I am a faculty and a part time research scholar. My research is based on application of CBCT in Cleft lip and palate patients.Review of literature including guidelines given by American association of Orthodontics, American Association of Oral and maxillofacial radiology, Sedentext CT justify it's use in such subjects. I want expert's opinion on ethical issues in such clinical situations.
How do you suppose to get the children still and steady for the duration of the scanning process?
Dear Dr Parveen,
I agree with Dr Tatakis. It is very important to consider in term of the risk/benefit. In our Institution, the CBCT has been used with tools in care of syndromic orofacial cleft patient, with goal to establish the plan of orthodontic treatment, which is started after of seven years old.
In terms of research, we are conducting a study that uses TCCB to characterize the maxillar and mandible structure of a specific group syndromic cleft palate (mandibulofacial dysostosis). The knowledge of the abnormalities these structures could contribute with syndromic delineation and with more adequate craniofacial treatment. This project was evaluated by Ethical Committee that considered the benefit of project this nature.
we use CBCT if the patient has to undergo a bone graft in the mixed dentition period. it is helpful to plan a correct orthodontic and surgical treatment plan.
i agree with dr tatakis for the consideration about the risk / benefit ratio both for clinical care and clinical research
Dear all, even with the consideration about the risk / benefit, I think that using digital radiography with subtraction facilities may be effective and more safe
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Traditional 2D imaging may be adequate but 3D CBCT = anatomical truth (see my and Dr David Hatcher's article in 2002 AJODO and see article Dr Sean Carlson and I and others did in ORtho Town on The Truth About CBCT radiation dose) Now with medium FOV CBCT [iCAT FLX] aqusition dose (8-15 microSV at 4.8 seconds) is less than a traditional panoramic (18-24 microSV) . Radiation dose is ALARA, As Low As Reasonably Achievable. Only use CBCT when you need the anatomical truth of you patient.
Dear all
Thank for your valuable feedback.
Dear Dr. Tatakis, my project is a clinical research to compare two different surgical procedures to address sagittal discrepancy in Non Syndromic Unilateral Cleft lip and palate (NSUCLP) using CBCT. One is a relatively new technique which is simple with minimal morbidity and high predictability. The other approach for advancement by Le Fort I osteotomy which is more traumatic and supposed to be more stable than other. The purpose of study is to know whether new approach can be fitted in surgical protocol in the management of CLP patient.
Hello,
You should ask yourself if there is a simpler but yet effective method to compare the effectiveness of these surgical methods. Can you use, for example, lateral cephalometric radiographs or clinical measurements? If so, make your project with these methods; if not, use CBCT.
Any measurements made on 2D images will not be accurate . if you want the anatomic truth then CBCT is the imaging modality of choice. Use the smallest Field of View that gives you the information you need and the resolution that gives you the best info keeping in mind the radiation dose should be As Low As Reasonably Achievable . with the newer Lowe Dose protocols CBCT is close to or lower that a traditional 2D Pan and Ceph. for cleft patients you need to know the 3D anatomy so my personal opinion . . 3D CBCT.
The advantage of CBCT is obvious, but the dose is a special concern to the patients and doctors. I see there are some clinical studies from CBCT on children. I also wondering if that is justified enough, even it is a retrospective study.
By the way, we also have to notice the new change to ALADA , which is called As Low As Diagnostically Acceptable.
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