Correcte diagnosestelling door cone beam CT Reinhilde Jacobs Oral Imaging Center KU Leuven
.
Parachute approach to evidence based medicine Potts et al BMJ. 2006; 333: 701–703
Known? • Parachutes are widely used to prevent death and major injury after gravitational challenge • Parachute use is associated with adverse effects due to failure of the intervention and iatrogenic injury • Studies of free fall do not show 100% mortality
New? • No randomised controlled trials of parachute use have been undertaken • The basis for parachute use is purely observational, and its apparent efficacy could potentially be explained by a “healthy cohort” effect • Individuals who insist that all interventions need to be validated by a randomised controlled trial need to come down to earth with a bump
We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Diagnosis Planning
Navigation CAD/CAM
www.sedentexct.eu
Optimisation:
dosimetry vs image quality
Slice 5 S1
1 2
S2
3
1
Bone surface
14
Bone surface
2
Bone surface
S1
Skin
3
Bone marrow
S2
Skin
4
Bone marrow
S3
Skin
5
Bone surface
S4
Skin
6
Bone surface
S5
Skin
7
Parotid gl.
S6
Skin
8
Parotid gl.
9
Parotid gl.
10
Parotid gl.
11
Parotid gl.
12
Parotid gl.
13
Bone surface
4 5 6
S3
7
8 9 11 12
10
S4
13
14
S5 S6
i‐ C AT
os 28 Ga m lil e Ne As os xt G 35 en m er A at ion s 1 Ko 3c da m k 9 0 Ko Ilu da 00 u m k 9 a pp er 00 fr 0 Ko on lo da we t k 9 r m 50 Ko ol 0 ar da l a k 9 rg e f Ne 500 iel wT d sm Ne om all wT fi el om VGi d la V r Gi g sm e fi el all d fie Pa ld x‐ Pi H Un ca R ss i 3D o T fr rio Pi o h ca igh nt ss o T d os rio Pr e lo oM w ax do 3 s D Pr hig e oM Sc h d ax an 3 os or D e a 3 l ow D d ex os te e nd Sc e d f an i or a 3 e ld Sc Sc an D u p an or a 3 pe r or a 3 D l D up owe pe r r+ lo we r Ve Sk ra vie yVie we w po cs 3D
Ga lil e
Effective dose (µSv)
Effective dose for CBCT
400
350
300
250
200
150
100
50
0
Liang et al 2010
• Accuracy: 200-400 μm • Radiation dose 2-5 days eq • Costs balanced
? 1 CBCT replacing series conventional diagnostics
Sanderink 1999
y X-ra e c sour
7째 upward: changing relationships between structures
Info dimensions+morphology +neurovascularisation
Anterior jaw bone neurovascularisation has signficant size/diameter
1
2
3
4
Sensory dysfunction!
50y, Female Case from Dr. Livia Corpas
Osteodent
Osteodent
Jaw Bone
Osteoporosis
Osteodent • Workpackage 3 (Athens) – Quantitative index: PMI
Benson et al. (1991)
Osteodent • Workpackage 3 (Athens) – Qualitative index:
Klemetti et al. (1994)
Dense homogenous
Heterogeneous
Sparse homogenous Lindh et al. 1996
• DXA
Osteodent: Leuven UJ
LJ
Roberts et al Osteop Int 2010