2 Legal Issues Concerning Cone Beam Computed Tomography

2

Legal Issues Concerning Cone Beam Computed Tomography

Shawneen M. Gonzalez


Introduction
This chapter will cover the standard of care and recommendations about cone beam computed tomography use in dentistry. The topics covered include specific recommendations from both American and European oral and maxillofacial radiological societies broken into three separate categories: prescription, use, and interpretation. Legal issues regarding cone beam computed tomography are largely recommendations to date, as there have been no major legal cases involving cone beam computed tomography as of the writing of this book.

Standard of Care

Standard of care is the base level at which a dentist must perform specific duties, including but limited to endodontic procedures, restorative procedures and diagnosis and treatment planning. If a health care professional performs below this level, it is considered malpractice and negligence. Violations of the standard of care can result in a loss of licensure and monetary repercussions for the dental professional.

There are two primary legal cases involving technology and standard of care: Frye v. United States (1923) and Daubert v. Merrell Dow (1993). In 1993 the United States Supreme Court dismissed the Frye mandate that technology is admissible in court as long as it has “general acceptance” in the scientific community. Even though this ruling rejected the Frye mandate on a federal level, there are still several states that continue to follow Frye’s test for admission of technology as standard of care. For those states following Frye’s standard, an expert in the field is tapped to determine if the technology has become “general acceptance” for the field in question. The ruling of Daubert determined that “scientific knowledge must be derived from the scientific method supported by good grounds in validating the expert’s testimony, establishing a standard of evidentiary reliability” (Stevens).

Recommendations

American Academy of Oral and Maxillofacial Radiology and American Dental Association Recommendations

The American Academy of Oral and Maxillofacial Radiology (AAOMR) came out with recommendation in 2008 about the use of cone beam computed tomography (CBCT). Since then, they have come out with more recommendations in specific areas such as implants and endodontics. This chapter will cover only the original basic recommendations, as the others are noted in Chapters 1 (introduction) and 9 (implants). The American Dental Association (ADA) came out with several recommendations about CBCT in 2012. These recommendations apply to those offices that have a CBCT unit as well as those offices that refer out for this procedure. Because there is overlap of the recommendations, I have combined them as recommendations made for the United States of America.

Prescribing a Cone Beam Computed Tomography Scan

There are several things a referring practitioner must perform and consider prior to prescribing a CBCT scan.

1. Review the patient’s medical and dental history along with performing a thorough clinical exam. Documentation of these procedures and justification that the excess radiation will result in a benefit outweighing the radiation risk must be included in the patient’s chart prior to prescribing a scan.
2. Determine if standard 2D radiographic images show or do not show the area in question to the extent they need.
3. Have basic knowledge and education in CBCT imaging to understand what the scan will or will not show. The ADA recommends using evidence-based articles and continuing education courses to understand cone beam CT basics.

Use of Cone Beam Computed Tomography Scan

These recommendations apply to offices and/or imaging centers that have a CBCT unit or are planning to purchase one.

1. Prior to installing a CBCT in your office, a health physicist should be consulted to determine the desired location of the machine has adequate shielding based on the machine perimeters (kVp, mA, and exposure times). The health physicist will also ensure that the office is in compliance with federal and/or state radiation regulations. The evaluation schedule will be determined by state and/or federal radiation regulations.
2. After a CBCT unit is installed, proper training and education on safe use when performing scans must be achieved by all dental professionals/>

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 2 Legal Issues Concerning Cone Beam Computed Tomography
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