Lambrechts P et al (2014) European Society of Endodontology position statement: the use of CBCT in endodontics. Int Endod J 47:502–504

    Article  Google Scholar 

  • Evans G, Bishop K, Renton T (2012) Guidelines for surgical endodontics version 2. http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/documents/surgical_endodontics_2012.pdf.

    Google Scholar 

  • Faculty of General Dental Practice (UK) (2013) In: Horner K, Eaton KA (eds) Selection criteria for dental radiography, 3rd edn. Faculty of General Dental Practice (UK) Royal College of Surgeons of Surgeons of England, London

    Google Scholar 

  • Federal Food, Drug and Cosmetic Act (FFDCA) (2017) Chapter V, Subchapter C—Electronic product radiation control; Title 21 Code of Federal Regulations (Subchapter J, Radiological health) Parts 1020.30 21 (1938) (revised April, 2017)

    Google Scholar 

  • Friedland B (2009) Medicolegal issues related to cone beam CT. Semin Orthod 15:77–84

    Article  Google Scholar 

  • Friedland B (2010) Conebeam computed tomography: legal considerations. Alpha Omegan 103:57–61

    Article  PubMed  Google Scholar 

  • Friedland B, Miles DA (2014) Liabilities and risks of using cone beam computed tomography. Dent Clin N Am 58:671–685

    Article  PubMed  Google Scholar 

  • Fryback DG, Thornbury JR (1991) The efficacy of diagnostic imaging. Med Decis Mak 11:88–94

    Article  CAS  Google Scholar 

  • Gazelle GS, Halpern EF, Ryan HS, Tramontano AC (2007) Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral. Radiology 245:517–522

    Article  PubMed  Google Scholar 

  • Government of Western Australia Radiological Council (2016) http://www.radiologicalcouncil.wa.gov.au/Pages/FAQ/Dentists.html

  • Graskemper JP (2004) The standard of care in dentistry: where did it come from? How has it evolved? J Am Dent Assoc 135:1449–1455

    Article  PubMed  Google Scholar 

  • Haney E, Gansky SA, Lee JS, Johnson E, Maki K, Miller AJ, Huang JC (2010) Comparative analysis of traditional radiographs and cone-beam computed tomography volumetric images in the diagnosis and treatment planning of maxillary impacted canines. Am J Orthod Dentofac Orthop 137:590–597

    Article  Google Scholar 

  • Harris D, Horner K, Grondahl K, Jacobs R, Helmrot E, Benic GI et al (2012) E.A.O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res 23:1243–1253

    Article  PubMed  Google Scholar 

  • Haute Autorité de Santé (2009) Tomographie Volumique a Faisceau Conique de la Face (Cone Beam Computerized Tomography). Rapport d’évaluation Technologique. Service évaluation des actes professionnels. Haute Autorité de Santé, Saint-Denis La Plaine. http://www.has-sante.fr/portail/upload/docs/application/pdf/2009-12/rapport_cone-beam_version_finale_2009-12-28_17-27-28_610.pdf. Accessed 1 Aug 2016

  • Health Protection Agency (HPA) Working Party on Dental Cone Beam CT Equipment (2010a) Guidance on safe use of dental cone beam CT (Computed Tomography) equipment. HPA Centre for Radiation, Chemical and Environmental Hazards, Oxfordshire. pp 1–56, ISBN 978-0-85951-681-5. www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287143862981. Accessed 1 Aug 2016

  • Health Protection Agency (HPA) Working Party on Dental Cone Beam CT Equipment (2010b) Guidance on safe use of dental cone beam CT (computed tomography) equipment. HPA Centre for Radiation, Chemical and Environmental Hazards, Oxfordshire. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287143862981. Accessed 3 Aug 2016

  • Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M (1990) Frequency and costs of diagnostic imaging in office practice—a comparison of self-referring and radiologist-referring physicians. N Engl J Med 323:1604–1608

    Article  CAS  PubMed  Google Scholar 

  • Hollingworth W (2005) Radiology cost and outcomes studies: standard practice and emerging methods. AJR Am J Roentgenol 185:833–839

    Article  PubMed  Google Scholar 

  • Hollingworth W, Jarvik JG (2007) Technology assessment in radiology: putting the evidence in evidence-based radiology. Radiology 244:31–38

    Article  PubMed  Google Scholar 

  • Holmes SM (2007) iCAT Scanning in the Oral Surgery Office. OMS National Insurance Company Newsletter, Rosemont, 2:181

    Google Scholar 

  • Horner K, Islam M, Flygare L, Tsiklakis K, Whaites E (2009) Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 38:187–195

    Article  CAS  PubMed  Google Scholar 

  • Horner K, O’Malley L, Taylor K, Glenny AM (2015) Guidelines for clinical use of CBCT: a review. Dentomaxillofac Radiol 44:20140225

    Article  CAS  PubMed  Google Scholar 

  • Husain J, Burden D, McSherry P, Morris D, Allen M, Clinical Standards Committee of the Faculty of Dental Surgery RCoSoE (2012) National clinical guidelines for management of the palatally ectopic maxillary canine. Br Dent J 213:171–176

    Article  CAS  PubMed  Google Scholar 

  • Isaacson KG, Thom AR, Horner K, Whaites E (2008) Guidelines for the use of radiographs in clinical orthodontics, 3rd edn. British Orthodontic Society, London

    Google Scholar 

  • Jerrold L (2007) Litigation, legislation, and ethics. Liability regarding computerized axial tomography scans. Am J Orthod Dentofac Orthop 132:122–124

    Article  Google Scholar 

  • Katheria BC, Kau CH, Tate R, Chen JW, English J, Bouquot J (2010) Effectiveness of impacted and supernumerary tooth diagnosis from traditional radiography versus cone beam computed tomography. Pediatr Dent 32:304–309

    PubMed  Google Scholar 

  • Kuftinec M (2007) Liability regarding computerized axial tomography scans. Am J Orthod Dentofac Orthop 132:569

    Article  Google Scholar 

  • Levin DC, Rao VM (2004) Turf wars in radiology: the overutilization of imaging resulting from self-referral. J Am Coll Radiol 1:169–172

    Article  PubMed  Google Scholar 

  • Magenau JL (1997) Digital diagnosis: liability concerns and state licensing issues are inhibiting the progress of telemedicine. Commun Law 19:25–43

    Google Scholar 

  • Michigan Department of Community Services (2006) Michigan Department of Community Healthcon-212, Certificate of Need Review Standards for CT Scanner Services. http://www.michigan.gov/documents/mdch/CON-212_CON_Rev_Stds_CT_Scanners_12-27-06_181839_7.pdf. Accessed 24 June 2016

  • New York State Department of Health Special Committee on Telemedicine (2009) Statements on telemedicine Board for Professional Medical Conduct, New York Department of Health. Revised: January 2009. http://www.health.ny.gov/professionals/doctors/conduct/telemedicine.htm. Accessed 9 Aug 2016

  • Noffke CE, Farman AG, Nel S, Nzima N (2011) Guidelines for the safe use of dental and maxillofacial CBCT: a review with recommendations for South Africa. SADJ 66(262):264–266

    Google Scholar 

  • Pakchoian AJ, Dagdeviren D, Kilham J, Mahdian M, Lurie A, Tadinada A (2015) Oral and maxillofacial radiologists: career trends and specialty board certification status. J Dent Educ 79:493–498

    PubMed  Google Scholar 

  • Parashar V, Whaites E, Monsour P, Chaudhry J, Geist JR (2012) Cone beam computed tomography in dental education: a survey of US, UK, and Australian dental schools. J Dent Educ 76:1443–1447

    PubMed  Google Scholar 

  • Petersen LB, Olsen KR, Christensen J, Wenzel A (2014) Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars. Dentomaxillofac Radiol 43(6):20140001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Petersen LB, Olsen KR, Matzen LH, Vaeth M, Wenzel A (2015) Economic and health implications of routine CBCT examination before surgical removal of the mandibular third molar in the Danish population. Dentomaxillofac Radiol 44(6):20140406

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Royal College of Dental Surgeons of Ontario (2016) Dental CT scanner—general information. http://rcdsoupgrade.staging.moveable.ca/Assets/DOCUMENTS/Forms/Dental_CT_Scanners/RCDSO_Dental_CT_Scanner_Information_sheet.pdf. Accessed 24 June 2016

  • Scarfe WC (2011) “All that glitters is not gold”: standards for cone-beam computerized tomographic imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:402–408

    Article  PubMed  Google Scholar 

  • Scarfe WC (2013) Accreditation of advanced imaging facilities for dentistry—assuring minimal standards for high quality diagnostic imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 116:267–269

    Article  PubMed  Google Scholar 

  • Scarfe WC (2014) Image gently. Responsible use of X-rays in dentistry for children is aim of new education and awareness initiative. J N J Dent Assoc 85:32

    PubMed  Google Scholar 

  • Scarfe WC (2015) Data, data everywhere but not a byte to share…? Oral Surg Oral Med Oral Pathol Oral Radiol 119:370–373

    Article  PubMed  Google Scholar 

  • Special Committee to Revise the Joint AAE/AAOMR Position Statement on use of CBCT in Endodontics (2015) AAE and AAOMR joint position statement: use of cone beam computed tomography in Endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 120:508–512

    Article  Google Scholar 

  • The Image Gently™ in Dentistry Campaign (2016) http://www.imagegently.org/Roles-What-can-I-do/Parent/Dentist. Accessed 1 Aug 2016

  • Turpin DL (2007) Befriend your oral and maxillofacial radiologist. Am J Orthod Dentofac Orthop 131:697

    Article  Google Scholar 

  • Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC, American Academy of Oral and Maxillofacial Radiology (2012) Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 113:817–826

    Article  PubMed  Google Scholar 

  • Walter C, Kaner D, Berndt DC, Weiger R, Zitzmann NU (2009) Three-dimensional imaging as a pre-operative tool in decision making for furcation surgery. J Clin Periodontol 36:250–257

    Article  PubMed  Google Scholar 

  • White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, Law CS, Levin MD, Sauer RA, Valachovic RW, Zeller GG, Goske MJ (2014) The image gently in dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 118:257–261

    Article  PubMed  Google Scholar 

  • Yang Jie, Tamimi D, Farman AG, Benjamin S, Cordell KG, Zeller GG (2011a) The secure exchange and utilization of digital images in dentistry. American Dental Association Technical Report no. 1060

    Google Scholar 

  • Yang J, Tamimi D, Farman AG, Benjamin S, Cordell KG, Zeller GG: American Dental Association (2011b) ADA Technical Report No. 1060 for the Secure Exchange and Utilization of Digital Images in Dentistry. http://ebusiness.ada.org/productcatalog/552/Informatics/ADA-Technical-Report-No-1060-The-Secure-Exchange-and-Utiliza/ADA1060-2011D. Accessed 4 Aug 2016

  • Yang J, Angelopoulos C, Mallya S, Liang H, Deahl T, Ganguly R, Ramesh A, Parashar V, Williamson G, Cederberg R, American Academy of Oral and Maxillofacial Radiology Executive Committee (2016) American Academy of Oral and Maxillofacial Radiology Executive opinion statement on Teleradiology. Oral Surg Oral Med Oral Pathol Oral Radiol 122(4):509–510

    Article  PubMed  Google Scholar 

  • Zhang A, Critchley S, Monsour PA (2016) Comparative adoption of cone beam computed tomography and panoramic radiography machines across Australia. Aust Dent J 61(4):489–496. doi:10.1111/adj.12417

    Article  CAS  PubMed  Google Scholar 

  • Zinman EJ, White SC, Tetradis S (2010) Legal considerations in the use of cone beam computer tomography imaging. J Calif Dent Assoc 38:49–56

    PubMed  Google Scholar 

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Acknowledgments

Sections of this chapter are based on previously published works by Dr. Bernard Friedland (2010), Drs. Bernard Friedland and Dale Miles (2014), and Dr. William C. Scarfe (2011, 2013, 2015).

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Correspondence to Bernard Friedland B.Ch.D., M.Sc., J.D. .

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Friedland, B., Scarfe, W.C. (2018). Ethical and Medicolegal Issues Related to CBCT. In: Scarfe, W., Angelopoulos, C. (eds) Maxillofacial Cone Beam Computed Tomography. Springer, Cham. https://doi.org/10.1007/978-3-319-62061-9_6

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