Who should read cone-beam CT volumes?

2008 11 10 13 09 04 626 Farman Thumb2

Editor's note: Allan Farman's column, Talking Pictures, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

I have been surprised by the contents of blogs from oral and maxillofacial pathologists that discuss the reading of cone-beam CT datasets. When I look at oral and maxillofacial radiology blogs, I see no similar discussions on participation in reading histopathology slides to assist in biopsy services! Surely, biopsy services cannot be so slow that oral and maxillofacial pathologists need to look for other forms of employment?

The oral and maxillofacial radiology community is not averse to admitting oral and maxillofacial pathologists, so long as it is understood that there is a price ... namely, adequate training and experience to become a diplomate of the American Board of Oral and Maxillofacial Radiology. This requires more than two years of specific training in radiology.

In fact, that the oral and maxillofacial radiology profession is not averse to receiving "retreads" from oral and maxillofacial pathology can be gleaned from the fact that the immediate past president (James Geist, D.D.S.), current president (Laurie Carter, D.D.S., Ph.D.), and president-elect (myself) of the American Academy of Oral and Maxillofacial Radiology all are converts from the discipline of oral and maxillofacial pathology.

Medical pathologists do look at radiographs. In fact, while I was engaged in oral and maxillofacial pathology, I insisted on receiving relevant radiographs and clinical information with biopsy specimens. But this does not mean that pathologists are experts in reading radiographs. There is a great difference between viewing a radiograph in the context of known pathosis, or for orientation purposes, and reading an image volume for primary interpretation. A radiologic report is needed not merely to detect a disease process but also to facilitate the dentist's treatment approaches and, when necessary, selection of additional imaging procedures.

Just as many specialists might well have some experience in interpretation of histopathology slides, it is the pathologist that one should rely upon for the comprehensive report of cases -- not the radiologist or surgeon. For reading cone-beam CT datasets, reliance is best placed upon the appropriately credentialed expert: the oral and maxillofacial radiologist.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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