Thursday, November 17, 2005

Chair Upgrade/Denver in February

We also consider the chair upgrade worthwhile! I have not hit any shoulders either - HOWEVER - I have hit the chin cup!! Every once in a while I still use the chin cup on a wiggle worm patient - or the implant case on an 80 year old patient with tremors I had the other day. I forgot to remove the chin cup and holder and the tube head hit it. I does not make the i-CAT very happy when you do that!!

Is anyone using the .3 voxel 20 second scan for implants & TMJ? I am using the .4 for TMJ and .3 for implants. I did not see alot of difference between the 2 for TMJ cases.

We would volunteer one our offices in Denver for the users meeting. How about Denver in February? Skiing is great at that time of year!



Blogger Craig Dial said...

I think we should consider a scan protical for each type of need. Important factors to think about are: dose to the patient, the quality of scan, the reason for the study, and the area requested.

For example, if a single site implant area is requested, then the beam should be colimated to that arch.

Scan Protical sugestions:
TMJ = .25 or .3mm Voxel 13cm window 20 or 40 second time
TMJ 2nd scan (w/appl, or open)= .4mm voxel, 6cm window, 10 second time
Implant one arch = .2 voxel 6cm window 40 second time
Implant 2 arch = .3 or .25 Voxel, 13 cm window 20 or 40 seconds
Jaw Pathology = .25mm Voxel 13 cm 40 seconds
Ortho = .4mm voxel, 22cm window 40 seconds

We have options, so we should use these to benifit the patient, the Dr. reduce dose when possible, and increase value. Comments?

4:09 PM  
Blogger Duane Perry said...

What if the doctor calls a week later and wants to view the opposite arch that was originally taken? Are we better off taking the entire skull so that the Dr. has alternatives for additional treatment at a later date without having the patient return to the lab and be exposed again? I have never been informed as to the image quality differences using the different settings of voxels. Does ISI provide that information or do we find out through trial and error? Where's Arun when you need him (Ha,ha,)?

8:46 AM  
Blogger Don Croall said...

A critical question. Are we benefiting the patient by reducing the exposure and, at the same time, doing them a disservice by not including the entire volume?

11:11 AM  
Blogger Matt Kroona said...

My policy is to do full scans on all adult patients regardless of the area of interest. This policy has been reinforced twice this past week with patients in for mandibular implants. While recording the axial annimation that I do on all patients, I discovered significant TMJ problems, which I was able to bring to the attention of the doctor. With a limited height scan I would have missed this.

On children (TMJ, impactions, etc.) I limit the exposure to the area of interest, and on all wide open TMJ views, I do a limited height 10 second scan.

1:05 PM  
Blogger devery said...

I concur with Don Croall and Duanne. I feel that our responsibility with this new technology is to do a scan that gives a complete diagnostic of the patient. The radiation to the patient from the complete scan of 20 secs at .3 and the reduced height can not be that significant. I recently took a scan on a 12 year old with impacted maxillary cuspids and discovered an anamoly in the mandible.

9:19 PM  

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