Principles of CBCT

Cone Beam
Computed
Tomography -
Principles
Resource faculties:
Prof. Dr. Jyotsna Rimal (HoD)
Dr. Iccha Kumar Maharjan (Associate Prof.) Presenter:
Dr. Pragya Regmee (Assistant Prof.) Sagar Adhikari
Dr. Abhinaya Luitel (Senior Resident) JR III
DepartmentDepartment
of Oral Medicine
of Oral Medicine andand Radiology
Radiology
 Contents
•What is CBCT?
•History
•How does CBCT work?
•Components of image production
•Stages in volumetric data display
•Medical CT Vs CBCT
•Clinical Consideration

2
 What is CBCT?

• Most significant technological advancement in maxillo-

facial imaging since the introduction of panoramic
radiography.

• A form of x-ray computed tomography

• X-rays are divergent forming a cone

3
 History

• Initially developed commercially for angiography in the

early 1980s.

• First introduced in the European market in 1996 by QR

s.r.l. (NewTom 9000) and into the US market in 2001

4
 History

• October 25, 2013, during the "Festival della Scienza" in

Genova, Italy, the original members of the research
group: Attilio Tacconi, Piero Mozzo, Daniele Godi and
Giordano Ronca received an award for the cone-beam CT
invention.

5
6
Principles of CBCT
 How does a CBCT work?

Detector
Rotates Records after Reconstructed
attenuation by by complex
patient tissues algorithms

X-ray source Raw data

9
10
11
 Components of image production:

1. X-Ray Generation

2. X-Ray Detection

3. Image Reconstruction

12
 1. X-Ray Generation

– Patient stabilization

– X-ray generation

– Scan volume

– Scan factors

13
Patient stabilization

14
 X-ray generator
• High voltage generator
• X-ray tube-
 anode
 cathode
 tube envelop
 tube housing
• Collimator

15
X-ray generation and detection specifications of currently available
CBCT systems

16
17
3D Accuitomo 170, J Morita X-Mind trium Pan 3D, Rayscan Alpha 3D, LED Newtom 5G, QR srl,
Corp., Osaka, Japan Acteon North America, Medical Diagnostics Verona, Italy
Mt. Laurel, NJ Inc., Atlanta, GA

18
• X-ray generation  continuous or pulsed to coincide with
the detector activation.
• Preferably pulsed to coincide with the detector sampling
 Actual exposure time can be substantially less than
scanning time.
 Considerably reduces patient radiation dose.

19
•Exposure factors can be controlled manually or
automatically
•KvP 60 to 90
•mA 6 to 10
•180 to 360 degree rotation of the x-ray generator and
sensor

20
 Scan volume or Field of View:
• Primarily depend on:

– the detector size and shape,

– the beam projection geometry, and

– the ability to collimate the beam

• Shape of the scan volume: either cylindrical or spherical.

• Collimation: limits radiation exposure to the region of interest

(ROI) 21
Classification of Cone Beam Computed Tomography Units
according to the Field of View (FOV). 23
Abramovitch K, Rice DD. Basic principles of cone beam computed tomography. Dental Clinics. 2014 Jul
1;58(3):463-84. 24
 Region of interest beyond FOV?

• “Bioimage registration” or “mosaicing”

• A software used to fuse the images together (“stiching”

or “blending”)

• Disadvantage: scanning the overlapped area double

times, increase in dosage of radiation.

25
Increasing Field of
View (FOV) by
“Stitching”
Volumetric Data
Sets..
26
 Region of interest beyond FOV?

• Offset the position of the detector, collimate the beam

asymmetrically, and scan only half the patient's ROI in
each of the two offset scans

27
Asymmetric CBCT Geometric Configuration to Increase Field of View (FOV)
28
 Scan Factors
• The number of images that constitute the projection data from the
scan determined by:

– the detector frame rate (number of images acquired per

second),

– the completeness of the trajectory arc (180 to 360 degrees),

– the rotation speed of the source and detector.

29
Detector frame rate
• Fixed or variable.
• Higher frame rates
– increase the signal-to-noise ratio images with less noise and
reduced metallic artifacts
– associated with a longer scan time and higher patient radiation
dose
– more data are obtained, and primary reconstruction time is
increased.

30
• “Quick-scan” or “fast-scan” protocols use markedly
lower frame rates with considerable reduction in patient
radiation dose.

• Image resolution may not be adequate for all diagnostic

tasks.

31
Rotation angles
• Fixed or variable (most are fixed)
• Fixed  a full 360 degrees or partial trajectory arcs.
• A limited scan arc
– potentially reduces the scan time and patient radiation dose
– mechanically easier to perform
– may have greater noise and reconstruction interpolation
artifacts.

32
Rotation speed

• Short scan time: reduces motion artifact resulting from patient

movement.

• Decreased scanning times achieved by

– increasing the detector frame rate,

– reducing the number of projections, or

– reducing the scan arc.

33
 2. Image detection
(1) Image intensifier tube/charge-coupled device (II/CCD)
combination or
(2) Flat panel detectors (FPDs)
(3) Complimentary Metal Oxide Semiconductors (CMOS)
• A sensor which has smaller pixel size has better resolution .
• One pixel can be 0.007 to 0.3mm size.
34
 Voxel
• The spatial resolution is determined by individual volume
elements called voxels.
• These are cubic in nature equal in all dimensions
• The principle determinant of voxel size is
the pixel size of the detector.
• CBCT voxel: 0.4 to 0.076 mm

35
 Grayscale

• The ability of a CBCT scan to display differences in

attenuation.

• Called bit depth of the system and determines the number

of shades of grey available to display the attenuation.

36
 Grayscale

• 12 bit detectors capable of identifying 212 or 4096

shades of gray .

• A 16 bit detector 216 or 65,536 shades of grey

• File sizes and image processing time increase by folds.

37
 3. Reconstruction

• Primary reconstruction

• Secondary reconstruction

38
Image reconstruction

39
Acquisition stage

40
Back projection: Basis image

41
Back projection: Basis image

42
Back projection: Basis image

43
Back projection: Basis image

44
45
46
47
 Scan time
• Average time for one CBCT scan may vary from 7-30
seconds.
• Includes the initial scout image scan
• It also varies if half a rotation or a full circle rotation is
used.

48
 Reconstruction times
• vary depending on
– the acquisition parameters (voxel size, size of the image
field, and number of projections),
– hardware (processing speed, data throughput from
acquisition to reconstruction computer), and
– software (reconstruction algorithms) used
• Reconstruction should be accomplished in an acceptable
time (<5 minutes) to facilitate clinical workflow.
49
 Resolution
• The ability of an image to differentiate between two
closely placed objects.
• Two types-
spatial resolution
contrast resolution

50
Resolution

51
 Stages in volumetric data display

1. Reorient the data

2. Optimize the data

3. Explore the data

4. Format the data

52
Formatting the data

53
Multi-planar reformatting
54
Indirect volume rendering
55
Ray Sum Images
56
Maximum intensity projection 57
Medical CT Vs. CBCT

58
59
60
61
 0.05 to 0.15
0.4 to 2

62
 Clinical Considerations

• Patient Selection Criteria

• Patient Preparation

• Imaging Protocol

• Exposure Settings

63
 Patient Selection Criteria

• ALARA
• Guidelines from the American Academy of Oral and
Maxillofacial Radiology (AAOMR) and the American
Dental Association (ADA)
• Should be used as an adjunctive diagnostic tool to
existing dental imaging techniques for specific clinical
applications, not as a screening procedure.

64
Patient Preparation

65
Imaging Protocol

Scan
mode

66
 Exposure settings

• ALARA principle

• Scout exposure- can be made to avoid high energy x-rays

or to ensure whether the right part of the jaw is imaged.

67
Exposure Setting

Effect of
Exposure
Parameters
on Image
Quality. 68
Scan Time and Number of Projections
• Adjusting the detector frame rate to increase the number
of basis image projections results in reconstructed images
with fewer artifacts and better image quality

• Increasing the number of projections requires longer

primary reconstruction times and increases patient
radiation exposure proportionately.

69
Pictorial Plot of the Effect of Number of Basis Projection Images and Size of Field of View (FOV) on Image Quality70
Summary

71
72
Which of the following is the first step of CBCT data acquisition?
a. Linear gain calibration
b. Offset correction
c. Defect interpolation
d. Temporal artifact correction

Answer: a

73
The rotation trajectory in CBCT is:
a. 3600
b. 2700
c. 1800
d. Any of the above

Answer: d

74
• Volumetric surface reconstruction is a form of:
a. Indirect volumetric rendering
b. Direct volume rendering
c. Multi-planar reconstruction
d. Ray sum image

Answer: a

75
 Conclusion
This technique hugely expands the fields for
diagnosis and treatment possibilities, not to forget
many more research frontiers as well.
However CBCT should be used with careful
consideration, it should not be used where 2D
imaging suffices.

76
 References:
• White SC, Pharoah MJ. Oral radiology-E-Book: Principles and interpretation. Elsevier Health Sciences; 2014 May 1.
• Abramovitch K, Rice DD. Basic principles of cone beam computed tomography. Dental Clinics of North America. 2014 Jul
1;58(3):463-84.
• Whaites E, Drage N. Essentials of dental radiography and radiology. Elsevier Health Sciences; 2013 Jun 20.
• Horner K, Islam M, Flygare L, Tsiklakis K, Whaites E. Basic principles for use of dental cone beam computed tomography:
consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofacial Radiology. 2009
May;38(4):187-95.
• Venkatesh E, Elluru SV. Cone beam computed tomography: basics and applications in dentistry. Journal of Istanbul
University Faculty of Dentistry. 2017;51(3 Suppl 1):S102.
• Scarfe WC, Farmna AG, Sukovic P. Clinical applications of cone beam tomography in dental practice. J Can Dent Assoc.
2006;72:75–80.
• Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:106–114
• Hatcher DC (October 2010). "Operational principles for cone-beam computed tomography". Journal of the American Dental
Association (1939) 141 (Suppl 3): 3S–6S.PMID
• Carter L, Farman AG, Geist J, et al. American Academy of Oral and Maxillofacial Radiology executive opinion statement on
performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 2008;106:561–562.

77
Thank you!!

78