Diagnostics Management Radiography

Cone Beam Questions for Dale Miles

Dr, Dale Miles is a board certified radiologist, He has reported findings on more than 1600 Cone Beam CT scans. I recently asked him about what he is seeing with this new technology.  

EMMOTT: What have you discovered now that you have examined so many cone beam scans?

MILES:  I posted an article on my web site on the reportable findings of the first 380 cases. There are usually over 2 reportable findings per scan. These conditions were not life threatening in most cases, but would have to have been seen, described by the clinician taking or ordering the scan and recorded in the patient’s chart. In many cases there was a need for referral to a primary care physician, otolaryngologist or internist for follow-up evaluation and management

EMMOTT: What kinds of reportable findings or hidden pathologies are you finding?

MILES: Larry, there’s been a lot of “press” in the dental journals about “sclerotic plaques” in the oropharyngeal airway and “stroke risk”. I’ve seen a different type of carotid calcification called “medial arterial sclerosis” or MAC in about 13 of my current cases. This type of calcification occurs in the medial layer of the artery not the intimal. It is seen very often in uncontrolled diabetics especially as their disease advances to involve kidneys. They are basically on in or on their way to ESRD (end-stage renal disease). These patients will lose limbs. Their vascular problems are now getting so severe and so rapid that they will usually have a “below the knee” amputation within a year or two of this finding without aggressive intervention.

EMMOTT: That is incredible. However as a dentist or oral surgeon I am not aware of these possibilities. What are the liabilities?

MILES: In the American Journal of Orthodontics and Dentomaxillofacial Orthopedics Dr. David Turpin states that “It only makes sense that, in Orthodontics, we understand when to refer our patient’s CBCT scans to specialists in radiology – for the best possible care.”

In my opinion it just makes sense, legally and economically to do that. What dentist or dental specialist wants to scroll through 512 slices in 3 anatomic planes of section just to see if there is any hidden or occult pathology, let alone wait 10-12 minutes for positioning, reconstruction and display of the data to make a simple clinical decision? If the data is needed to plan an implant case, there’s no better way. But you had better be prepared to spend a lot of your time looking at images. No clinician makes their living looking at a single radiographic case for 30-45 minutes per patient. Radiologists do! And they decrease your liability substantially. If you’re going to order or acquire cone beam data, you should have that data looked at by an oral and maxillofacial or medical radiologist.

You can learn more or contact Dale here.