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Question: How CBCT Panoramic Scans Compare To Real Panoramic X-Ray?

If you have a Cone Beam scanner at your office then you have probably tried to take panoramic shots with it. You might have also noticed that these shots are not as good as those taken by a panoramic X-Ray machine.
One of our readers, a doctor who has an iCAT, was asking how to improve the quality of his scanner's panoramic shots.
We know that Imaging Sciences offers TruPan, a software that should help with this kind of problem. Some scanners such as those offered by Vatech also have dedicated Panoramic X-Ray sensors that give you a true panoramic image.
We would like to hear your proposed solutions and any experience you have with the issue and pre-mentioned software / scanners.
Feel free to post comments.

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Comments

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by Anonymous - 02/10/2010 - 15:49

CBCT panos are not as pretty, but they are a true one to one image vs. the pano that is not.

CBCT Vs. Digital Pano

by Vatech - 02/12/2010 - 17:19

The answer to the question is simple once explained. Real Digital Pans are just clearer than those generated from CBCT machine using only a flat panel sensor. This is due to a physical limitation of processing capabilities. When speaking of image clarity most talk on terms of line pairs. The gold standard of imaging in the dental industry has always been pa's. They are so clear one can detect caries from them. Well Intra Oral Sensors have a standard line pair value of 20, while digital pans have a line pair average of 8, and the Flat Panel CT sensors hold a standard line pair value of only 1-2. So physically it can not produce the same quality image as a Real Digital Pan Sensor. This is why Vatech has developed multi optional devices giving the user the choice of a True Digital Pan + One Shot Ceph + Fully Customizable FOV CT with ranges from 5x5 to 15x15. The consumer can choose any configuration from a simple Digital Pano to a Pan/Ceph to Digital + CT Combo or a Dedicated CT Only device. Vatech has a device to fit all needs and with 2 in 1 CT Device prices starting at only $99,000 they have something to fit all budgets as well.

Below is a link to the all new PaX Reve 3D the Worlds Most Advanced 3 in 1 Imaging Device.

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line pairs

by Mark Hillebrandt - 02/13/2010 - 06:02

There is absolutely no limitation on line pairs per mm for a flat panel CBCT sensor relative to a panoramic sensor due to processing limitations or any other limitation. In fact a panoramic sensor is a flat panel sensor just configured in the shape of a narrow rectangle as opposed to a large square. Many manufactures of panels use the same panel plate for CBCT sensors, panoramic sensors and intraoral sensors. There are mammography flat panel sensors (which are flat panels made by in the same factories that make flat panels for dental CBCT) that produce 28 line pairs per mm.

Intraoral sensors typically achieve higher line pair values than panoramic or CBCT machines because the sensor is positioned closer to the patients anatomy. In fact the distance from the object being imaged has a larger effect on line pairs per mm then the sensor itself.

Additionally, line pairs per mm are only one metric of what we subjectively call image quality. With panoramic imaging you must also consider focus and the focal planes as well as distortion. Focus and distortion have little to do with the sensor and are driven primarily by the mechanical rotational arc of the machine, the patient positioning mechanism and the processing of the image in the software before display.

-Mark Hillebrandt
Imaging Sciences International

can you elaborate a bit about

by admin - 02/10/2010 - 18:16

can you elaborate a bit about what you mean by pretty?

Traditional pan vs 3D reconstructed pan

by Mark Hillebrandt - 02/12/2010 - 09:23

I'm Mark Hillebrandt the head of product management for i-CAT.

On the i-CAT there are two available options for taking a panoramic x-ray. One uses a traditional 2D sensor configuration and is called i-pan. The other is a 3D reconstructed pan, which means that the panoramic view is pulled out of the 3D data set and displayed like a normal panoramic image. i-CAT also provides an enhancement to the 3D reconstructed view called Tru-Pan which optimizes the panoramic image for optimal focus.

i-pan or the traditional 2D panoramic function on the i-CAT works just like a normal panoramic machine. It works by automatically configuring the sensor and x-ray source to only capture 2D data as opposed to 3D. The i-pan scan results in a normal panoramic dose of x-rays to the patient and is fast and efficient.

The second method of capturing a panoramic scan on the i-CAT works by taking a 3D scan and pulling out or reconstructing the panoramic image. When you take a 3D scan, all the information from a panoramic image is inside the data, it just needs to be pulled out and displayed in the traditional panoramic format. On the i-CAT this can be done by using an arch tool or through the optional Tru-Pan module. When using the standard arch tool, the user will define the focal arch for the panoramic image. When using Tru-Pan, the software will analyze the image and automatically create a highly optimized focal arch that keeps all the patients dental anatomy in focus at once. A 3D reconstructed panoramic image requires exposing the patient to 3D levels of radiation, which on the i-CAT is approximately 2X-3X the radiation received from a single traditional panoramic scan.

In terms of the image quality that each method produces, the 3D reconstructed pan allows for the refocusing of the image to bring the anatomy into better focus after the scan has been taken, where all traditional panoramic scans (including i-CAT's i-pan) do not. Additionally, the optional Tru-Pan module is the only panoramic function that offers variable focal planes where all dental anatomy can be brought into focus at once.

Finally a word about the accuracy of any panoramic image. All panoramic images are 2D representations of 3D information (anatomy). By definition they are distorted and do not represent actual distances. You are likely familiar with a flat map (2D) of the globe, where Greenland and Antarctica appear far bigger than they really are when viewed on the actual 3D globe itself. The same effect is seen on all panoramic images. When you map 3 dimensional data onto a flat surface you get distortion, it is unavoidable fact of physics. All panoramic images are distorted with regards to distance and size whether they come from a traditional 2D panoramic scan or a 3D CBCT scan. Additionally in most cases, only part of the panoramic image will be in focus at any one time. As stated before, Tru-Pan solves the focus problem, but nothing can solve the distortion problem on panoramic images.

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