Pi Is 1120179721002519

Physica Medica 88 (2021) 193–217
Contents lists available at ScienceDirect
Physica Medica
journal homepage: www.elsevier.com/locate/ejmp
Review paper
Dental cone beam CT: An updated review

Touko Kaasalainen a,*, Marja Ekholm b,c, Teemu Siiskonen d, Mika Kortesniemi a
a
HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, P.O. Box 340, Haartmaninkatu 4, 00290 Helsinki, Finland
b
Institute of Dentistry, University of Turku, Lemminkaïsenkatu 2, 20520 Turku, Finland
c
South West Finland Imaging Center, Turku University Hospital, Lemminkaïsenkatu 2, 20520 Turku, Finland
d
Radiation Practices Regulation, Radiation and Nuclear Safety Authority - STUK, P.O. Box 14, FI-00881 Helsinki, Finland
A R T I C L E I N F O
A B S T R A C T
Keywords:
Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant
Dental
CBCT
popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-
Characteristics dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony struc-
Dosimetry tures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging
Image quality and summarise the technical features of currently used CBCT scanner models, extending to recent developments
Guidelines in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diag-
Development nostic reference levels. We also consider the outlook of potential techniques along with issues that should be
Cone beam CT resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the
Imaging
patient.
1. Introduction
soft tissue and alveolar bony anatomy, are not adequately represented
in traditional images and may lead to missed clinical findings, e.g.
Digitalisation of medical imaging has brought major
periapical lesions located on the tip of the root canal [9]. There are
transformations in dental radiology with restructuring of the imaging
also additional complications in implementing imaging settings of the
process (image acquisition, post-processing, and image review
dental area. Parallel projections require a well-defined and maintained
methods), which enables more efficient image archiving and
direc- tional setting of the radiography equipment to provide accurate
communication (PACS systems) [1]. Dental x-ray imaging forms a
geometric representation of the dental structures. Due to these
variable combination of radiological imaging techniques. The
limitations and acknowledging the complicated 3D anatomy of the
methods include 2D imaging (intraoral, cephalometric radiography,
dental area, 3D imaging has increased in popularity to provide an
panoramic x-ray) and 3D imaging (multislice
accurate depiction of the multiplanar details of maxillofacial bone
computed tomography [CT] and cone beam CT [CBCT]) techniques
structures and surrounding soft tissues [5,10].
[2–6].
Traditional dental x-ray imaging has for decades applied 2D image Rapid progress in medical imaging physics and technology, involving
acquisition and panoramic mode. However, superposition of true volu- several hardware and computational methods, has overcome many
metric anatomy in these overlaid 2D images conceals potentially challenges to achieve 3D dental imaging (known as CBCT) and to
important clinical findings that would require multiplanar visualisation offer tools to improve 3D image quality in terms of spatial resolution,
to reveal local and typically focal findings in any possible orientation contrast, and anatomical coverage [3,5]. CBCT is also known as digital
[3,5,7,8]. More specifically, due to human anatomy, projection radiog- volume tomography, which refers to representation of image data in
raphy and panoramic imaging of the dental area are mainly performed digital forms, and most essentially, depiction of anatomy in three di-
from the mediolateral direction (from outside of the jaw towards inside mensions. The development of CBCT began in 1995 when Italian de-
of the oral cavity). As such, the labiopalatal (through lips to tongue) velopers Attilio Tacconi and Piero Mozzo introduced the first dental
and buccolingual (through cheek to tongue) structures are overlaid and CBCT model, the NewTom DVT 9000 [11]. The commercial launch
their dimensional nature can therefore only be subjectively estimated. of the device came a few years later, along with similar equipment
Many clinically relevant structures, such as dental roots related to developed by Arai et al. in 1999 [12].
surrounding
* Corresponding author at: HUS Medical Imaging Center, Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), 00290 Helsinki, Finland.
E-mail address: touko.kaasalainen@hus.fi (T. Kaasalainen).
https://doi.org/10.1016/j.ejmp.2021.07.007
Received 3 February 2021; Received in revised form 16 June 2021; Accepted 9 July 2021
Available online 17 July 2021
1120-1797/© 2021 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
T. Kaasalainen et al. Physica Medica 88 (2021) 193–
217
The principle of CBCT adapts the basic CT technique where the x-ray
characterised by the cone- or pyramid-shaped x-ray beam, which is
tube exposes the patient from one side and an imaging detector mea-
directed on the selected dental part contained in the scan FOV. In this
sures the attenuated x-rays on the other side of the patient, while both
instance, the cone refers to a beam that is around the same dimensional
the x-ray tube and detector rotate around the patient [13] (Fig. 1). The
size in the vertical (z) direction as compared to axial (x,y) direction
exposure during the rotational scan can utilise either continuous expo-
(Fig. 1). Modern CBCT scanners use flat-panel detectors (FPD) structured
sure or pulsed exposure; the latter is increasingly applied in dental CBCT
as a pixel matrix of amorphous silicon thin-film transistors (TFT) or
[14]. Pulsed exposure reduces the effective exposure time and reduces
complementary metal-oxide semiconductors (CMOS) to capture the
the dose to the patient [5]. The attenuation of the x-rays follows the
image signal. Both TFT and CMOS detector techniques are based on
basic physical interactions between radiation and atomic composition
the indirect conversion principle, where the absorbed x-rays at the
of the patient anatomy in the exposed field of view (FOV). These
detector scintillation layer are first converted into light photons that are
physical interactions include mainly photoelectric effect and Compton
detected by photodiodes and finally read from the whole photodiode
scattering, which set the basic balance for the contrast representation of
pixel matrix. By this process, one raw-data projection view from a
the images. The contrast information in the image signal is mostly
single angular direction is acquired to be compiled with other
contributed by the photoelectric effect, whose contribution diminishes
projections in the CBCT raw data. The scintillation material that is
steeply as the x-ray photon energy increases. Therefore, the image
used to absorb the x-rays and convert their energy into light photons
contrast decreases when higher tube voltages are applied. At the same
consists of thallium-doped caesium iodide (CsI:Tl) or terbium-
time, the contribution from scattering increases along with the spectral
activated gadolinium oxysulfide (Gd2O2S:Tb). FPD technology
shift towards higher quantum energy x-rays [15].
provides benefits for imaging, including high spatial resolution, large
3D image reconstruction is the core part of CT imaging in the
dynamic range of signal levels, slim structure, and more streamlined
computational aspect. Image reconstruction attempts to solve the
imaging chain when compared with traditional image intensifier (II) or
mathematical inverse problem, namely how can the patient image
charge-coupled device (CCD) based image detectors, which have
(which is the 3D map of material-specific attenuation values in the pa-
become obsolete in CBCT equipment [3,22,23]. CMOS technology
tient) be deduced from the x-ray shadow signal acquired during the
provides even higher resolution, faster image readout, and lower
exposure? Traditional analytical reconstruction algorithms have been
electronic noise in comparison to current amorphous silicon detector
used in typical mainstream CBCT scanners. These algorithms are typi-
models, which have potential for more optimised scans and improved
cally based on the approximate Radon inverse transformation intro-
clinical image quality [24].
duced by Feldkamp et al. in 1984 [16]. In recent years, iterative Acquired raw data in the form of projection x-ray images go through
reconstruction algorithms have been increasingly applied due to the
various pre-processing steps before they can be used for image recon-
potential for image quality improvements and artefact reduction
struction. This pre-processing considers detector features and exposure
[17,18]. The iterative image reconstruction approach may also mitigate
factors, which corrects for different limitations and inherent variabilities
one of the most pertinent challenges in CBCT, which is sensitivity to
of the detector. These include dark current adjustments of the detector in
motion artefacts due to the relatively long scan time [19], which is
addition to gain and pixel defects by performing gain and offset
inevitable with typical CBCT C-arm type gantry design. Recently, arti-
correction. A series of raw data projections are acquired at a rapid rate
ficial intelligence (AI) based deep-learning (DL) methods have been
during the rotational CBCT scan. Such a high frame rate may also leave
developed as the latest advancement in image reconstruction [20,21].
partial signal from the previous projection image in the subsequent
DL image reconstruction methods utilise large amounts of typical clin-
projection image readout. This possible latent image signal must be
ical or technical phantom image data (or both) to solve the recon-
erased from the projection image data by applying afterglow correction.
struction problem and to provide improved image quality. The
Exposure factors involve x-ray beam properties, which include x-ray
challenge in these new AI-based reconstruction algorithms is that the
spectrum (affected by tube voltage and beam pre-filtration), scatter
learning data should be sufficiently representative to cover highly
distribution at the detector surface (depending on spectrum, scan, and
variable patient anatomy and contrast cases. Thus, the reconstruction
patient geometry), focal spot size, and focus-to-detector distance
method should be generalisable to all imaging cases and provide
(affecting image sharpness and tube output). Exposure factors also
reliable and accurate image quality for all patients [21].
extend to detector response (based on the specific detector and readout
The distinctive exposure geometry utilised in CBCT scanners is
electronics design), among other physical features of the scan [13,25].
One of the primary economic benefits of CBCT equipment when
Fig. 1. The basic CBCT scan principle includes rotation of the gantry with an x-ray tube and image detector. The cone beam of the x-ray is attenuated through
the patient and the FOV is exposed throughout the scan. Partial exposure of tissues is given within the rotational (axial) region around the FOV as the conical x-ray
beam sweeps the required angular range to acquire the set of raw-data projection images, which are used to reconstruct the final three-dimensional CBCT image
194
data. 217
195
217
compared with multi-slice CT scanners is related to the significantly
quantum energy) x-rays in the polychromatic x-ray beam due to patient
lower requirement of x-ray output in CBCT scanners, which places it
structures. Beam hardening increases the mean energy of the trans-
typically at the same level of x-ray tube current and spectral output as
mitted x-ray spectrum [15]. Thus, the resulting image data corre-
dental panoramic x-ray scanners [10]. The footprint for CBCT installa-
sponding to the beam-hardened projections represent lower attenuation
tion (with or without cephalostat) requires only a few square meters of
than the real attenuation in the patient. Softer x-rays may be
room space (similar to panoramic equipment) and therefore the transi-
completely depleted in this process (called photon starvation), and this
tion from panoramic imaging to CBCT does not require major alterations
is also related to artefact appearance. Thus, the beam-hardening effect
in dental facilities. Most CBCT gantry designs involve patient positioning
is accentuated in the presence of extensive metallic restorations, dental
in a standing or sitting position (in contrast to supine lying position),
implants, and orthopedic hardware [27]. Additional artefacts are pro-
which also helps reduce equipment footprint [5,14]. Indeed, the gantry
duced by undersampling, which are related to large density differences
of vertical CBCT follows the structure of the panoramic device and
between metals and the surrounding lower attenuating structures,
may combine both functionalities (and also cephalometric imaging) in
causing thin white streaks originating from the metal target. Thus,
addition to providing an advanced digital detector, image reconstruc-
streak artefacts are caused by multiple sources, including scatter, beam
tion and processing workstation, and related software package. The
hardening, and sampling issues [28]. Low-contrast resolution of CBCT is
electrical supply and HPAC (heating, plumbing, air-conditioning) fac-
also decreased by truncation effects, which are caused by smaller
tors required by the CBCT scanner are similar to panoramic x-ray
FOVs than the whole surrounding anatomy [29,30] (Fig. 1). In CBCT
equipment, and therefore does not require further renovations.
scans, the rotating x-ray beam sweeps through all attenuating
Medical imaging examinations using x-rays must always conform
structures of the patient regardless of if they are inside or outside the
to the main radiation protection principles, where the minimisation of
FOV. Thus, extra FOV structures also cause decreases in signal in the
the exposed anatomical region is a pivotal part of the optimisation of
acquired raw-data projection images, which appear as contrast
the medical exposure. Furthermore, minimisation of the exposed
deviation in the reconstructed images. Truncation artefacts appear as
volume also improves image quality, as scattered radiation, which
a band of lighter than expected gray scale voxels on the edge of the
reduces image contrast, is mitigated with a smaller exposed FOV [13].
FOV if not corrected [29]. Another cause of the lowered soft-tissue
In dental CBCT imaging, varying FOV selection is an essential characteristic
contrast accuracy in dental CBCT is due to the lower number
in all modern scanners, which enables indication-specific optimisation
(typically hundreds) of raw-data projections when compared with
of image FOV and also affects radiation exposure to the patient. User
multi-slice CT acquisitions (typically thousands of projections).
adjustments in FOV size and image quality settings also determine
Nevertheless, a sharp 3D representation of bony tissues is the key
the voxel size used in the image acquisition. Acquired voxel size is
strength of dental CBCT imaging, and thus the limited soft-tissue
directly linked to observed spatial resolution according to the sampling
contrast remains a tolerable limitation that is mitigated through
principles. As such, small details in dental structures are represented
development of new scanner hardware and image reconstruction
more accurately with smaller voxel sizes. However, smaller voxel sizes
methods [5].
require higher radiation doses to achieve the same signal-to-noise ratio The required spatial resolution is driven by the smallest clinical de-
(SNR) when compared with larger voxel size. According to Poisson tails that must be distinguished to make reliable clinical decisions. For
statistics, the relative dose increase to maintain SNR is inversely example, a periodontal ligament gap in the range of 100 µm (0.1 mm)
proportional to the square root of the relative voxel volume decrease. must be seen in periodontal CBCT applications for reliable diagnosis
For example, a four times larger voxel volume enables halving the [31,32]. Spatial resolution is not only linked to the voxel size. Focal
dose with the same image noise [5,15]. spot size, contrast resolution and range, detector motion unsharpness,
One of the main strengths in CBCT imaging is the possibility to create detector fill factor, number of raw-data projections per rotation, noise
various 3D visualisations and multi-planar reformats of the volumetric performance, and reconstruction technique also clearly impact spatial
image data. This possibility is accentuated by production of isotropic resolution at the technical level. However, patient movement poses a
or nearly isotropic image data, e.g. creating voxels where the voxel significant challenge to spatial resolution [5]. Therefore, the observed
dimensional length is approximately the same in all three directions (x, spatial resolution, achieved in technical phantom scans in QA testing,
y, and z) [5]. Isotropic image data enable similar image quality is not reached in clinical scans with patients. Even if the patient would
regardless of the projected direction of the reformatted slices, which be perfectly fixated to the imaging position at the CBCT scan
significantly aids interpretation and review of the complex 3D isocentre, hemodynamic pulsation produces periodical motion, which
anatomy of the jaw region. There is also a wide range of post-processing also extends to maxillofacial anatomy and scanned dental structures.
options to utilise 3D image data beyond cross-sectional views. These This cardiac
options cover traditional dental, virtual panoramic (curved multiplanar pulsation alone can create spatial unsharpness of 80 to 90 µm. When all
reformat) or cephalometric views, or bilateral multiplanar projections relevant factors in clinical CBCT scans are considered, the motion blur is
of the tem- pomandibular joint [10]. All CT imaging techniques, at the order of 500 µm (corresponding to 1 line pair per mm), thereby
including dental CBCT, are inherently accurate in geometry. This resulting in notably larger spatial uncertainty than the small voxel size
means that the reconstructed images represent 3D x-ray attenuation [32,33]. In practice, involuntary patient motion can add even more
distribution of the object and do not encompass diverging projection unsharpness to the final image if not corrected. Therefore, different
geometry with varying magnifying ratio of superimposed structures motion correction algorithms have been incorporated to several recent
across the central beam axis, as in traditional dental imaging or in the CBCT scanner models to overcome this image quality challenge and
acquired CBCT raw-data projections (before reconstruction). consequently offer sharper clinical images [34].
Therefore, the linear measurements can be performed accurately and The main exposure parameters used in CBCT scans present the
reproducibly from multiplanar CBCT image data [26]. same general rules on image quality and radiation exposure of the
Although dental CBCT can produce superior spatial resolution with patient as in other medical imaging modalities that use x-rays. Tube
the smallest voxel sizes often < 100 µm, the low-contrast resolution voltage and pre- filtration adjust the spectrum of x-rays, which in turn
to describe soft tissue structures is limited due to various physical affects the image contrast (through balance between photoelectric
and
effect and Compton scatter) and radiation dose. Tube current and
technical factors [10]. These factors include inevitable scattered radia-
exposure time are directly proportional to the tube output and the
tion that reduces the contrast in the projection raw data and conse-
radiation dose, which affect image noise level according to Poisson
quently also the final reconstructed image data. Scatter also causes
statistics (noise level is inversely proportional to the square root of the
streak artefacts emerging from metal surfaces. Another factor is beam
dose). Dose is affected by tube voltage roughly as proportional to the
hardening, which is caused by the higher attenuation of softer (lower
voltage value squared [15].
In this review, we provide an updated summary of the current
196
status of dental CBCT imaging, availability of different scanner models, 217
recent
197
217
developments in scanner technology, and clinical aspects. We also movements of x-ray tube and detector head. This also allows access to
address the regulatory perspective regarding dose optimisation, dosim-
etry, and diagnostic reference levels. This review can be regarded as an
update to our previous review article published in 2015 [5].
2. Technical characteristics of current dental CBCT scanners
The last 5 to 10 years have seen a steady development of

incremental technical CBCT features; current technology seems to be
relatively static (see our previous CBCT review article [5]). Even so,
new CBCT equipment models are continuously being developed and
released. The systems available on the market and used in clinical
work vary remarkably in their imaging features and capabilities. The
end users can select a proper CBCT device for their clinical needs
from a wide range of different CBCT systems. The technical properties
of the currently available scanners are summarised in Table 1 and are
discussed in the text. To gather the data, an email inquiry was sent to
each CBCT manufacturer with a request for brochures and technical
data sheets of various CBCT devices. As some of the manufacturers
did not respond to the inquiry or were not willing to share technical
information for this review article, the data were completed as
comprehensively as possible by searching for technical specifications
from the manufacturers’ bro-
chures and manuals and from other information available on the
internet (mostly from manufacturers’ webpages). Recent scientific
literature was also searched with the keywords “CBCT technology”
and “Dental CBCT” to obtain updates on the essential technical and
review
articles published since our previous review. A recent review article
from Gaêta-Araujo et al. [14] comprehensively summarised features
of currently and formerly available CBCT equipment from 1996 to
2019. Their study included altogether 279 different CBCT models
from 47 manufacturers, of which 203 systems were reported to be still
available in 2020.
2.1. General features
CBCT systems are typically divided into three different categories

according to FOV size: (1) large FOV (>15 cm maximum scan
volume height), (2) medium FOV (from 10 to 15 cm field height), and
(3) small
FOV (≤10 cm field height) [35]. Most of the devices also allow pano-
ramic imaging, and with an additional arm, cephalometric imaging with
the same unit. A few CBCT systems also have 3D photography capability
for assisting pre-operative treatment planning and follow up.
Moreover, some of the dental CBCT systems currently available may
also be used for orthopaedic CBCT imaging. All currently available
systems have a dose display (as required by regulations) that are
mostly based on computational estimations. A major portion of the CBCT
systems present dose after each exposure using a dose quantity of dose-
area product (DAP) or kerma-air product (KAP or PKA, similar to DAP
in diagnostic radiology), although a few systems use computed
tomography dose index (CTDI) for this purpose. Some systems report
both dose quantities.
2.2. Gantry size and type
The size and geometry of CBCT systems vary mostly on the technique
used for patient positioning. The weight of the systems ranges from 67
kg up to 1050 kg. Most devices allow scanning both in standing and
sitting positions, while a few systems utilise scanning only in a supine
position. Gaêta-Araujo et al. [14] reported that 80% of the CBCT devices
were either wall- or floor-mounted standing position systems (mostly
with wheelchair access), while supine lying position was used only in
3% of the devices. While the standing position is the most used for dental
CBCT scanning, it is vulnerable to patient movements especially when
sufficient head fixation tools are not used. To minimise patient motion-
related artefacts, standing devices can typically also be used in a sitting
position due to motorized columns of the systems, allowing vertical
198
wheelchair patients. Some of the vendors also provide motion- 217
correction algorithms and other solutions to improve image quality
regardless of patient movement. For example, 3Shape X1
Scancomfort device (3Shape A/S, Copenhagen, Denmark) uses head-
tracking technology to measure patient movement during the
scanning, and reconstruction software then readjusts data for any
motion to deliver sharp images. Although standing-position systems
are frequently used, seated- and supine-position systems may allow a
more comfortable imaging experience to a patient and thereby reduce
motion-related artefacts. Some of the seated systems also have a
vertical column, which provides access to wheelchair patients. Supine
lying position equipment require significantly larger room dimensions
than the standing and seated systems and may also have other
essential requirements for the space, possibly due to the greater
weight of such systems.
2.3. Field of view (FOV)
from FOVs suitable for a single jaw or a few teeth (D × H usually

4 × 4 cm or 5 × 5 cm, or from 2 × 2 cm in freely adjustable FOV
systems vary full craniofacial imaging (from approximately 15 × 15
cm up to 26 × 30 cm or 17 × 32 cm). The FOV dimensions depend on the
systems) to The FOVs available in dental and maxillofacial CBCT
detector size and shape, beam projection geometry, and the ability to
collimate the beam
[22]. While most of the devices utilise either one or a few prefixed
FOVs (up to 23 different FOVs) planned for different indications, a
user can freely adjust the FOV in the certain limits in both the vertical
and the horizontal cross-sectional volumes in some equipment.
Additionally, some CBCT devices allow stitching of the adjacent 3D
volumes either in the horizontal or vertical direction, or both,
resulting in larger FOVs. We want to emphasise that the FOV along
with the voxel size is one of the most important parameters that
affects patient radiation dose and image quality and should be
selected according to the clinical task.
2.4. Data collection during the scan
◦
angle of 360 ◦ for data
For CBCT data reconstruction, a scan arc of at least 180 should
acquisition; the range varies between 180 ◦ and 540◦ depending on the
be dental CBCT systems use a rotation
system. In a used to acquire the projection images [22]. Most
currently available
few devices, it is possible to select two or three different rotation angles
for scanning, which allows reduced radiation exposure to the patient.
While the lower angular range typically helps reduce patient dose [36],
this may also reduce image quality. Moreover, some CBCT units utilise
offset of the central ray of the beam from the rotational centre of the
device to expand the width of the FOV, effectively imaging half of
first 180◦ of rotation and the adjacent half through

the
the second 180◦ of rotation. This strategy allows reduction in the size
field through the
and expense of the flat panel detector. The number of projection
images per
rotation varies remarkably between devices. This may also affect
image quality to some extent as the increased number of samples
theoretically provides higher image quality. The grayscale depth of
the image data varies between 12 and 16 bits, and almost every new
CBCT model utilises either 14 bits or 16 bits.
2.5. Voxel and focal spot size
Most modern dental CBCT systems allow selection of the voxel

size used according to clinical requirements. Since our previous dental
CBCT review article in 2015 [5], the voxel sizes available in the
devices have tended to be even smaller, possibly due to improved
image reconstruction algorithms, image noise reduction, and
patient movement correc-
tion methods. The smallest voxel size currently available is 50 µm
(Smart3D-X scanner, LargeV Instrument Corp Ltd., Beijing,
China),
while the largest possible voxel size is 600 µm (Planmeca CBCT systems,
Planmeca Oy, Helsinki, Finland). The voxel size is related to
spatial
resolution. Therefore, smaller voxel sizes enable higher spatial
199
Table 1
T. Kaasalainen et al.
Technical characteristics of the currently available dentomaxillofacial CBCT equipment.
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
3Shape X1 Scancomfort N/A 60–90 4–12 N/A N/ 0.075–0.400 N/A 5.8 N/A <300 180 / N/A 1.60 Seated / freely 230 Yes Iterative
A 360 £ Standing / adjustable reconstruction,
1.30 Wheelchair FOV from 3D head tracking
£ 2 system, scout
2.30 £ 2 to 15 £ image, free head
15 (standard: positioning
2 £ 2–8 £ 8;
option: 15 £
Acteon Group X-Mind Prime 3D CsI / 60–86 2–12.5 2.5 0.5 0.088- N/A 7 Pulsed N/A 270 16 1.11 Seated / 8; 15 £ 15) 67 No MAR
5 £ 5; 8.5 £
CMOS mmAl £ Standing / 5; 8.5 £ 9.3;
0.95 Wheelchair 12 £ 10
£
2.18
197
Acteon Group X-Mind Trium TLD CsI / 80–90 4–12 7.0 0.5 0.075–0.150 18–27 4–12 Pulsed 29 360 N/A 1.50 Seated / 4 £ 4; 6 £ 6; 185 No MAR
CMOS mmAl £ Standing / 8 £ 8; 11 £
1.10 Wheelchair 8
£
2.36
Air Techniques Provecta 3D Prime CsI / 50–99 4–16 5.8 0.5 0.080–0.200 2–18 0.5–20 Pulsed N/A 180–540 14 1.55 Seated / 5 £ 5; 13 £ 180 No MAR
CMOS mmAl £ Standing / 7; 13 £ 8.5
1.21 Wheelchair
£
2.25
Asahi Roentgen Solio X CsI / 60–85 2–8 2.5 0.6 0.100 N/A 6–12 N/A N/A 180 / N/A 1.29 Seated / 5.1 £ 5.5; 9 130 No MAR
aSi mmAl (180◦ / 270 / £ Standing / £ 9.1
360◦) 360 0.99 Wheelchair
£
2.28
Asahi Roentgen Auge Solio Z CsI / 60–100 2–12 2.5 0.6 0.100–0.315 8.5–17 8.5–17 Continuous N/A 180 / 12 1.37 Seated / 5.1 £ 5.5; 200 No MAR, scout
aSi mmAl 270 / £ Standing / 9.7 £ 10; image
360 1.16 Wheelchair 16.1 £ 10
£
217
Physica Medica 88 (2021) 193–
2.29
Carestream CS 8100 3D CsI / 60–90 2–15 2.5 0.6 0.075–0.400 3–15 3–15 Continuous <120 220 14 1.20 Seated / 4 £ 4; 5 £ 5; 95 No MAR
CMOS mmAl £ Standing / 8 £ 5; 8 £ 8;
1.40 Wheelchair 8£ 9
£
2.40
Carestream CS 8200 3D CsI / 60–90 2–15 2.5 0.6 0.075–0.400 3–15 3–15 Continuous <120 220 14 N/A Seated / 4 £ 4; 5 £ 5; 95 No MAR
CMOS mmAl Standing / 8 £ 5; 8 £ 8;
Wheelchair 12 £ 10
Carestream CS 9300 60–90 2–15 0.7 0.090–0.500 12–28 6.2–20 32–55 16 160 No
(continued on next page)
Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
CsI / 2.5 Continuous 190 / 1.60 Seated / 5 £ 5; 8 £ 8;
aSi mmAl / pulsed 360 £ Standing / 10 £ 5; 10 £
1.16 Wheelchair 10; 17 £ 6;
£ 17 £ 11; 17
2.38 £ 13.5
Carestream CS 9600 CsI / 60–90 2–15 2.5 0.3 0.075–0.400 5.5–40 5.5–40 Continuous N/A 360 14 1.67 Seated / 4 £ 4; 5 £ 5; 210 Yes MAR, scout
CMOS (60–120 mmAl / £ Standing / 5 £ 8; 6 £ 6; image
option + 0.15 0.7 1.28 Wheelchair 8 £ 5; 8 £ 8;
CBCT 90– / 0.7 £ 10 £ 5; 10 £
120) mmCu 2.53 10; 12 £ 5;
12 £ 10; 16
£ 6; 16 £
10; 16 £ 12;
16 £ 17
CsI / 60–90 2–15 9 £ 15; 18.4 176 No
Carestream 9500 2.5 0.7 0.200–0.300 24 10.8 Pulsed <140 360 14 1.73 Seated /
198
aSi mmAl £ Standing / £ 20.6

1.64 Wheelchair
£
2.40
Cefla Dental Group MyRay Hyperion X5 CsI / 90 4–15 6 0.6 0.080–0.160 6.4–16.8 1.6–4.4 Pulsed 0–15 N/A 16 1.03 Seated / 6 £ 6; 6 £ 7; 99 No MAR, scout
aSi mmAl £ Standing / 8 £ 6; 8 £ 7; image
0.87 Wheelchair 10 £ 6; 10 £
£ 7; 10 £ 10
2.25
Cefla Dental Group MyRay Hyperion X9 CsI / 90 2–16 6.5 0.5 0.068–0.150 3.6–14.4 1.6–8.0 Pulsed 0–15 180 / 16 1.14 Seated / 4 £ 4; 6 £ 6; 155 No MAR, scout
Pro aSi mmAl 360 £ Standing / 7 £ 6; 8 £ 6; image, real-time
1.39 Wheelchair 8 £ 8; 10 £ mA-modulation
£ 6; 10 £ 8; 10
2.45 £ 10; 13 £
8; 13 £ 10;
13 £ 16
Dabi Atlante Eagle 3D CsI / 60–85 4–8 2.5 0.5 0.080–0.500 N/A 7–32 Pulsed 22–97 N/A N/A 1.27 Seated / 5 £ 5; 6 £ 8; 115 No MAR, scout
CMOS mmAl £ Standing / 8 £ 8; 8 £ image, motion
1.12 Wheelchair 12; 8 £ 16; correction
217
£ 13 £ 16; 18
2.44 £ 16; 23 £
16
Dentium Rainbow CT CsI / 60–100 4–12 N/A 0.5 0.200–0.300 19 N/A N/A <60 N/A N/A N/A Seated / 5 £ 5; 16 £ N/A No
CMOS Standing / 10; 16 £ 18
Wheelchair
Dentsply Sirona Orthophos SL 3D CsI / 60–90 3–16 2.5 0.5 0.080–0.220 2.2–14.4 N/A Pulsed N/A N/A N/A 1.37 Seated / 5 £ 5.5; 8 £ N/A No MAR
aSi mmAl £ Standing / 8; 11 £ 10
+ 0.3 1.04 Wheelchair

Table 1 (continued
)
Otherinformat
3Dfacesc
Reconstructionti
Totalfiltrati
Rotationang
Detect
Greyscale,
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
/ 1.0 £
mmCu 2.25
Dentsply Sirona Axeos CsI 85 3–16 2.5 0.5 0.080–0.220 2.2–14.4 N/A Pulsed N/A N/A N/A 1.37 Seated / 5 £ 5.5; 8 191 No MAR
/ mmAl £ Standing / £
aSi + 0.3 1.04 Wheelchair 8; 11 £ 10;
/ 0.5 £ 17 £ 13
/ 2.25
1.0
mmCu 0.5 0.080–0.200 2–18 0.5–20 Pulsed N/A 180–540 14 1.55 Seated / 180 No
Dürr Dental VistaVox S CsI / 50–99 4–16 5.8 £ Standing / 5 £ 5; 13 £
CMOS mmAl 1.21 Wheelchair 7; 13 £ 8.5
£
2.21
Genoray Papaya 3D Premium N/A 60–90 4–12 N/A 0.5 0.075–0.400 7.7–14.5 N/A N/A N/A 180 N/A 1.20 Seated / 3.5 £ 4; 4 160 No Freely adjustable
£ Standing / £ FOV
199
/
360 1.13 Wheelchair 5; 7 £ 7; 8
£
£
8; 14 £ 8;
2.38
14
£ 14; 23 £
24 (19
programs
available)
HDX Will DENTRIα CsI / 80–110 4–10 2.5 0.5 0.100–0.300 N/A 8–36 Pulsed <60 360 14–16 1.36 Seated / 16 £ 8; 16 243 No Freely adjustable
CMOS mmAl £ Standing / £ FOV, scout
or CsI 1.20 Wheelchair 14.5 (freely image, MAR
/ aSi £ adjustable
2.46 FOV)
HDX Will Eco-X CsI 60–90 4–10 2.5 0.5 0.200–0.300 N/A 8–24 Pulsed N/A 360 14 1.23 Seated / N/A No AI-MAR, mA-
/ aSi mmAl £ Standing / 10 £ 8; 12 modulation
£
0.98 Wheelchair
10; 16 £ 9
£
2.31
HDX Will Q-Face CsI / 60–90 4–10 2.5 0.5 0.100–0.300 8–36 N/A Pulsed <60 360 14 1.39 Seated / 305 Yes MAR
CMOS mmAl £ Standing /
217
5 £ 16; 8 £
1.53 Wheelchair
16; 9 £ 16;
£
14.5 £ 16;
2.36
16 £ 16; 16
ImageWorks Corp. Panoura X-era CsI / 70–90 2–4 2.5 0.2 0.090–0.230 N/A 12–20 N/A N/A 360 16 1.37 Seated / 210 No
£ 21
CMOS mmAl £ Standing /
4.4 £ 6.4; 8
1.07 Wheelchair
£ 7.9; 11 £
£
7.9; 15.6 £
2.31
7.9
Imtec Iluma LFOV CsI / 120 1–3.8 N/A 0.3 0.090–0.400 7.8–40 7.8–40 Continuous 120 190 16 1.68 Seated up to 21.1 £ 350 No
aSi £ 14.2
/
360 1.96
Table 1 (continued
)
3Dfacesc
Otherinformat
Totalfiltrati
Reconstructionti
Rotationang
Detect
Greyscale,
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
kg
me
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
£
2.16
Imtec Iluma SFOV CsI 120 1–3.8 N/A 0.3 0.090–0.400 7.8–40 7.8–40 Continuous 120 190 16 1.68 Seated up to 10.8 £ 350 No
/ aSi / £ 9.6
360 1.96
£
2.16
Instrumentarium Orthopantomograph CsI / 57–90 4–16 3.2 0.5 0.085–0.300 10–20 2.3–12.5 Pulsed <30 360 16 1.39 Seated / 6 £ 4; 6 £ 8 200 No MAR, scout
OP300 CMOS mmAl £ Standing / image
0.97 Wheelchair
£
2.41
Instrumentarium/ Orthopantomograph CsI / 60–95 2–16 3.2 0.5 0.080–0.400 27–45 1.7–20 Pulsed <30 360 16 1.10 Seated / 5 £ 5; 6 £ 120 No MAR, scout
PaloDEx / Kavo OP 3D CMOS (CBCT mmAl £ Standing / 9; image, FOV
6 £ 11; 9 £
200
95) 0.77 Wheelchair adjustable in

£ 14 height direction
2.44 (0.5 cm steps
between 5 and 9
cm)
Instrumentarium / Orthopantomograph CsI / 57–90 0.5 0.085–0.420 11–42 1.2–12.6 Pulsed <30 360 16 1.13 Seated / 200 No MAR, scout
3.2–16 3.2
PaloDEx / OP 3D Pro CMOS (CBCT mmAl £ Standing / 5 £ 5; 6 £ image. FOV
Kavo 8;
90) 0.83 Wheelchair freely positioned
8 £ 8; 8 £
£
15; 13 £ 15
2.41
Instrumentarium/ Orthopantomograph CsI / 90–120 3–8 10 0.5 0.125–0.400 4.8–26.9 2–7.4 Pulsed <30 360 16 1.34 Seated / 5 £ 8; 8 £ 231 Yes scout image
PaloDEx / Kavo OP 3D Vision ¼ i- aSi mmAl £ wheelchair 8; (option)
CAT V17 1.22 4 £ 16; 6 £
£ 16; 8 £ 16;
1.82 10 £ 16; 11
£ 16; 13 £
16; 17 £ 23
LargeV Instrument Smart3D-X CsI / 60–100 2–10 N/A 0.5 0.050–0.250 N/A 9.5–18.5 Pulsed <60 360 N/A 1.51 Seated / 5 £ 8; 8 £ 250 No deep-learning
CMOS £ Standing / 8; based
1.79 Wheelchair 12 £ 8; 15 reconstruction
217
£
£ algorithm, MAR,
9; 16 £ 10
2.36 panoramic image
can be
reconstructed
from CBCT
image dataset
Morita Veraviewepocs 3D CsI / 75–90 1–10 2.5 0.5 0.125 9.4 9.4 Continuous 60–240 180 / 14 1.30 Standing / 4 £ 4; 4 £ 190 No scout image
R100 CMOS mmAl 360 £ Wheelchair 8;
+ 0.2 1.02 8£ 8
mmCu £
2.36
Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
Morita 3D Accuitomo 170 CsI / 60–90 1–10 3.1 0.5 0.080–0.250 5.4–30.8 5.4–30.8 Continous 20–120 180 / 14 1.20 Seated 4 x 4; 6 x 6; 400 No scout image
aSi mmAl 360 x 8 x 8; 10 x
1.62 5; 10 x 10;
x 14 x 5; 14 x
2.08 10; 17 x 5;
17 x 12
Morita Veraview X800 N/A 60–100 2–10 2.5 0.5 0.080- 9.4–17.9 9.4–17.9 Continous N/A 180 / N/A 1.20 Seated / 4 x 4; 4 x 8; 185 No scout image
mmAl 360 x Standing / 8 x 4; 8 x 5;
+ 0.2 1.40 Wheelchair 8 x 8; 10 x
mmCu x 4; 10 x 5; 10
2.33 x 8; 15 x 5;
15 x 7.5; 15
x 14
Owandy I-Max Touch 3D CsI / 60–86 6–10 2.5 0.5 0.092 20 8 Pulsed 120 180 14 1.27 standing/ 4 x 9; 5 x 9; 161 No
aSi mmAl (TMJ) / x seated/ 9x 8
201
200 1.14 wheelchair

x
2.45
Owandy I-Max 3D CsI / 60–86 2–12.5 2.5 0.5 0.088–0.175 21.2 6.2–7 Pulsed N/A 270 16 1.27 Seated / 5 x 5; 8.5 x 67 No MAR
CMOS mmAl x Standing / 5; 8.5 x 9.3;
0.95 Wheelchair 11.6 x 10.2
x
2.23
Planmeca ProMax 3D s CsI / 60–90 1–14 2.5 0.5 0.075–0.400 N/A 3–36 Pulsed 2–25 200 16 1.25 Seated / 4.2 x 4.2; 119 Yes Advanced
aSi mmAl x Standing / 4.2 x 6.8; 5 stitching with up
+ 0.5 1.00 Wheelchair x 5; 5 x 8; to three
mmCu x 6.8 x 4.2; 8 horizontal
2.34 x 4; 8 x 5 volumes and two
(+double vertical volumes,
and triple adaptive image
scans) noise optimizer,
MAR, movement
correction
Planmeca ProMax 3D Classic CsI / 60–90 1–14 2.5 0.5 0.075–0.400 N/A 3–36 Pulsed 2–25 200 16 1.25 Seated / 4.2 x 4.2; 119 Yes Advanced
217
aSi mmAl x Standing / 4.2 x 6.8; 5 stitching with up
+ 0.5 1.00 Wheelchair x 5; 5 x 8; to three
mmCu x 6.8 x 4.2; horizontal
2.34 6.8 x 6.8; 8 volumes,
x 4; 8 x 5; 8 adaptive image
x 8; 11 x 5; noise optimiser,
11 x 8; MAR, movement
(+double correction
and triple
scans)

Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
Planmeca ProMax 3D Plus CsI / 60–120 1–14 2.5 0.5 0.075–0.600 14–35 3–36 Pulsed 2–55 200 / 16 1.43 Seated / 3.4 x 4.2; 141 Yes Adaptive image
aSi mmAl 360 x Standing / 3.4 x 6.8; 4 noise optimiser,
+ 0.5 1.10 Wheelchair x 5; 4 x 8; MAR, movement
mmCu x 6.8 x 4.2; correction
2.39 6.8 x 6.8; 8
x 4; 8 x 5; 8
x 8; 8.5 x 5;
10 x 6; 8.5
x 8.5; 10 x
10; 16 x 10;
20 x 6; 20 x
10
Planmeca ProMax 3D Mid CsI / 60–120 1–14 2.5 0.5 0.075–0.600 14–35 3–36 Pulsed 2–55 200 / 16 1.43 Seated / 3.4 x 4.2; 141 Yes Adaptive image
aSi mmAl 360 x Standing / 3.4 x 6.8; 4 noise optimiser,
+ 0.5 1.10 Wheelchair x 5; 4 x 8; MAR, movement
202
mmCu x 6.8 x 4.2; correction, 4D

2.39 6.8 x 6.8; 8 jaw motion
x 4; 8 x 5; 8
x 8; 8.5 x 5;
8.5 x 8.5; 10
x 6; 10 x 8;
10 x 10; 10
x 14; 16 x
8; 16 x 10;
16 x 14; 20
x 6; 20 x 8;
20 x 10; 20
x 14; 20 x
17
Planmeca Viso G5 CsI / 60–120 1–16 2.5 0.5 0.075–0.600 N/A 1.5–36 Pulsed N/A 210 / 16 1.52 Seated / 3 x 3 to 20 165 Yes Live virtual FOV
aSi mmAl 360 x Standing / x 17 (0.5–2 positioning,
+ 0.2 1.39 Wheelchair cm steps adaptive image
/ 0.5 x depending noise optimiser,
mmCu 2.36 on the MAR, movement
217
program) correction, 4D
jaw motion
Planmeca Viso G7 CsI / 60–120 1–16 2.5 0.5 0.075–0.600 N/A 1.5–36 Pulsed N/A 210 / 16 1.52 Seated / 3 x 3 to 26 165 Yes Live virtual FOV
aSi mmAl 360 x Standing / x 30 (0.5–2 positioning,
+ 0.2 1.39 Wheelchair cm steps adaptive image
/ 0.5 x depending noise optimiser,
mmCu 2.36 on the MAR, movement
program) correction, 4D
jaw motion
PointNix 50–90 4–10 N/A 0.5 0.160 19 N/A N/A 10–40 360 14 150 No MAR
Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
Point 3D Combi CsI / 1.25 Seated / 12 x 9; 14 x
500C/S aSi x Standing / 9
1.06 Wheelchair
x
2.30
PointNix Point 800 HD 3D Plus CsI / 50–90 4–10 N/A 0.5 0.183–0.427 19 N/A N/A 10–40 360 14 1.25 Seated / 10 x 9; 12 x 150 No MAR
aSi x Standing / 9
1.06 Wheelchair
x
2.30
PreXion Excelsior CsI / 60–110 1–6 N/A 0.3 0.080–0.200 5.2–23.6 N/A Pulsed N/A 360 16 1.56 Seated / 5 x 5; 10 x N/A No
aSi x Standing / 5; 10 x 8; 15
1.16 Wheelchair x 8; 15 x 13
x
2.22
203
PreXion Explorer CsI / 90–110 1–5 2.7 0.3 0.074–0.300 10–20 5–10 Pulsed <60 360 16 1.56 Seated / 5 x 5; 10 x 185 No
aSi mmAl x Standing / 10; 15 x 8;
1.11 Wheelchair 15 x 16
x
2.27
QR Systems NewTom VGi evo CsI / 110 1–32 12 0.3 0.100–0.300 15–25 0.9–6 Pulsed <60 360 16 1.64 Seated / 5 x 5; 8 x 5; 377 No Scout image,
aSi mmAl / x Standing / 8 x 8; 10 x mA-modulation,
0.6 1.29 Wheelchair 5; 10 x 10; MAR
x 12 x 8; 15 x
2.33 5; 15 x 12;
16 x 16; 24
x 19
QR Systems NewTom 5G XL CsI / 110 1–32 11.2 0.3 0.075–0.300 18–36 0.9–9 Pulsed <60 360 16 3.61 Supine / 6 x 6; 8 x 5; 660 No Scout image,
aSi mmAl x seated 8 x 8; 10 x mA-modulation,
1.75 (orthopaedic) 5; 10 x 10; MAR
x 12 x 8; 15 x
1.80 5; 15 x 12;
15 x 22; 18
x 16; 21 x
217
19
QR Systems NewTom 7G Body CsI / 70–120 5–120 21 0.3 0.090–0.500 7.2–26 1.4–8.8 Pulsed <60 360 16 3.94 Supine / 4 x 4; 6 x 6; 1050 No Scout image,
aSi mmAl / x seated 8 x 6; 8 x 8; mA-modulation,
0.6 2.05 (orthopaedic) 10 x 10; 13 MAR
x x 6; 13 x 8;
2.08 13 x 12; 15
x 6; 13 x
17; 13 x 32;
17 x 12; 17

Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
x 17; 17 x
22; 17 x 32
QR Systems GiANO HR CsI / 90 2–16 6.5 0.5 0.068–0.300 6.4–33.6 1.6–10.4 Pulsed <60 360 16 1.39 Seated / 4 x 4; 6 x 6; 155 No Scout image,
Professional aSi mmAl x Standing / 7 x 6; 8 x 6; mA-modulation,
1.80 Wheelchair 8 x 8; 9 x MAR
x 16; 10 x 6;
2.45 10 x 8; 10 x
10; 13 x 8;
13 x 10; 13
x 14; 13 x
16; 15 x 6;
16 x 10; 16
x 18
QR Systems NewTom Go CsI / 90 4–15 6.0 0.6 0.080–0.160 6.4–16.8 1.6- Pulsed <60 360 16 1.03 Seated / 6 x 6; 6 x 7; 99 No Scout image,
aSi mmAl x Standing / 8 x 6; 8 x 7; mA-modulation,
204
0.87 Wheelchair 8 x 10; 10 x MAR

x 6; 10 x 7; 10
2.28 x 10
Ray Medical Rayscan α CsI / 60–90 4–17 2.6 0.5 0.100–0.300 4.-14 N/A Pulsed N/A 360 N/A 1.48 Seated / 5 x 9; 10 x 150 No MAR
CMOS mmAl x Standing / 10
1.12 Wheelchair
x
2.30
Ray Medical Rayscan α+ CsI / 60–90 4–17 2.6 0.5 0.070–0.300 4.9–14 N/A Pulsed >4 360 16 1.48 Seated / 4 x 3 to 16 148 No MAR, freely
CMOS mmAl x Standing / x 10 adjustable FOV
1.12 Wheelchair
x
2.30
Ray Medical Rayscan Studio CsI / 60–90 4–17 N/A 0.5 0.070–0.300 4.9–16 N/A Pulsed N/A 360 16 N/A Seated / 4 x 3 to 20 N/A Yes MAR, freely
CMOS Standing / x 20 adjustable FOV
Wheelchair
Saletec Acteon WhiteFox CsI / 105 6–10 9.2 0.5 0.100–0.500 18–27 6–9 Pulsed 30 360 14 1.89 Seated / 6 x 6; 8 x 8; 275 No Scout image
aSi mmAl x Standing / 12 x 8; 15 x
1.58 Wheelchair 13; 20 x 17
217
x
2.48
Shenzen Anke Dentom CBCT CsI / 50–90 1–10 N/A 0.5 N/A N/A N/A Pulsed N/A 360 16 N/A Seated / 4 x 4 to 16 N/A No Freely adjustable
High-technology aSi Standing / x 13 FOV, MAR,
Wheelchair adjustable image noise
FOV correction
Soredex Scanora 3D CsI / 60–90 4–12.5 6.6 0.5 0.133–0.350 10–26 2–6 Pulsed 60–240 360 12 1.60 Seated 6 x 6; 7.5 x 310 No
CMOS mmAl x 10; 7.5 x
1.40 14.5;13 x
14.5
Table 1 (continued
)
Otherinformat
3Dfacesc
Totalfiltrati
Reconstructionti
Rotationang
Greyscale,
Detect
Scanmo
Tubepotential,
PatientPositio
Tubecurrent,
Manufactu
Weight,
×
Tradena
FocalSpot,
VoxelSize,
Scanningti
Exposureti
FOV(D × H),
× W
or
de
me
kg
an
me, s
me, s
mm
mm
bit
rer
on
le,◦
ning
Spacerequirements(D
mA
ion
kVp
me, s
cm
H), m
x
1.97
Soredex Scanora 3Dx CsI / 60–90 4–10 6.6 0.5 0.100–0.500 18–34 2.4–6 Pulsed 60–240 360 14 1.60 Seated 5 x 5; 5 x 310 No
aSi mmAl x 10; 8 x 10; 8
1.40 x 16.5; 14
x x 10; 14 x
1.97 16.5; 18 x
16.5; 24 x
16.5
Soredex Cranex 3D CsI / 60–90 4–12.5 3.2 0.5 0.133–0.350 10–26 2.3–6 Pulsed 60–240 180 / 14 1.60 Standing / 6 x 6; 7.5 x 200 No
CMOS mmAl 360 x Seated / 10; 7.5 x
1.40 Wheelchair 14.5;13 x
x 14.5
1.97
Soredex Cranex 3Dx CsI / 57–90 4–16 3.2 0.5 0.085–0.400 10–40 1–9 Pulsed 60–240 180 / 14 1.96 Standing / 5 x 5; 6.1 x 200 No
205
CMOS mmAl 360 x Seated / 7.8; 7.8 x

1.41 Wheelchair 7.8; 7.8 x
x 15; 13 x 15
2.41
Trident X-View 3D PAN CsI / 61–85 4–10 2.5 0.5 0.160 15 9.2 N/A >10 230 14 1.07 Standing / 8.5 x 8.5 125 No
CMOS mmAl x Seated /
1.72 Wheelchair
x
2.23
Vatech Green 16/18 CsI / 60–99 4–16 N/A 0.5 0.080–0.300 4.9–9 N/A N/A N/A 360 14 1.49 Seated / 5 x 5; 8 x 9; 134 No MAR
CMOS x Standing / 12 x 9; 13 x
1.13 Wheelchair 10; 16 x 9;
x 18 x 10
2.17
Vatech Green 21 CsI / 60–120 4–10 N/A 0.5 0.200–0.400 18 N/A N/A N/A 360 14 1.57 Seated / 8 x 8; 12 x 321 Yes
CMOS x Wheelchair 9; 17 x 11;
1.53 17 x 15; 21
x x 19
2.18
217
Vatech Pax-i3D CsI / 50–90 4–10 N/A 0.5 0.120–0.300 15–24 N/A N/A N/A 360 14 1.29 Seated / 5 x 5; 8 x 5; N/A No
CMOS x Standing / 8 x 8; 12 x
1.12 Wheelchair 9
x
2.34
Vatech Pax-i3D Green CsI / 50–100 4–16 2.8 0.5 0.080–0.300 5.9–15 N/A Pulsed 13–212 360 14 1.33 Seated / 5 x 5; 8 x 5; 182 No Scout image,
CMOS mmAl x Standing / 8 x 8; 12 x MAR
1.20 Wheelchair 9; 17 x 15
x
2.34
217
resolution and delineation of smaller fine structures, such as in dental

trauma cases. Not only voxel size but also the focal spot size affects
reconstruction
spatial resolution. Most of the recent CBCT systems utilise a focal spot
Arch-shaped
compressed-
size of 0.5 mm (range 0.2 to 0.7 mm). The smaller the focal spot size,
volume,
sensing
the smaller the penumbra at the detector, which results in a sharper
MAR
Otherinforma
tion image [25].
No
No
3Dfaces
can 2.6. Exposure settings
220
137
Weight,
kg
Most of the dental CBCT devices use a pulsed x-ray beam
10 x 7; 10 x
5 x 5; 10 x
8.5; 12 x 9
5 x 5; 8 x
exposure, although a few vendors still utilise a continuous radiation
7; 10 x
12 x 9
exposure. Usually, the pulsed irradiation results in lower patient doses
FOV(D × H),
8.5;
than continuous exposure mode, as the radiation is turned off
aSi ¼ amorphous silicon, CMOS ¼ complementary metal-oxide semiconductor, CsI ¼ caesium iodide, FOV ¼ field of view, MAR ¼ metal artefact reduction, N/A ¼ not available
8;
cm
intermittently during the image acquisition process. Only a few CBCT
systems use fixed tube current and tube potential for 3D imaging,
Standing /
Standing /
Wheelchair
Wheelchair
Seated /
Seated / whereas most scanners enable these to be changed in certain limits,

resulting in better possibilities for scan optimisation in terms of
PatientPositio
ning radiation dose and image quality. Typically, tube current values
× W ×
selectable for 3D imaging are between 2 and 15 mA, but the range
1.39
1.11
2.34
1.39
1.11
Spacerequirements(D 2.34
x
H), m covering all units is 1 to 120 mA. Tube voltages range from 50 to 120
kVp, with typical values between 60 and 90 kVp. However, the lower
14
14
Greyscale,
bit
kVp values may not always be available in CBCT scans, but only in the
panoramic or cephalographic imaging modes. As in multi-slice CT
scanners, the kV optimisation would also be beneficial in CBCT
◦ Rotationan
360
360
gle, scanning. The total x-ray tube filtration of the equipment that affects
the x-ray spectra varies remarkably (from 2.5 mm-Al at minimum up to
<90
<90
Reconstructiont 21 mm-Al [NewTom 7G Body, QR Systems srl, Verona, Italy]).

ime, s Additionally, more CBCT vendors are currently offering an additional
copper filtration in their newest systems, whereas 6 years ago this was
only available in the Planmeca CBCT systems. The additional copper
N/A
N/A
Scanmo filtration is used to harden the photon beam and to reduce patient dose.
de The set of x-ray spectra from the scanners is presented in Fig. 2.
N/A
N/A
Exposureti 2.7. Scan time

me, s
The scanning times of current CBCT vary between 2 and 45 s,

0.080–0.300 18
0.080–0.300 18
Scanningti
me, s
depending, for example, on the acquired number of projections and
rotation arc of the scan. The exposure times are typically less than this
because of the pulsed irradiation and ranges from 0.5 to 40 s.
VoxelSize,
mm 2.8. Image reconstruction
0.5
0.5
FocalSpot,
mm The reconstruction technique still mostly used in dental CBCT sys-
mmAl
tems utilises 3D filtered back projection (FBP) by Feldkamp-Davis-Kress

N/A
2.8
Totalfiltrat
ion
(FDK) algorithm [25] due to its simplicity and rapid reconstruction
times. However, as discussed previously [5], CBCT, with its limited
4–16
4–16
Tubecurrent, amount of projections, shorter angular range in data acquisition, and

mA
truncated data could benefit considerably from more advanced iterative
reconstruction techniques. Recently, some CBCT models have been
50–99
50–99
Tubepotential, introduced that use iterative reconstruction methods (X1 Scancomfort,

kVp 3Shape A/S, Copenhagen, Denmark) or DL-based reconstruction
CMOS
CMOS
methods (Smart3D-X scanner, LargeV Instrument Corp Ltd., Beijing,

CsI /
CsI /
Detect
or
China). The reconstruction times differ between the scanners from
almost real-time reconstructions up to a few minutes, depending on the
acquisition parameters (FOV, voxel size, number of projections, rotation
angle), hardware (processing speed, data transfer from acquisition to
Pax-i3D Smart
reconstruction computer), and software (reconstruction algorithms)

Smart Plus
used.
Tradena
me 2.9. Metal-artefact reduction techniques
Table 1 (continued
Metal restorative materials (e.g. dental implants, metal fillings and

crowns, fixed orthodontic appliances) and related artefacts are
common in dental imaging. Metal implants result in streaking and
Vatech
Vatech
beam- hardening artefacts in the CBCT images that can be seen as dark
Manufactu
rer shading and bright streaks, especially around highly attenuating
)
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217
metallic objects within the image volume [37]. However, many dental consistency. In addition to this user-level regular testing, further
CBCT systems currently have noise/scatter correction and metal-artefact technical-level testing of the scanner is performed during regular
reduction algorithms to overcome the decreased image quality due to maintenance service visits by the vendor, including x-ray tube and ra-
highly attenuating metal implants. diation output specific parameters.
3. Quality assurance 4. Patient dose and optimisation aspects
Optimisation of radiological imaging equipment should span the The overarching principles of optimisation and justification have
wider context of quality management and quality assurance (QA) to been present in the radiation protection system since its establishment
connect the optimal setting of examination parameters to technical in the ICRP publication 26 [42], from where they have later been
conformance of the scanners. This also applies to dental CBCT. QA adopted to international and European safety standards [43,44]. In
process and quality control (QC) tests form important part of medical medical use of radiation, justification requires that the radiological
imaging quality and safety in any radiological imaging method. QA aims procedure must improve the diagnosis and treatment of patients.
to assure that the technical performance and vendor specifications of Moreover, an individual patient must benefit from that particular
the equipment are continuously maintained in clinical use and through exposure, considering the specific characteristics of the exposed
the equipment life cycle. QC is a key part of QA to periodically assess person. Therefore, justification requires weighing the benefits and
that quality requirements are met. On a more general level, QA and possible harm caused by the exposure. In medical exposures, the
QC also aim to reduce uncertainties and errors and to reduce the harmful effects of ionizing radiation are minimised as far as practically
likelihood of accidents and incidents. possible to maximise the net benefit to the patient (i.e. the patient
Manufacturers have specific QA programmes for imaging equipment exposures are optimised).
and should conform to applicable standards, such as those provided by Optimisation starts from a proper selection of equipment,
DIN (German institute for standards) [38,39] and guidelines such as competent and trained operators, and day-to-day working methods. QA
published by SEDENTEXCT [40] and European Federation of Organi- processes must also be established to ensure compliance with
sations for Medical Physics (EFOMP) [41]. However, clinical staff should regulations and proper functioning of the equipment. Optimisation of
also be aware of the testing needs and perform regular QA tests, as the exposure should be done at the level of individual patient, such as
required for the user and to monitor the constancy of their equipment. through selection of the appropriate imaging modality, x-ray tube
Thus, the QA and QC activities and responsibilities cover vendor, ser- voltage, filtration, exposure time, tube current, field size, and voxel
vice, and users as connected shareholders in the overall quality and size and from information from earlier examinations. In recent CBCT
safety of imaging. While focusing on the clinical use of CBCT devices, low- dose protocols have become increasingly common (see a
scanners, image quality evaluation is a particularly important part of recent review for a discussion of possibilities and limitations [45]).
the overall QA programme and should be integrated together with However, the lack of automatic exposure control in dental CBCT
radiation exposure and technical performance monitoring for all CBCT devices has limited optimisation efforts. This has also been noted in
scanners regardless of specific application area. the ICRP publication 129
Without going into details of QA/QC testing procedures, typical [46] and discussed in relation to the recent EURADOS survey [47]. Thus,
image quality tests focus on the following properties: image grayscale on-site optimisation of imaging parameters is of great importance. In
values (CT numbers), image uniformity, (high contrast) spatial resolu- the optimisation process, a multi-professional team is a prerequisite
tion, low-contrast resolution (contrast-to-noise ratio [CNR]), image for optimal results, as technical, diagnostic, and dosimetric aspects
noise, artefacts, and geometric precision. Scanner calibrations related must be considered (see e.g. ICRP Task Group 108,
to image quality testing typically include geometric and detector pixel https://www.icrp.org).
calibration. Testing of radiation output typically includes Differences in radiation dose levels are large not only between
measurements of KAP or DAP and air kerma at the focus-to-detector various CBCT devices from different vendors but also within the same
distance and in phantom dose indicators (e.g. traditional CTDI). It scanner models [14,35,48,49]. The same authors also stated that a 50-
should be emphasised that possible Hounsfield Unit (HU) scaling in fold difference in radiation exposure to a patient can easily be
dental CBCT is only indicative and cannot be accurately calibrated as observed when changing the settings in specific CBCT equipment.
compared to multi- slice CT. Widely varying non-optimised doses were also found for example in
As an example of the practical dental and ear, nose, and throat the SEDENTEXCT research project [40] and in the European
(ENT) radiology CBCT (Instrumentarium OP300) user level image DIMITRA (dentomaxillofacial paediatric imaging: an investigation
QA, phantom testing is performed quarterly based on vendor toward low- dose radiation induced risks) project [50]. A recent study
phantoms and integrated QA and calibration application (the vendor by the IAEA
advises a 6-month frequency for the phantom scan procedure). Image [51] revealed that optimisation in dental and maxillofacial CBCT im-
quality tests mainly follow the previously mentioned typical targets. aging was still not at a mature stage, 7 years after the publication of
Three separate phantoms are used for image quality tests, including SEDENTEXCT guidelines. This conclusion was also supported by a sur-
3D calibration phantom, QC phantom, and constancy test phantom vey performed by the EURADOS working group 12 [47].
(Fig. 3).
The resulting QA/QC documentation may be provided by 5. Dosimetry and use of diagnostic reference levels
automatic log files and images. Spatial resolution can be determined
subjectively from line-pair pattern or objectively from a point source CBCT dosimetry still lacks a consensus on dose metrics at a
providing high- contrast impulse response function in the form of an practical level (KAP vs. CTDI, or some other dose quantity) [47,51]. This
MTF curve (as a function of spatial frequencies). may also have implications on optimisation, as comparisons of dose
Technical QA procedures of dental CBCT may offer automatic fea- levels between clinics, or even between different vendors or models,
tures for QA monitoring and analysis purposes. By an integrated and may be difficult. We have discussed CBCT dosimetry issues and
automatic QA software, the regular CBCT QA process can be streamlined related challenges in our previous publication [5]. To fulfil the need
and does not require detailed technical knowledge from the users. for practical guidance in QC of CBCT devices, the joint EFOMP-ESTRO-
However, in addition to the scanner image QA phantom testing, the IAEA protocol was published in 2017 [52]. The protocol is applicable to
users also perform regular display monitor QA, which ensures that the all CBCT devices and is described at a practical level that can be
overall image review process chain is covered in the QA programme directly applied in the clinics. The topics cover the assessment of
and conforms to the general radiology QA programme (of all image quality and radiation output of the device and include a
modalities) for
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217
discussion on image quality phantoms.
Several studies have investigated radiation exposures to patients
from dentomaxillofacial CBCT examinations. Effective and organ
doses
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217
have been determined using thermoluminescent dosimeters (TLD), centre position of the jaw. Medium FOV was positioned in the lateral and
optically stimulated luminescence (OSL) dosimeters, and metal- –
anterior position due to larger coverage of the dental structures in
oxidesemiconductor field-effect transistor (MOSFET) detectors
mandible and maxilla in the same scan. Large FOV was centred for◦
rotation with additional simulations using 200◦ latero-posterior rotation
[53–55]. Recent studies have also used Monte Carlo simulations to es- whole skull indication. All simulations were performed with 360
timate effective and organ doses [53,55–57]. The magnitudes of these for selected FOV and anatomical positions (third molar small FOV and
biological dose quantities vary remarkably in dental CBCT depending on whole skull large FOV). Simulations were performed with PCXMC
the FOV size, positioning, and exposure parameters. An example of a 3D 2.0 rotational version (STUK, Helsinki, Finland). As a necessary part
dose map produced with a Monte Carlo simulation is shown in Fig. 4. of the effective dose conversion coefficient calculations, organ doses
were also determined and thyroid dose contribution was given a
5.1. Conversion coefficients from DAP to effective dose specific emphasis due to the relevance for shielding aspects.
As shown in Table 2, the DAP to effective dose conversion co-
Effective doses can also be estimated using appropriate dose con- efficients vary from 0.06 to 0.3 µSv/mGycm2 with an average of 0.18
version factors from DAP or KAP. Mah et al. reported in their review µSv/mGycm2. Thus, our conversion coefficients from DAP to effective
article the usage and magnitudes of effective dose conversion co- dose are also consistent with those reported by Mah et al. [49]. A whole-
skull scan with large FOV (20 × 20 cm) applying soft spectrum and
efficients for dental CBCT equipment and examinations [49]. They re-
ported that conversion coefficients range from 0.035 to 0.31 µSv/ partial rotation represented the lowest conversion coefficients. The
mGycm2 with a mean value of 0.129 µSv/mGycm2. They found FOV size highest conversion coefficients were found with the highest photon
significantly affects the obtained conversion coefficients and depends
energy spectrum and small FOV, demonstrating the contribution of
in part on the relative contribution of thyroid and salivary glands and
scatter with higher photon energies and dose collection from partially
their inclusion in the primary beam.
exposed tissue outside of the FOV. It should also be noted that the whole-
For the current review, we also performed Monte Carlo simulations
skull scan does not have partially exposed tissue outside of the axial
to provide conversion coefficients from DAP (mGycm2) to effective dose
scan FOV, although the scatter from its larger FOV extends further in
(µSv) with various scan scenarios. Our simulations were motivated by the vertical (craniocaudal) anatomical direction. The relative
the fact that highly variable FOV size, spectral characteristics, and contribution of thyroid dose to effective dose varied from 3% to 16%
scan modes involving applied mAs (by pulsed exposure and mA with an average of 8%. Contributions around 10% were related to
levels) and whole-skull exposure with higher photon energy spectrum, and the
angular scan range (typically between 180◦ and 360◦ in axial plane) in highest contributions extending to 16% were related to canine scans of
different scanner models make it difficult to report effective doses the mandible (lower jaw), where partial exposure had most coverage to
comprehensively and also specifically for relevant dental CBCT in-
the thyroid position. Upper estimates of the thyroid effective dose
dications. The variable scan scenarios in our Monte Carlo simulations
relative contribution were
covered three different FOV sizes, three x-ray photon spectra, variable ◦ ◦
200 and 360determined
rotation, which extended the scan FOVsimulations
(26 cm diameter
× 35 cm height) to include the thyroid entirely within the direct expo-◦
anatomical FOV positions (mainly focusing on small FOV), and additionally from two medium-spectrum with
angular scan range (Table 2). Three x-ray spectral qualities were
revealed a 35% contribution of thyroid dose to ◦effective dose in 200
chosen to represent soft, medium, and hard x-ray beam spectrum posterior rotation and 43% contribution in 360 full rotation, respec-
sure (against the appropriate imaging practice). These simulations
produced by low, medium, and high added filtrations, respectively tively. These results emphasise the general recommendation to limit the
(adapted from the data in Fig. 2), corresponding to different scanner scan FOV by size and anatomical positioning to avoid direct thyroid
models. Three FOV sizes were chosen to represent typical small, exposure.
medium, and large FOVs (Table 1). Anatomical FOV positions were
selected by the relevant main indications for the scan of third molar
(wisdom tooth) on the lateral side, upper and lower canine in the
antero-lateral position, and anterior
◦
with
angle 90-kVp
Fig. 2. tube
X-rayvoltage
spectraand typical
from CBCT10scanners
anode
referenced taking into account the total applied
filtration by
aluminium (solid lines) or combined aluminium and
copper (dash lines). Mean photon energy (keV) of
each spectrum is marked in parentheses on the spec-
trum labels. As anticipated, increase in total
filtration will significantly affect the spectral shape
and mean energy of the beam. Furthermore, added
copper filtration clearly reduces the lower energy
part of the spectrum.
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5.2. Diagnostic reference levels justified. Despite recent advances in CBCT, radiation doses of low-
dose imaging protocols are still often higher than in conventional
Diagnostic reference levels (DRLs) have been introduced as a prac- intraoral, panoramic, or cephalometric radiographs. Therefore, CBCT
tical tool to facilitate optimisation. While the DRLs do not classify pa- imaging indications and referral criteria are of utmost importance in
tient exposures as good or bad, they contribute toward good imaging
clinical practice [46,63,64].
practices by indicating exceptionally high (or low) exposures. The Eu-
ropean Basic Safety Standard [44] requires that “Member States shall
ensure the establishment, regular review and use of diagnostic reference 6.1. Guidelines
levels for radiodiagnostic examinations”. However, very few countries
Since the introduction of the CBCT technique in dental and maxil-
currently have established national DRLs in dental CBCT imaging
lofacial imaging in the late 1990 s, the practitioners saw a long period
(Table 3, see also [58] for a general discussion on optimisation and
of non-existent protocols or guidelines on how to approach
DRLs). Switzerland published their national DRLs for five dental in-
optimisation and patient protection in clinical practice. Guidelines
dications [59] as did Finland for four dental or maxillofacial indications
were first established at the international level by the American
[60] and Sweden for three non-indication-based examinations in the
Academy of Oral and Maxillofacial Radiology in 2008 [65] and the
dental region [61]. In the UK, Public Health England has suggested DRLs
European Academy of Dental and Maxillofacial Radiology (EADMFR) in
both for a specific adult and child CBCT protocol [62]. The DRL can
2009 [66], and further complemented by the EU-funded SEDENTEXCT
be established at several levels, from European (regional) to national
consortium with its Safety and Efficacy of a New and Emerging
and local (clinic). However, as dental CBCT equipment are often in
Dental X-ray Modality research project in 2012 [40]. In addition to the
small private clinics that may not have access (although required by
European guidelines, national guidelines from different countries are
legisla- tion [44]) to medical physics expert service, national and
also available, including a recent review compiling and summarising the
regional efforts are needed to ensure widespread application of
CBCT-related guidelines from organisations and associations within
DRLs.
North America [8,40,67].
Although the SEDENTEXCT panel members stated that especially the
6. Clinical aspects
referral criteria should be reviewed and updated at intervals of no>5
years, financial support for reviewing the guidelines is unfortunately
In 2D radiographs, the superimposition of different anatomical still insufficient [40,68]. However, during the past 8 years, several
structures and geometric distortion may impair image interpretation. systematic reviews and position statements focusing on various maxil-
This can be avoided using 3D imaging (Figs. 5 and 6). If a 3D exami- lofacial imaging indications of CBCT have been published.
nation provides new information compared to conventional 2D
imaging and impacts treatment decisions or planning, it can be
considered
Fig. 3. Example of QC and constancy

phantom scans and resulting axial im-
ages from Instrumentarium OP300
CBCT scanner: a) a constancy phantom
positioned for the scan, b) an axial
image of the uniform section of the
constancy phantom with automatic
reporting of the acceptance of the test
results covering the material-specific
contrast and noise values in addition to
uniformity value, c) an axial image
showing the different material
cylinders in the QC phantom and d) an
axial image of the high contrast line-
pair patterns for the visual evaluation
of the spatial resolution.
Approximation of CT numbers (in HU;
Hounsfield units) in density calibration
is demonstrated with a fairly wide
tolerance of material-
specific densities, e.g. —200 to + 200
HU for acryl (PMMA) voxel values. It
should be noted that this range of
allowed density variation is over an
order of magnitude greater than in
typical multi-slice CT scanners.
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217
6.2. CBCT imaging indications Finland [75]. Before a surgical operation, alveolar bone volume,
restricting
As children and young people are at greater risk of adverse effects
of ionizing radiation, special care must be taken when imaging these
patient groups [69]. However, there are some indications that the
optimisation is insufficiently performed in the case of young patients
[50]. Therefore, the European DIMITRA project proposed an ALADAIP
principle (As Low as Diagnostically Acceptable being Indication-
oriented and Patient-specific) when imaging children [50]. In
paediatric dentistry and orthodontics, impacted or supernumerary teeth
frequently need surgical intervention. CBCT scanning is justified if the
exact position of the tooth, its relationship with intimate anatomical
structures, and possible resorption of neighbouring teeth cannot
reliably be assessed from 2D radiographs or if CBCT imaging will
otherwise influ- ence treatment planning [50,70]. According to the
updated EADMFR recommendation, preoperative CBCT imaging
should not be used routinely to evaluate the relationship with
mandibular third molars (wisdom teeth) and the mandibular canal, but
only if the surgeon has a specific clinical question that cannot be
answered by panoramic or intraoral imaging [68]. Traumatic or
congenital loss of permanent teeth can be treated with an
autotransplantation operation and the dimensions of both the tooth
transplant and the recipient site bone volume can be measured reliably
from CBCT images. If orofacial cleft (lip and/or palate cleft) operations
need volumetric assessment of bone defect, CBCT scanning can
replace medical multi-slice CT scanning before a bone-grafting
operation. Craniofacial syndromes, skeletal asymmetries requiring
surgical intervention, and orthognathic surgery are other possible
indications for CBCT imaging. One significant clinical disad- vantage
of CBCT imaging is the longer scanning time compared to
conventional imaging. Therefore, cooperation of paediatric patients
must be considered. Movement of the patient during the scanning time
can produce image artefacts and impair image quality [50,69,71,72].
The root canal anatomy of a single tooth may be complex,
especially
in multirooted molars and premolars, and all 2D radiographs have
limitations in depicting morphological details of teeth and the sur-
rounding alveolar bone structure. The European Society of Endo-
dontology has published position statements in 2014 [73] and 2019
[74] on the use of CBCT in endodontics. It concluded that CBCT
imaging should be considered in the following cases: suspicion of
periapical pathoses when 2D radiographs are inconclusive and the
patient has contradictory symptoms, assessment of root canal anatomy
prior to initial endodontic treatment and in re-treatment cases, and
prior to periradicular surgery [74]. Dental trauma, especially horizontal
root fractures, and possible later complications such as resorptions and
root canal obliterations, and developmental tooth anomalies can be
accurately diagnosed in CBCT images [69,74]. In endodontic and
dental trauma imaging, a higher spatial resolution may be required to
delineate complex and detailed structures, such as root canals and
fractures. However, it is good to remember that smaller voxels capture
fewer x-ray photons and therefore provides more noise to the images,
which may lead to use of increased radiation dose levels in scanning.
We remind readers that the voxel size should be selected according to
clinical indication. Additionally, although the theoretical spatial
resolution of CBCT devices may be high due to small focal spot and voxel
sizes, beam projection geometry, scatter, patient movement, detector
motion blur and fill factor, number of projections, and reconstruction
algorithms also impact the final spatial resolution and thus the
capabilities of viewing detailed structures. As CBCT scanning can last
from a few seconds up to 45 s, the imaging is vulnerable to patient
motion. As discussed previously, the heart beating alone can induce
80–90 µm movement of the
patient’s head [31,33].
In a recent nationwide survey conducted in co-operation with the
Finnish Radiation and Nuclear Safety Authority, the most common im-
aging indication was preoperative implant planning in the facilities
performing CBCT examinations of the head and neck region in
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217
anatomical structures (e.g. sinuses, nerve canals), bone structure, and Monte Carlo simulations that were reported in section 5.1.
alveolar ridge morphology must to be assessed. Cross-sectional
imaging is needed if clinical examination and conventional imaging
are insufficient. CBCT imaging is especially advisable before bone
augmentation and sinus floor elevation operations. Successful
occlusal rehabilitation with implants involves both surgical and
prosthetic planning. In computer-guided planning, both CBCT data
and digital impression are transferred to a software and the position of
the implant in relation to occlusion can be planned virtually. After
that, surgery can be performed with custom-made stereolithographic
guides. Post-operative imaging with CBCT is restricted to specific
complications, such as unexplained pain and infections. Metal
restorations and implants can cause image artefacts and have a
negative impact on image quality [76–78].
Only osseous structures can reliably be assessed when imaging the
temporomandibular joint (TMJ). Soft tissues and intra-articular anat-
omy should be evaluated from magnetic resonance images. The diag-
nostic benefit of CBCT images and impact on treatment outcome
currently remains uncertain [79,80]. The gold standard in
maxillofacial trauma imaging is multi-slice CT, but CBCT may be
indicated if soft- tissue imaging is not needed [40,81]. CBCT can also
be advantageous in evaluation of the radiological characteristics of
bony pathoses of the mandible and maxilla before surgical
intervention [40].
6.3. Competency
Since CBCT imaging has been in wide use for approximately 10–20
years, most working-age dentists are not familiar with CBCT equipment,
image acquisition, or referral criteria. It is also noteworthy that there are
significant differences between undergraduate curricula regarding ra-
diation physics, radiation biology, safety and protection, and training in
3D-image interpretation. Continuing education is therefore essential
and in many European countries, updating education in radiation pro-
tection is mandatory. As a DentoMaxilloFacial radiologist is a registered
speciality only in a few countries in Europe, EADMFR has published a
recommendation of core competencies and minimum training re-
quirements for dentists involved with dental CBCT [82]. Two training
levels are recommended; a basic level for dentists who prescribe CBCT
scans, and an advanced level for the dentists who perform CBCT
imaging and evaluate the 3D images. The aim is to ensure that dentists
have adequate knowledge and skills in the justification and optimisation
processes and CBCT image evaluation.
7. Use of patient shields in dental CBCT
Use of wearable radiation shields for patients during x-ray exami-

nations is a tradition that dates back over 70 years [83]. The rationale
for these protective measures is to reduce radiation exposure to the
radiosensitive organs of patients and thereby improve radiological
optimisation and radiation safety. This tradition has been embraced
by both radiology professionals and patients and reinforced by
regulators. However, significant development of medical imaging
technology has brought new and more effective tools for
optimisation, thereby providing enhanced radioprotection for patients
in most of the x-ray imaging examinations and interventional
procedures. This development has also been acknowledged in several
scientific publications, policy statements, and guidelines over the past
decade. Accordingly, the weight of evidence has gradually questioned
the legacy use of personal
patient shields [83–88]. The evidence brought by these studies
suggest that contrary to the historical perspective that shielding
is always
beneficial to patients, shielding may have an adverse effect on
imaging examination and may actually increase the radiation
exposure to patients. In this review, we will not address this subject
in depth. We will discuss what has been considered a consensus
opinion to improve consistency in application of shielding in dental
CBCT. We also discuss the use of thyroid shielding based on our
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217
Fig. 4. A) A photo of the physical exposure of an anthropomorphic adult female head phantom positioned for the CBCT scan with Planmeca Viso 7G CBCT scanner
and B) a 3D dose distribution within an anthropomorphic phantom model (Atom 702-D, CIRS, Norfolk, VA, USA) produced with Monte Carlo simulation (ImpactMC,
Vamp GmbH, Germany) corresponding to wide FOV of 26 × 30 cm (width × height) scan. Exposure was performed with 10 mA and 3.2 s effective exposure time (32
mAs). DAP was 1370 mGycm2, corresponding to an estimated effective dose of 115 µSv (ratio of 0.084 µSv/mGycm2; effective dose divided by DAP). Mean photon
covered
energy of 64ankeV angular
of the x-rayrange
beam was 210◦ with
ofproduced in 100latero-posterior rotation
kVp tube voltage and (i.e.plusanterior
2.5 mm-Al 0.5 mm-Cupart was ofnot
pre-filtration directlyRotational
the scanner. exposed).
exposure
In short, external radiation shields, mainly the thyroid collar shield,

are not generally recommended in dental CBCT for radioprotection of largest FOVs, when consistent practices and risk of misplaced shields are
patients, although different recommendations have also been presented considered, even this slight benefit can be seen as controversial [83].
[83,89]. The reasons for this alignment are as follows: 1) scan FOV To study the relative contribution of thyroid dose to effective dose,
should be optimised in all examinations, and thus the thyroid gland we performed Monte Carlo simulations as described in section 5.1. We
should not normally be in the primary x-ray beam, 2) use of a thyroid found this contribution to be mainly below 10%. The highest contri-
shield can easily interfere with the primary beam and cause significant butions (reaching 15% to 16%) were related to scans of the mandible
artefacts, likely rendering diagnostically unacceptable images (as shown (lower jaw), where direct exposure is closest to the thyroid position. It
in Fig. 7), and 3) externally applied shielding is inefficient to protect is also such scans focused on the lower-jaw FOV where the risk of
radiosensitive organs from internal scatter. These reasons have also been artefact from a thyroid shield is most pronounced. Higher contributions
discussed in a recent review by McGuigan et al. [90]. Radiation exposure to effective dose from thyroid dose can be acquired with paediatric
from scatter to radiosensitive organs below the head and neck can al- patients but also if the thyroid is partially or entirely in direct exposure
ways be assumed to be low in all dental x-ray examinations regardless (i.e. in the scan FOV). However, such FOV positioning should not
of specific modality and should not cause concern for e.g. pregnant occur with an appropriately performed CBCT scan. While considering the
patients [91]. As stated by the British Institute of Radiology in their dental CBCT DRLs presented in Table 3 in combination with the
recent and comprehensive patient shielding guidance, although there conversion coefficients shown in Table 2, the typical dental CBCT
might be a slight benefit from thyroid shielding in dental CBCT indications imply an
studies with the effective dose of approximately 50–100 µSv. As such, the contribution of
thyroid dose to effective dose can be assumed to be approximately 10
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Table 2
8. Future aspects
Conversion coefficients from DAP to effective dose based on Monte Carlo sim-
ulations. Conversion values cover three different FOV sizes (small, medium,
large), three x-ray beam spectra (90 kV with variable added filtrations: soft, 8.1. General development for optimisation
indications, and example of partial 200◦ rotational exposure in third

medium, hard), different anatomical positions corresponding to main dental
FOV and whole skull large FOV scans in addition to default 360◦ rotation. Mean
molar small In general, dental CBCT technology has shown incremental but
photon energies in keV are marked in parentheses in three spectra used in
steady development in many specific areas and applications during the
simulations.
past few years. New scanner models have already enabled a wider se-
Spectra with lection of different FOV sizes to optimise imaging for specific indications
90 kV
(minimising the volume of exposed tissue) and to accommodate a
Soft (46.5 Medium (54.9 Hard (65.3 larger FOV to cover the whole cranial anatomy [14]. The adjustability
2.5 mm-Al + 2.5 mm-Al +
keV) keV) keV)
of FOV size has also improved, with more seamless and flexible
FOV Location 2.5 mm-Al
0.2 mm-Cu 1.0 mm-Cu
diameter and height value settings to accommodate any individual
Small (3 × 3
target size and patient-specific anatomy. This flexibility is important,
Third Molar 0.15176 0.22431 0.28592
(360◦)
cm)
not only for the indication and for patient-specific optimisation of
Third Molar 0.16687 0.24106 0.30310 radiation exposure, but also for an easier patient positioning and
(200◦) streamlined scan procedure.
Canine (up) 0.15354 0.23188 0.29903
Canine 0.09780 0.16181 0.21921
8.2. Reconstruction methods
(down)
Anterior 0.13703 0.20972 0.27303
centre Reconstruction methods are steadily progressing further from the
traditional 3D Feldkamp algorithm. Iterative reconstruction methods
× 8 cm)
Medium (8 Third Molar 0.12726 0.19384 0.25099
have complemented traditional algorithms and have potential for
Anterior 0.11438 0.17811 0.23340
reduced image noise and artefacts in various CT and CBCT
Large (20 ×
centre
Skull (360◦) 0.06245 0.09721 0.12699
applications [18]. Iterative methods attempt to solve the main
20 cm) reconstruction inverse problem in various converging steps. Iterative
Skull (200◦s) 0.05798 0.09071 0.11917 algorithms include varying methods regarding the level of modelling of
the actual scan from a technical and physical perspective. Iterative
reconstruction can be done either in the image domain or at the raw
Table 3 data level. The basic principle of iterative reconstruction is to gradually
Diagnostic reference levels of dentomaxillofacial CBCT examinations in various (in iteration steps) update the image data such that the raw data, which
countries. Note that indications differ between the countries. is simulated (in forward-projection) from this image data, will
Finland [60] KAP, PKA approach the true (measured) raw-data projections [29]. Thus, when
(mGycm2) the difference between the simulated and the real raw data is
sufficiently small (i.e. when the image data estimate will not change
Presurgical imaging of implant treatments (single tooth) 360
beyond the threshold value between the consecutive iteration steps),
the iteration has reached the final solution. Iterative methods have
shown a clear value in CT and
Assessment of the relationship between a wisdom tooth and the 380 CBCT imaging due to the flexibility of iterative methods to model
mandibular canal
various image acquisition geometries, and therefore provide more
Assessment of the periapical region and the root canal 550
morphology of the tooth faithful assumptions of the actual image acquisition techniques [17].
Imaging of the paranasal sinuses (excluding traumas) 1150 The non-linearities built into iterative methods, mainly in the form of
Sweden [61] regularisation, have also revealed limitations of these methods as they
Part of jaw (1 quadrant) 300*/150**
may create images that deviate from traditional images on image
Upper or lower jaw (2 quadrants) 460*/180**
Upper and lower jaw (4 quadrants) 540*/260**
texture, yielding even unnatural looking images [18]. This has raised
Switzerland [59] concerns and has also highlighted the need for further development of
Wisdom tooth 662 reconstruction techniques [21].
Single tooth implant 683 The most recent advances in CT image reconstruction are focused
Tooth position anomalies 542
in the realm of AI, where the DL image reconstruction algorithms are
Pathological dentoalveolar modifications 569
Endodontics 639
showing promising results for image quality improvements [92]. Due
UK [62] to its nature, the DL iterative reconstruction algorithm is based on
the
Adult (imaging prior to placement of a maxillary molar 265 learning data, which should represent a balanced distribution of clini-
implant)
cally relevant sets of image data, including various indications. This
Child (imaging of an impacted maxillary canine of a 12-year- 170
old child) means that such algorithms are much more detached from the original
linear approximations of image reconstruction and as such require
KAP = PKA = kerma-air product, *Upper level, **Lower level.
careful clinical validation to demonstrate reliability in specific clinical
settings [21]. Due to its flexibility in various tasks also included in the
µSv or less in most CBCT examinations. Only a part of this thyroid tional shielding obsolete [83].
dose
contribution can be reduced with an externally placed thyroid shield
and the remaining portion of thyroid dose is accumulated from inter-
nally scattered x-rays without relevant means of avoidance. Therefore,
although thyroid shielding has dose-reduction capability, the contribu-
tion of shielding in dental CBCT effective dose reduction can be regarded
as fairly small and should be considered against the risk of artefacts
caused by the shields. In summary, the use of external patient shields
remains controversial [83,89], although modern technology with
improving dose optimisation capabilities will gradually render tradi-
212
217
radiological imaging process, the development and clinical imple-
mentation of DL algorithms in dental CBCT systems and clinical
applications are likely to be significant factors in the upcoming
years.
Regardless of the type of image reconstruction technique, the
image reconstruction should also be able to perform corrections for
metallic implants and involuntary patient movement during the scan.
The challenge with patient involuntary movement during the scan is
emphasised in dental CBCT, as the scan times are considerably
(approximately an order of magnitude) longer than with multi-slice
CT scanners. The challenge has already been addressed by existing
motion artefact correction methods, which have been
integrated into CBCT
213
217
Fig. 5. Example clinical CBCT images in a case of apical periodontitis of the first maxillary incisor, presented in a) panoramic and b) intraoral images before
root- canal treatment and later c-d) in CBCT images during treatment.
Fig. 6. Example clinical CBCT images from extraction of the maxillary wisdom tooth and the second molar, indicating postoperative complication. Root fragment in
the left maxillary sinus is targeted in the panoramic image and CBCT images.
214
217
Fig. 7. Example
scanner: ofwith
a) a scan an artefact caused by an inappropriately
an anthropomorphic head phantompositioned thyroid
with a thyroid shield
shield with respect
positioned around 8×
to thethe 15 cm
neck, b) FOV scanned
an axial with
image Instrumentarium
with OP300
an artefact, c) an axialCBCT
image
without artefact when the scan was performed without a thyroid shield.
reconstruction for certain vendors [34]. An example of motion artefact

compensates for the changes in average projection-based attenuation of
correction in combination with noise reduction is presented in Fig. 8.
the patient while the x-ray tube is rotating around the patient during the
scan. Beam-shaping filters also attempt to achieve the same goal of
equalising the detector signal by prefiltering the peripheral part of the
8.3. Developing optimisation tools
x- ray beam on every raw-data projection during the scan. This shaped
prefilter has a shape of a bowtie and compensates the attenuation
Radiation exposure in CT imaging has been recognised as an essen-
generated by the patient, assuming cylindrical patient geometry where
tial optimisation target for decades. Accordingly, there are many tech-
the x-ray projections passing through the central part of the patient
nical optimisation features available [93], also for dental CBCT
attenuate more than the peripheral x-rays. In addition to detector signal
scanners. Low-dose scan protocols may utilise increased beam filtration,
equalisation, beam-shaping filters also help by reducing peripheral ra-
enhanced reconstruction settings, larger voxel size, and minimised
diation exposure to the patient and improve image quality by reducing
tube output, either with lower tube currents or with lower effective
the amount of scatter from the peripheral anatomy. However, these
mAs as enabled with pulsed exposure. Possible further improvements
potential optimisation methods, namely spectral optimisation, tube
may involve tube voltage reduction if allowed by increased x-ray tube
current modulation, and beam-shaping filters, require further develop-
power, indication, and patient anatomy. This attempts to maximise the
ment for dental CBCT hardware and x-ray production performance [5].
contrast in the image data by maximising the contribution of
Finally, image detectors are becoming more sensitive in capturing the
photoelectric effect at lower photon energies. Tube current
relevant image signal and reduce electronic noise by integrating the
modulation, which is routinely used in multi-slice CT scanners, may
digital signal readout electronics more closely to the detector elements
also be an efficient technique for optimisation in dental CBCT [6].
and via development of entirely new detector material and detector
This technique aims to maintain a relatively constant net signal at the
type developments, such as photon-counting detectors [93,94].
image detector for different raw-data projections of the image
acquisition by producing tube current, which
Fig. 8. Example of ultra-low dose pa-

tient images demonstrating the effect of
CBCT noise reduction and motion arte-
fact suppression algorithm in axial
(upper row) and sagittal (lower row)
reformats. Left: images with no correc-
tions applied, Centre: images with
noise reduction (AINO), Right: images
with noise reduction and motion
correction (CALM). Original images
acquired with
Planmeca ProMax Classic, 80 × 80 × 80
mm FOV, 0.15-mm voxel size, 90-kVp
tube voltage, and 18 mAs exposure.
Images courtesy of Planmeca Oy,
Finland.
215
217
8.4. Photon-counting detectors [7] White SC, Pharoah MJ. The evolution and application of dental
maxillofacial imaging modalities. Dent Clin North Am 2008;52:689–705.
https://doi.org/ 10.1016/j.cden.2008.05.006. PMID: 18805224.
Current CT and CBCT image detectors are energy-integrating de- [8] Hayashi T, Arai Y, Chikui T, Hayashi-Sakai S, Honda K, Indo H, et al. Clinical
tectors that accumulate the total energy delivered from absorbed x-ray guidelines for dental cone-beam computed tomography. Oral Radiol 2018;34(2):
photons into measured signal intensity. Therefore, the detected signal 89–104. https://doi.org/10.1007/s11282-018-0314-3.
[9] Durack C, Patel S. Cone beam computed tomography in endodontics. Braz Dent
does not reveal the characteristics of the applied photon spectrum.
J 2012;23(3):179–91. https://doi.org/10.1590/S0103-64402012000300001.
With photon-counting detectors, every absorbed photon releases [10] Adibi S, Zhang W, Servos T, O’Neill PN. Cone beam computed tomography in
electric charge carriers that are collected into measured charge signal dentistry: what dental educators and learners should know. J Dent Educ 2012;76
(11):1437–42. https://doi.org/10.1002/(ISSN)1930-783710.1002/jdd.
as an individual detection event per each x-ray photon. This photon- v76.1110.1002/j.0022-0337.2012.76.11.tb05404.x.
energy specific signal amplitude can then be compared to pre-set [11] Mozzo P, Procacci C, Tacconi A, Tinazzi Martini P, Bergamo Andreis IA. A new
volumetric CT machine for dental imaging based on the cone-beam technique:
threshold levels and are consequently counted into the corresponding preliminary results. Eur Radiol 1998;8(9):1558–64. https://doi.org/10.1007/
photon energy bin. Depending on the number of threshold levels, s003300050586.
which also reflect the complexity of the photon counting detector read- [12] Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K. Development of a
compact computed tomographic apparatus for dental use. Dentomaxillofac Radiol
out electronics, multi-energy image data can be produced. Multi- 1999;28: 245–8. https://doi.org/10.1038/sj/dmfr/4600448.
energy image data may provide more advanced contrast [13] Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 1: physical
representations (e.g. material-specific spectral imaging), yielding principles. AJNR Am J Neuroradiol 2009;30(6):1088–95. https://doi.org/
10.3174/ajnr.A1653.
material density maps and virtual monochromatic images [94]. [14] Gaêta-Araujo H, Alzoubi T, Vasconcelos KdF, Orhan K, Pauwels R, Casselman JW,
et al. Cone beam computed tomography in dentomaxillofacial radiology: a two-
decade overview. Dentomaxillofac Radiol 2020;49(8):20200145. https://doi.org/
8.5. General future aspects
10.1259/dmfr.20200145.
[15] Bushberg JT, Seibert JA, Leidholdt Jr E. The Essential Physics of Medical Imaging.
These new hardware- and software-based methods can be 4th ed. Lippincott Williams & Wilkins (LWW); 2020.
[16] Feldkamp LA, Davis LC, Kress JW. Practical cone-beam algorithm. J Opt Soc
combined with significant potential to improve image quality and
Amer 1984;1:612–9. https://doi.org/10.1364/JOSAA.1.000612.
reduce radiation exposure to patients, as foreseen with future CBCT [17] Beister M, Kolditz D, Kalender WA. Iterative reconstruction methods in X-ray CT.
scanners. As these developments have already been implemented in Phys Med 2012;28(2):94–108. https://doi.org/10.1016/j.ejmp.2012.01.003.
[18] Stiller W. Basics of iterative reconstruction methods in computed tomography:
conventional CT imaging and the speed of how these features are a vendor-independent overview. Eur J Radiol 2018;109:147–54.
emerging in certain CT scanners (e.g. by AI algorithms and photon- https://doi.org/ 10.1016/j.ejrad.2018.10.025.
[19] Niebler S, Scho¨mer E, Tjaden H, Schwanecke U, Schulze R. Projection-based
counting detectors) also secure the future outlook for dental CBCT
improvement of 3D reconstructions from motion-impaired dental cone beam CT
imaging. Despite these tech- nological advancements, the value of new data. Med Phys 2019;46(10):4470–80. https://doi.org/10.1002/mp.
technology comes with well- educated and trained users who can take v46.1010.1002/mp.13731.
[20] Wang G. A Perspective on Deep Imaging. IEEE Access 2016;4:8914–24.
full benefit of the scanners and use them safely. This also involves https://doi. org/10.1109/ACCESS.2016.2624938.
multidisciplinary teams of physicists, radiologists, clinicians, and [21] Singh R, Wu W, Wang G, Kalra MK. Artificial intelligence in image
reconstruction: The change is here. Phys Med 2020;79:113–25.
engineers, who should work together for more effective optimisation https://doi.org/10.1016/j. ejmp.2020.11.012.
process in any medical imaging modality. Dental CBCT scanners have [22] Scarfe WC, Li Z, Aboelmaaty W, Scott SA, Farman AG. Maxillofacial cone beam
shown clear technical advancements in the past decade and scanner computed tomography: essence, elements and steps to interpretation. Aust Dent J
2012;57(Suppl 1):46–60. https://doi.org/10.1111/j.1834-7819.2011.01657.x.
technology, models, and applications have diversified. This technical [23] Baba R, Ueda K, Okabe M. Using a flat-panel detector in high resolution cone
development is proceeding alongside new hardware and software beam CT for dental imaging. Dentomaxillofac Radiol 2004;33(5):285–90.
https://doi. org/10.1259/dmfr/87440549.
methods, which complement each other. The main task for us is to
[24] Sheth NM, Zbijewski W, Jacobson MW, Abiola G, Kleinszig G, Vogt S, et al. Mobile
understand this development and to know what is available in current C-Arm with a CMOS detector: Technical assessment of fluoroscopy and Cone-
CBCT scanners. Thus, we can make sound decisions what is needed for Beam CT imaging performance. Med Phys 2018;45:5420–36.
https://doi.org/10.1002/ mp.13244.
clinical practice and how to use our CBCT scanners in an optimal way [25] Pauwels R, Araki K, Siewerdsen JH, Thongvigitmanee SS. Technical aspects of
for the benefit of the patient. dental CBCT: state of the art. Dentomaxillofac Radiol 2015;44(1):20140224.
https://doi.org/10.1259/dmfr.20140224.
[26] Suomalainen A, Vehmas T, Kortesniemi M, Robinson S, Peltola J. Accuracy of
Acknowledgements
linear measurements using dental cone beam and conventional multislice
computed tomography. Dentomaxillofac Radiol 2008;37(1):10–7.
We acknowledge technologist Eliisa Leppa ¨nen from the HUS Medical https://doi.org/ 10.1259/dmfr/14140281.
[27] Esmaeili F, Johari M, Haddadi P, Vatankhah M. Beam hardening artifacts:
Imaging Center for her collaboration in QA and anthropomorphic comparison between two cone beam computed tomography scanners. J Dent Res
phantom CBCT scans with Instrumentarium OP300 scanner. We Dent Clin Dent Prospects 2012;6:49–53. https://doi.org/10.5681/joddd.2012.011.
acknowledge Dr Mikko Lilja from Planmeca Oy for providing the motion [28] Barrett JF, Keat N. Artifacts in CT: recognition and avoidance. Radiographics
2004; 24(6):1679–91. https://doi.org/10.1148/rg.246045065.
correction clinical images. The authors declare no conflicts of interest. [29] Hsieh J. Computed Tomography: Principles, Design, Artifacts, and Recent
This research did not receive any grants from funding agencies in Advances. 2nd ed. Washington, USA: SPIE; 2009.
[30] Dang H, Stayman JW, Sisniega A, Zbijewski W, Xu J, Wang X, et al. Multi-
public, commercial, or governmental sector.
resolution statistical image reconstruction for mitigation of truncation effects:
application to cone-beam CT of the head. Phys Med Biol 2017;62(2):539–59.
References https://doi.org/10.1088/1361-6560/aa52b8.
[31] Brüllmann D, Schulze RKW. Spatial resolution in CBCT machines for dental/
maxillofacial applications – what do we know today? Dentomaxillofac Radiol
[1] Yoon DC, Mol A, Benn DK, Benavides E. Digital radiographic image processing 2015;44(1):20140204. https://doi.org/10.1259/dmfr.20140204.
and analysis. Dent Clin North Am 2018;62(3):341–59. https://doi.org/10.1016/j. [32] RALPH WJ, JEFFERIES JR. The minimal width of the periodontal space. J Oral
cden.2018.03.001. Rehabil 1984;11(5):415–8. https://doi.org/10.1111/jor.1984.11.issue-510.1111/
[2] Boeddinghaus R, Whyte A. Current concepts in maxillofacial imaging. Eur J Radiol j.1365-2842.1984.tb00594.x.
2008;66(3):396–418. https://doi.org/10.1016/j.ejrad.2007.11.019. [33] de Kinkelder R, Kalkman J, Faber DJ, Schraa O, Kok PHB, Verbraak FD, et al.
[3] Nemtoi A, Czink C, Haba D, Gahleitner A. Cone beam CT: a current overview of Heartbeat-induced axial motion artifacts in optical coherence tomography
devices. Dentomaxillofac Radiol 2013;42(8):20120443. https://doi.org/10.1259/ measurements of the retina. Invest Ophthalmol Vis Sci 2011;52(6):3908. https://
dmfr.20120443. doi.org/10.1167/iovs.10-6738.
[4] Suomalainen A, Pakbaznejad Esmaeili E, Robinson S. Dentomaxillofacial imaging [34] Santaella GM, Wenzel A, Haiter-Neto F, Rosalen PL, Spin-Neto R. Impact of
with panoramic views and cone beam CT. Insights Imaging 2015;6(1):1–16.
movement and motion-artefact correction on image quality and interpretability in
https://doi.org/10.1007/s13244-014-0379-4.
CBCT units with aligned and lateral-offset detectors. Dentomaxillofac Radiol 2020;
[5] Kiljunen T, Kaasalainen T, Suomalainen A, Kortesniemi M. Dental cone beam CT:
A review. Phys Med 2015;31(8):844–60. https://doi.org/10.1016/j. 49(1):20190240. https://doi.org/10.1259/dmfr.20190240.
ejmp.2015.09.004.
[6] Jain S, Choudhary K, Nagi R, Shukla S, Kaur N, Grover D. New evolution of cone-
beam computed tomography in dentistry: Combining digital technologies. Imaging
Sci Dent 2019;49:179–90. https://doi.org/10.5624/isd.2019.49.3.179.
216
217
[35] Ludlow JB, Timothy R, Walker C, Hunter R, Benavides E, Samuelson DB, et al.
Effective dose of dental CBCT – a meta analysis of published data and additional e0219103. https://doi.org/10.1371/journal.pone.021910310.1371/journal.
data for nine CBCT units. Dentomaxillofac Radiol 2015;44(1):20140197. https:// pone.0219103.g00110.1371/journal.pone.0219103.g00210.1371/journal.
doi.org/10.1259/dmfr.20140197. pone.0219103.g00310.1371/journal.pone.0219103.g00410.1371/journal.
[36] Mutalik S, Tadinada A, Molina MR, Sinisterra A, Lurie A. Effective doses of pone.0219103.g00510.1371/journal.pone.0219103.t00110.1371/journal.
dental cone beam computed tomography: effect of 360-degree versus 180-degree pone.0219103.t00210.1371/journal.pone.0219103.t00310.1371/journal.
rotation pone.0219103.t00410.1371/journal.pone.0219103.s001.
angles. Oral Surg Oral Med Oral Pathol Oral Radiol 2020;130(4):433–46. [56] Morant JJ, Salvado´ M, Casanovas R, Hernández-Giroń I, Velasco E, Calzado A.
https:// doi.org/10.1016/j.oooo.2020.04.008. Validation of a Monte Carlo simulation for dose assessment in dental cone beam
[37] Schulze R, Heil U, Groβ D, Bruellmann DD, Dranischnikow E, Schwanecke U, et CT examinations. Phys Med 2012;28(3):200–9. https://doi.org/10.1016/j.
al. Artefacts in CBCT: a review. Dentomaxillofac Radiol 2011;40(5):265–73. ejmp.2011.06.047.
https:// doi.org/10.1259/dmfr/30642039. [57] Oenning AC, Pauwels R, Stratis A, De Faria Vasconcelos K, Tijskens E, De
[38] Deutsches Institut für Normung. DIN 6868-15: Image quality assurance in X-ray Grauwe A, et al. Halve the dose while maintaining image quality in paediatric Cone
departments - Part 15: Ro¨V constancy testing of X-ray installations for dental Beam CT. Sci Rep 2019;9(1). https://doi.org/10.1038/s41598-019-41949-w.
radiographic equipment for digital cone-beam computed tomography. Berlin: [58] Tsapaki V. Radiation protection in dental radiology – Recent advances and
Deutsches Institut für Normung; 2015 [in German]. future directions. Phys Med 2017;44:222–6. https://doi.org/10.1016/j.
[39] Deutsches Institut für Normung. DIN 6868-161: Image quality assurance in X- ejmp.2017.07.018.
ray departments - Part 161: Ro¨V acceptance testing of dental radiographic [59] Deleu M, Dagassan D, Berg I, Bize J, Dula K, Lenoir V, et al. Establishment of
equipment for digital cone beam computed tomography. English translation of national diagnostic reference levels in dental cone beam computed tomography in
DIN 6868-161: 2013-01. Berlin: Deutsches Institut für Normung; 2016. Switzerland. Dentomaxillofac Radiol 2020;49(6):20190468. https://doi.org/
Original and English translation available at 10.1259/dmfr.20190468.
https://www.beuth.de/en/standard/din-6868-161/ 164214522. [60] STUK’s decision STUK S/4/2019, Sa¨teilyturvakeskuksen määraÿs
oikeutusarvioinnista ja sa¨teilysuojelun optimoinnista
[40] European Commission. Radiation protection 172. Cone beam CT for dental and
laä¨ketieteellisessa¨
maxillofacial radiology (Evidence-based guidelines). Luxembourg: Office for
altistuksessa. (In Finnish) www.stuklex.fi/fi/maarays/stuk-s-4-2019. [accessed 2
Official Publications of the European Communities; 2012. https://ec.europa.eu/
Feb 2021].
energy/sites/ener/files/documents/172.pdf [accessed 2 Feb 2021].
[61] Strålsa¨kerhetsmyndighetens fo¨reskrifter och allmänna råd om medicinska
[41] de Las Heras Gala H, Torresin A, Dasu A, Rampado O, Delis H, Hernańdez Giroń
I, exponeringar. Strålsäkerhetsmyndigheten (SSM). SSMFS 2018:5. (In
et al. Quality control in cone-beam computed tomography (CBCT) EFOMP- Swedish)
ESTRO- IAEA protocol. 2nd Edition, May 2019. https://www.stralsakerhetsmyndigheten.se/publikationer/foreskrifter/ssmfs-
https://www.efomp.org/uploads/ 2018/ssmfs-20185/ [accessed 2 Feb 2021].
2d23d153-b77c-4161-802c-5b8422d15e29/EFOMP_IAEA_ESTRO_%20CBCT_ [62] Holroyd JR, Smith JRH, Edyvean S. PHE-CRCE-59: Dose to patients from dental
2019_05_27.pdf [accessed 2 Feb 2021]. radiographic X-ray imaging procedures in the UK - 2017 Review. Public Health
England (PHE) 2020. Gateway Number: GW-1261. https://assets.publishing.
[42] International Commission on Radiation Protection (ICRP). Recommendations of
service.gov.uk/government/uploads/system/uploads/attachment_data/file/
the International Commission on Radiological Protection. ICRP Publication 26.
918078/2019_dental_NDRL_report.pdf. [accessed 2 Feb 2021].
Ann ICRP 1977;1.
[63] American Dental Association Council on Scientific Affairs. The use of cone-beam
[43] European Commission, Food and Agriculture Organizations of the United Nations,
computed tomography in dentistry: an advisory statement from the American
International Atomic Energy Agency, International Labour Organization, OECD
Dental Association Council on Scientific Affairs. J Am Dent Assoc 2012;143:899-
Nuclear Energy Agency, PAN American Health Organization, United Nations
092. doi: 10.14219/jada.archive.2012.0295.
Environment programme, World Health Organization. Radiation Protection and
[64] Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters.
Safety of Radiation Sources: International Basic Safety Standards. IAEA Safety
Radiat Prot Dosimetry 2015;165:156–61. https://doi.org/10.1093/rpd/ncv057.
Standards Series No. GSR Part 3, IAEA, Vienna (2014). https://www-pub.iaea.org/ [65] Carter L, Farman AG, Geist J, Scarfe WC, Angelopoulos C, Nair MK, et al. American
MTCD/publications/PDF/Pub1578_web-57265295.pdf. [accessed 2 Feb 2021]. Academy of Oral and Maxillofacial Radiology executive opinion statement on
[44] Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety performing and interpreting diagnostic cone beam computed tomography. Oral
standards for protection against the dangers arising from exposure to ionising Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(4):561–2. https://doi.org/
radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/ 10.1016/j.tripleo.2008.07.007.
europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2014:013:0001:0073:EN:PDF [66] Horner K, Islam M, Flygare L, Tsiklakis K, Whaites E. Basic principles for use of
Euratom, 97/43/. Official Journal of the European Union. L 2014 https://eur-lex.
[accessed 2 Feb 2021]. dental cone beam computed tomography: consensus guidelines of the European
[45] Yeung AWK, Jacobs R, Bornstein MM. Novel low-dose protocols using cone beam Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009;38
computed tomography in dental medicine: a review focusing on (4):187–95. https://doi.org/10.1259/dmfr/74941012.
indications, limitations, and future possibilities. Clin Oral Investig [67] Kim IH, Singer SR, Mupparapu M. Review of cone beam computed
2019;23(6):2573–81. https://doi.org/10.1007/s00784-019-02907-y. tomography guidelines in North America. Quintessence Int 2019;50:136–45.
[46] International Commission on Radiation Protection (ICRP). Radiological Protection https://doi.org/ 10.3290/j.qi.a41332.
in Cone Beam Computed Tomography (CBCT). ICRP Publication 129. Ann ICRP [68] Matzen LH, Berkhout E. Cone beam CT imaging of the mandibular third molar: a
2015;44(1). position paper prepared by the European Academy of DentoMaxilloFacial
[47] Siiskonen T, Gallagher A, Ciraj Bjelac O, Novak L, Sans Merce M, Farah J, et al. Radiology (EADMFR). Dentomaxillofac Radiol 2019;48(5):20190039. https://doi.
A European perspective on Dental Cone Beam Computed Tomography (CBCT) org/10.1259/dmfr.20190039.
systems with a focus on optimisation utilising DRLs (Diagnostic Reference [69] Horner K, Barry S, Dave M, Dixon C, Littlewood A, Pang CL, et al. Diagnostic
Levels). J Radiol Prot 2021 doi: 10.1088/1361-6498/abdd05. Epub ahead of efficacy of cone beam computed tomography in paediatric dentistry: a systematic
print. review. Eur Arch Paediatr Dent 2020;21(4):407–26. https://doi.org/10.1007/
[48] Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R. Cone beam computed s40368-019-00504-x.
tomography in implant dentistry: a systematic review focusing on guidelines, [70] De Grauwe A, Ayaz I, Shujaat S, Dimitrov S, Gbadegbegnon L, Vande Vannet B,
indications, and radiation dose risks. Int J Oral Maxillofac Implants 2014;29 et al. CBCT in orthodontics: a systematic review on justification of CBCT in a
(Suppl):55–77. https://doi.org/10.11607/jomi.2014suppl.g1.4. paediatric population prior to orthodontic treatment. Eur J Orthod 2019;41:381-9.
[49] Mah E, Ritenour ER, Yao H. A review of dental cone-beam CT dose conversion doi: 10.1093/ejo/cjy066.
coefficients. Dentomaxillofacial Radiol 2021;50(3):20200225. [71] American Academy of Oral and Maxillofacial Radiology. Clinical
https://doi.org/ 10.1259/dmfr.20200225. recommendations regarding use of cone beam computed tomography in
[50] Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B. Cone-beam CT orthodontics. [corrected]. Position statement by the American Academy of Oral
in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 2018; and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol
48(3):308–16. https://doi.org/10.1007/s00247-017-4012-9. 2013;116:238-57. doi: 10.1016/j. oooo.2013.06.002.
[51] Beganović A, Ciraj-Bjelac O, Dyakov I, Gershan V, Kralik I, Milatović A, et al. [72] Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes
IAEA and indications for its use. Dentomaxillofac Radiol 2015;44(1):20140282. https://
survey of dental cone beam computed tomography practice and related patient doi.org/10.1259/dmfr.20140282.
exposure in nine Central and Eastern European countries. Dentomaxillofac Radiol [73] Patel S, Durack C, Abella F, Roig M, Shemesh H, Lambrechts P, et al. European
2020;49(1):20190157. https://doi.org/10.1259/dmfr.20190157. Society of Endodontology position statement: the use of CBCT in endodontics. Int
[52] (EFOMP 2017) de Las Heras Gala H, Torresin A, Dasu A, Rampado O, Delis H, Endod J 2014;47(6):502–4. https://doi.org/10.1111/iej.2014.47.issue-610.1111/
Hernández Giroń I, et al. Quality control in cone-beam computed tomography iej.12267.
(CBCT) EFOMP-ESTRO-IAEA protocol (summary report). Phys Med 2017;39:67-72. [74] Patel S, Brown J, Semper M, Abella F, Mannocci F. European Society of
doi: 10.1016/j.ejmp.2017.05.069. Endodontology position statement: Use of cone beam computed tomography in
[53] Koivisto J, Kiljunen T, Tapiovaara M, Wolff J, Kortesniemi M. Assessment of Endodontics: European Society of Endodontology (ESE) developed by Int Endod J
radiation exposure in dental cone-beam computerized tomography with the use of 2019;52(12):1675–8. https://doi.org/10.1111/iej.v52.1210.1111/iej.13187.
metal-oxide semiconductor field-effect transistor (MOSFET) dosimeters and Monte [75] Turnbull-Smith SB. Cone-Beam Computed Tomography Examinations of the Head
Carlo simulations. Oral Surg Oral Med Oral Pathol Oral Radiol and Neck Region in Finland: Indications and Patient Radiation Dose. Tampere
2012;114(3): 393–400. https://doi.org/10.1016/j.oooo.2012.06.003. University of Technology 2016 http://urn.fi/URN:NBN:fi:tty-201608264465.
[54] Li Y, Huang B, Cao J, Fang T, Liu G, Li X, et al. Estimating radiation dose to major [accessed 28.12.2020].
organs in dental x-ray examinations: a phantom study. Radiat Prot Dosim 2020; [76] Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC, et al. Position
192:328-34. doi: 10.1093/rpd/ncaa196. statement of the American Academy of Oral and Maxillofacial Radiology on
[55] Lee C, Yoon J, Han S-S, Na JY, Lee J-H, Kim YH, et al. Dose assessment in dental selection criteria for the use of radiology in dental implantology with emphasis on
cone-beam computed tomography: comparison of optically stimulated
luminescence dosimetry with Monte Carlo method. PLoS ONE 2020;15(3):
217
217
cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol
2012;113:817–26. https://doi.org/10.1016/j.oooo.2012.03.005. Policy Number PP 26-B;2017. https://www.aapm.org/publicgeneral/
[77] Bornstein MM, Horner K, Jacobs R. Use of cone beam computed tomography in BismuthShielding.pdf. (accessed 16 Jan 2021).
implant dentistry: current concepts, indications and limitations for clinical practice [86] American Association of Physicists in Medicine (AAPM). AAPM Position Statement
and research. Periodontol 2000;2017(73):51–72. https://doi.org/10.1111/ on the Use of Patient Gonadal and Fetal Shielding. Policy Number PP 32-A; 2019.
prd.12161. [87] Marsh RM, Silosky M. Patient shielding in diagnostic imaging: discontinuing a
[78] Jacobs R, Salmon B, Codari M, Hassan B, Bornstein MM. Cone beam computed legacy practice. AJR Am J Roentgenol 2019;212(4):755–7. https://doi.org/
tomography in implant dentistry: recommendations for clinical use. BMC Oral 10.2214/AJR.18.20508.
Health 2018;18:88. https://doi.org/10.1186/s12903-018-0523-5. [88] McKenney S, Gingold E, Zaidi H. Gonad shielding should be discontinued for most
[79] Larheim TA, Abrahamsson A-K, Kristensen M, Arvidsson LZ. diagnostic imaging exams. Med Phys 2019;46:1111-4. doi: 10.1002/mp.13409.
Temporomandibular joint diagnostics using CBCT. Dentomaxillofac Radiol id=468&type=PP&current=true. [accessed 2 Feb 2021].
https://www.aapm.org/org/policies/details.asp?
2015;44(1):20140235. https://doi.org/10.1259/dmfr.20140235. [89] Pauwels R, Horner K, Vassileva J, Rehani MM. Thyroid shielding in cone beam
[80] Weiss 2nd R, Read-Fuller A. Cone Beam Computed Tomography in Oral and computed tomography: recommendations towards appropriate use.
Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel) 2019;7:52. Dentomaxillofac Radiol 2019;48(7):20190014. https://doi.org/10.1259/
https://doi.org/10.3390/dj7020052. dmfr.20190014.
[81] Carter JB, Stone JD, Clark RS, Mercer JE. Applications of Cone-Beam Computed [90] McGuigan MB, Duncan HF, Horner K. An analysis of effective dose optimization
Tomography in Oral and Maxillofacial Surgery: An Overview of Published and its impact on image quality and diagnostic efficacy relating to dental cone
Indications and Clinical Usage in United States Academic Centers and Oral and beam computed tomography (CBCT). Swiss Dent J 2018;128:297–316.
Maxillofacial Surgery Practices. J Oral Maxillofac Surg 2016;74(4):668–79. [91] Kelaranta A, Ekholm M, Toroi P, Kortesniemi M. Radiation exposure to foetus and
https://doi.org/10.1016/j.joms.2015.10.018. breasts from dental X-ray examinations: effect of lead shields. Dentomaxillofac
[82] Brown J, Jacobs R, Levring Jäghagen E, Lindh C, Baksi G, Schulze D, et al. Radiol 2016;45(1):20150095. https://doi.org/10.1259/dmfr.20150095.
Basic training requirements for the use of dental CBCT by dentists: a position [92] McCollough CH, Leng S. Use of artificial intelligence in computed tomography
paper prepared by the European Academy of DentoMaxilloFacial Radiology. dose optimisation. Ann ICRP 2020;49(1_suppl):113–25. https://doi.org/10.1177/
Dentomaxillofac Radiol 2014;43(1):20130291. https://doi.org/10.1259/ 0146645320940827.
[93] McCollough CH, Chen GH, Kalender W, Leng S, Samei E, Taguchi K, et al.
dmfr.20130291.
Achieving routine submillisievert CT scanning: report from the summit on
[83] British Institute of Radiology. Guidance on using shielding on patients for
management of radiation dose in CT. Radiology 2012;264(2):567–80. https://doi.
diagnostic radiology applications. BIR, London, UK; 2020. https://www.bir.org. org/10.1148/radiol.12112265.
uk/media/416143/final_patient_shielding_guidance.r1.pdf (accessed 2 Feb 2021).
[94] Flohr T, Petersilka M, Henning A, Ulzheimer S, Ferda J, Schmidt B. Photon-
[84] Fawcett SL, Gomez AC, Barter SJ, Ditchfield M, Set P. More harm than good? The counting CT review. Phys Med 2020;79:126–36. https://doi.org/10.1016/j.
anatomy of misguided shielding of the ovaries. Br J Radiol 2012;85(1016):e442–7. ejmp.2020.10.030.
https://doi.org/10.1259/bjr/25742247.
[85] American Association of Physicists in Medicine (AAPM). AAPM Position Statement
on the use of Bismuth shielding for the purpose of dose reduction in CT scanning.
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Physica Medica 88 (2021) 193–217

Contents lists available at ScienceDirect

Dental cone beam CT: An updated review

2. Technical characteristics of current dental CBCT scanners

The last 5 to 10 years have seen a steady development of

2.1. General features

CBCT systems are typically divided into three different categories

2.2. Gantry size and type

2.3. Field of view (FOV)

from FOVs suitable for a single jaw or a few teeth (D × H usually

2.4. Data collection during the scan

first 180◦ of rotation and the adjacent half through

2.5. Voxel and focal spot size

Most modern dental CBCT systems allow selection of the voxel

aSi mmAl £ Standing / £ 20.6

(continued on next page)

95) 0.77 Wheelchair adjustable in

200 1.14 wheelchair

(continued on next page)

mmCu x 6.8 x 4.2; correction, 4D

(continued on next page)

0.87 Wheelchair 8 x 10; 10 x MAR

CMOS mmAl 360 x Seated / 7.8; 7.8 x

resolution and delineation of smaller fine structures, such as in dental

Seated / whereas most scanners enable these to be changed in certain limits,

Reconstructiont 21 mm-Al [NewTom 7G Body, QR Systems srl, Verona, Italy]).

Exposureti 2.7. Scan time

The scanning times of current CBCT vary between 2 and 45 s,

tems utilises 3D filtered back projection (FBP) by Feldkamp-Davis-Kress

Tubecurrent, amount of projections, shorter angular range in data acquisition, and

Tubepotential, introduced that use iterative reconstruction methods (X1 Scancomfort,

methods (Smart3D-X scanner, LargeV Instrument Corp Ltd., Beijing,

reconstruction computer), and software (reconstruction algorithms)

Metal restorative materials (e.g. dental implants, metal fillings and

3. Quality assurance 4. Patient dose and optimisation aspects

Fig. 3. Example of QC and constancy

7. Use of patient shields in dental CBCT

Use of wearable radiation shields for patients during x-ray exami-

In short, external radiation shields, mainly the thyroid collar shield,

indications, and example of partial 200◦ rotational exposure in third

reconstruction for certain vendors [34]. An example of motion artefact

Fig. 8. Example of ultra-low dose pa-

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