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Dentomaxillofacial Radiology (2008) 37, 477–478 ’ 2008 The British Institute of Radiology http://dmfr.birjournals.

org

LETTER TO THE EDITOR

The so-called cone beam computed tomography technology (or CB3D, rather!)
Dentomaxillofacial Radiology (2008) 37, 477–478. doi: 10.1259/dmfr/51832728

As probably everybody in dentistry and radiology has noticed, ‘‘cone beam’’ volumetric radiography is currently enjoying phenomenal interest and expansion in the dentomaxillofacial field. This technology and the related machines are most commonly referred to as CBCT – cone beam computed tomography, a terminology which is now firmly established especially in the scientific literature. Unfortunately this name and acronym is etymologically wrong (and so are a number of other colloquial names in common use, such as ‘‘dental CT’’ or ‘‘digital volumetric tomography’’), and may cause significant confusion among non-specialists. The reason why it is wrong is because this technology does not use tomography. Consequently, it is not CT. The word ‘‘tomography’’ comes from the ancient Greek ´ Ein (to write). roots tomos (slice, layer), and craw According to Wikipedia, tomography is ‘‘imaging by sections or sectioning’’.1 According to the International Electrotechnical Commission technical report number 60788 (2nd edition 2004-02, Medical electrical equipment – Glossary of defined terms),2 CT is ‘‘reconstructive tomography in which recording and processing is effected by a computing system’’; reconstructive tomography is ‘‘tomography in which information obtained from the object is recorded for constructing images of layers in the object by processing’’; and tomography is ‘‘ radiography of one or more layers within an object’’. Contrary to classic CT, imaging is not performed ‘‘by sections’’ or layers in cone beam technology. A sequence of classic radiographic projections is performed and these two-dimensional images are churned by the reconstruction algorithm (Feldkamp, algebraic reconstruction technique (ART), or other) directly into a three-dimensional (3D) or volumetric data set, without passing through reconstructing a stack of individual sections, slices or layers. Indeed, the outcome of the scan is often presented to the observer as a sequence of axial slices or of cross-sections in other planes, but this is the result of a secondary operation by the application software, is not inherent with the cone beam technology and might be entirely avoided. In fact, various commercial 3D imaging software programs offer the option of displaying the reconstructed volumetric data set directly as a semitransparent volumetric rendering, a surface rendering, or a maximum intensity projection (MIP).

(To be really linguistically fastidious, one may also contend that a large part of cone beam machines nowadays are not even ‘‘cone’’ beam, but ‘‘pyramid’’ beam, due to the rectangular field of view of the detector. In this case the distinction is substantially irrelevant and pedantic.) I advocate that the term CBCT should be abandoned in the scientific literature and propose that it be replaced by the more sound CB3D – cone beam three-dimensional imaging, which describes exactly and tersely what this technology is about. As a matter of fact, many or even most of the most important commercial manufacturers of cone beam systems do not designate their products as CBCT, but as cone beam 3D or names akin. Why bother with a matter that may appear to be of mere linguistic fastidiousness, for a term and an acronym that are already rooted? Because the use of ‘‘tomography’’ and CT in the name is a source of considerable misunderstanding among the general public, the non-specialist professionals (and even some of the specialists!), and the regulatory and legislative bodies, conveying the idea that this is just a variation of CT – with all the strings attached. But it is not! Not only is the data-capturing technology different, the data themselves are somewhat different from those obtained with CT, as numerous scholars have pointed out. For instance, the consistency of CT numbers and their conversion into Hounsfield units (firmly established in CT) is still problematic3–8 and a matter of ongoing development in CB3D. Conversely, CB3D may usually lend to geometric accuracy and spatial resolution even higher than CT.9,10 The procedures and test objects (phantoms) for standardized assessment of performance, which were developed long ago for CT,11–13 are difficult or impossible to apply to CB3D to the extent that the development of a method and standard test object for CB3D has become a necessity and is among the goals of the recently-established SEDENTEXCT project (see www.sedentexct.eu) sponsored by EURATOM, as well as by a 3D imaging working group within the German DIN (Deutsches Institut fu ¨ r Normung). Radiation dose to patient and environment with CB3D is an order of magnitude smaller than with CT,
Dentomaxillofacial Radiology

Cancer risks from diagnostic radiology.org/wiki/Tomography. Br J Radiol 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007. Donta C. Dentomaxillofac Radiol 2004. 104: 829–836.) has fostered its adoption by a different class of users than the latter. Hourdakis CJ. Suetens P. let us bestow to cone beam 3D imaging a proper name of its own. 2. Brooks SL. Loubele M.org [homepage on the internet]. The much smaller purchase and maintenance cost of the former. 357: 2277–2278. 12. 20. Hashimoto K. but absolutely not least. Toogood RW. The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT. Thilander-Klang A. Jacobs R. 7. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008. 5. Thurman H. Three-dimensional cone-beam computed tomography for assessment of mandibular changes after othognathic surgery. 35: 410–416. Misch KA. 1977. Sawada K. Effects of image artifacts on gray-value density in limited-volume cone-beam computerized tomography. Adam G. Hall EJ. Hatcher D. Dose reduction in maxillofacial imaging using low dose cone beam CT. the socioeconomic implications of CB3D are vastly different from those of CT. 13.wikipedia. 6. but also resources required. 15. Sutthiprapaporn P. Sarment DP. Available from: http://www. Cervical soft tissue imaging using a mobile CBCT scanner with a flat panel detector in comparison with corresponding CT and MRI data sets. Dentomaxillofac Radiol 2006. Howerton B. Rothenburg L. Helmrot E. Araki M. 3. 250 Clearbrook Road. Diagnostic Radiology Committee Task Force on CT Scanner Phantoms: Judy PF. Phantoms for performance evaluation and quality assurance of CT scanners. IEC Technical Report 60788. 106: 106–114. Dentomaxillofac Radiol 2006. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. 33: 83–86. Am J Orthod Dentofacial Orthop 2007. Accuracy of three-dimensional measurements using cone-beam CT. Dentomaxillofac Radiol 2008. Begemann PC. International Electrotechnical Commission. 56: 413–417. N Engl J Med 2007. with different diagnostic goals. McCullough EC. 37: 245–251.org/pubs/reports/rpt_01. Radiation exposure during midfacial imaging using 4. Elmsford.14-18 yet many people are still sceptical about the radiological load from ‘‘CBCT’’ – because of that ‘‘CT’’ in the name – and associate it with that of much larger social relevance19. 11. 16. Major PW. 9. 102: 225–234. Pohlenz P. Tucker SFD. operational context: not the hospital/large clinic environment for multi-purpose diagnostics. Geneva: IEC Central Office. IEC. Grondahl K. Ivanovic M. Yamashina A. 96: 508–513. 81: 362–378. Radiation absorbed in maxillofacial imaging with a new dental computed tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003. Phillips CL. Comparison of image performance between conebeam computed tomography for dental use and four-row multidetector helical CT. Oesterhelweg L. Mol A. Dentomaxillofac Radiol 2008. Kawashima S. 4. et al. et al. cone beam computed tomography systems and conventional radiography. Geneva: International Electrotechnical Commission Central Office. Bailley LTJ. Akiyama Y. et al. 2002.20 from medical computed tomography. Report No. Carey J. expectations. Last. Ludlow JB. 48: 27–34. Schutyser F. Hayakawa Y. In conclusion. Computed tomography—an increasing source of radiation exposure. Cevidanes LHS. Dentomaxillofacial Radiology . Assessment of bone segmentation quality of cone-beam CT versus multislice spiral CT: a pilot study. [Updated 2008 September 6. Schulze D. 35: 219–226. Iwai K. Fujishita M. 19. Eur J Radiol 2005. J Oral Sci 2006. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007. Fang Y. Katsumata A. 35: 407–409. but the more capillary private practice or radiology centre. Hirukawa A. electrical power etc. 131: 44–50. Marchal G. Tsikakis K. Danforth RA. 18. Ekestubbe A. USA References 1. Brenner DJ. Okumura S. Chicago. as it deserves. Davies-Ludlow LE. Payne JT. Habermann CR. Lagrave ` re MO. Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. 8. Lofthag-Hansen S. Gavala S. IL: American Association of Physicists in Medicine. Naitoh M. Available from: http:// en. Mah JK. Pinsky HM. Brenner DJ. 2004. Styner MA. 104: 814–820. radiation shielding.pdf. Medical electrical equipment – a glossary of defined terms (2nd edn). Heiland M. cited 2008 September 14]. 17. 10. Hall EJ. Medical electrical equipment – Part 2-44: Particular requirements for the safety of X-ray equipment for computed tomography. unfettered by computed tomography! R Molteni Chief Technical Officer. Packota GV. Wikipedia. 1. Pinsky RW. Bassano D. for targeted clinical uses. Ariji E. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006. as well as the smaller footprint (in all senses including physical space occupation. Ludlow JB. NY 10523. Kamenopoulou V. Dentomaxillofac Radiol 2006. 37: 72–79. IEC publication 60601-2-44. Maes F. Dyda S. Balter S.and 16-slice computed tomography. Karayianni K.aapm.478 Letter to the Editor as has been firmly established by all authors who investigated the matter. AFP Imaging & QR/NewTom Dental. Dosimetry of 3 CBCT units for oral and maxillofacial radiology. Heiland M. 14. Density conversion factor determined using a conebeam computed tomography unit NewTom QR-DVT 9000. Bumann A. Tanimoto K. Blessmann M.